It’s long been known that ADHD and anxiety are frequently linked—but not all ADHD is created equal, and neither is its impact.
A comprehensive longitudinal study from Norway, tracking children from age 4 to 16, has drawn a sharper line under an increasingly urgent reality: girls with inattentive ADHD are more vulnerable to developing anxiety, particularly as they hit adolescence. And in many cases, that anxiety is rooted not just in neurobiology, but in being unseen.
The study broke ADHD down into its two standard dimensions: inattention (e.g., distractibility, forgetfulness) and hyperactivity-impulsivity (e.g., restlessness, acting without thinking). Researchers then examined how these traits interacted over time with symptoms of anxiety, using diagnostic interviews—not just checklists—to get a deeper picture.
The standout pattern?
In girls, inattention consistently predicted anxiety across all ages. And by adolescence, the relationship became reciprocal: anxiety also began to fuel increasing inattention. For boys, however, the picture looked different. The only reliable predictor was hyperactivity-impulsivity, and only in early childhood (ages 6–10), suggesting that boys' anxiety was more often triggered by external behavioural challenges rather than internal ones like cognitive overwhelm.
But Here’s the Tension: Is It Really About Sex, or About Visibility?
On the surface, these findings may read like a tidy sex differentiation—girls with inattentive ADHD get anxious, boys with hyperactivity do. But that framing risks reinforcing a trap the study itself quietly walks into: gendered assumptions baked into ADHD diagnosis.
Inattentive boys, for instance, are rarely spotlighted in such studies, and this one is no exception. The research design largely groups data along sex lines without interrogating cross-presentation: What about the quiet, daydreamy boys who go unnoticed, or the hyperactive girls whose behaviours may be misread as aggression or emotional dysregulation? The study shows us that girls with inattention suffer more—but is that because they’re female, or because inattention is the form of ADHD that is most under-detected, under-supported, and under-acknowledged—especially in girls?
And therein lies the deeper wound: late diagnosis.
Many girls only get diagnosed in adolescence or adulthood—after years of internalising failure, being told they “just need to try harder,” or masking their struggles to meet social expectations. By the time anxiety shows up on the radar, it’s often not the cause but the consequence of years spent compensating for undiagnosed cognitive challenges.
Implications for Care and Diagnosis
This study underscores what many ADHD advocates and clinicians have long argued: the diagnostic system has a visibility bias. Hyperactivity is loud. Inattention is quiet. Girls, by social conditioning, are quieter still. When researchers—and systems—equate behaviour with impairment, we miss the silent erosion of mental health happening in inattentive kids, especially girls.
So while the authors conclude that treating inattention in girls may help reduce anxiety, we might push that further: recognizing inattention early—especially when it doesn’t look disruptive—might be a preventative intervention in itself.
Final Thought: A Better Lens
This study provides vital insight, but it also invites critical questions.
Is anxiety primarily linked to the inattentive subtype—or does being an inattentive person in a system that doesn’t see you cause the anxiety?
And is the difference truly about sex, or simply about which behaviours our diagnostic models choose to measure, validate, and treat?
