ADHD in girls is associated with increased risk for several mental-health difficulties. That includes anxiety and depression, and research following girls with ADHD into adulthood has also found elevated risk for self-injury and suicide attempts in some groups.
This does not mean ADHD inevitably leads to self-harm, suicidality, or substance use. Risk develops through multiple pathways and is shaped by co-occurring conditions, trauma, bullying, social support, treatment access, family context, sleep, and many other factors.
The important point is that these concerns should not be dismissed as unrelated to ADHD—and they should never be reduced to “just ADHD.”
Why mental-health risk may be higher
Several experiences can overlap for an ADHD girl:
- repeated correction or criticism
- feeling chronically behind despite working hard
- academic stress
- peer rejection or bullying
- difficulty regulating strong emotions
- impulsive behavior during periods of distress
- sleep disruption
- anxiety or depression
- trauma or other adverse experiences
- shame about needing help
- hiding difficulty until it becomes severe
No single pathway explains every girl.
When ADHD is missed, the explanation can become personal
A girl who does not know she has ADHD may spend years trying to explain why ordinary tasks seem harder for her.
She may decide:
- I am lazy.
- I am irresponsible.
- I ruin everything.
- I am too sensitive.
- I should be able to handle this.
Those beliefs can become part of her self-concept, especially when adults respond mainly with criticism rather than support.
Related: ADHD and Self-Worth in Women
Girls may hide distress until adults underestimate it
Some ADHD girls become skilled at looking fine.
They may continue getting good grades, stay polite, avoid asking for help, or keep distress private. Adults may therefore underestimate how much anxiety, exhaustion, shame, or hopelessness is building underneath the visible performance.
This is one reason adults should ask about the cost of functioning, not only whether the girl is still attending school or completing assignments.
Related: ADHD Girls and Masking: The Cost of Looking Fine
Self-harm needs its own assessment
Self-harm can serve different functions for different people. It may be used to reduce overwhelming emotion, interrupt numbness, express distress, punish oneself, or cope with experiences that feel unmanageable.
ADHD can be relevant because impulsivity, emotional dysregulation, shame, rejection, and difficulty accessing coping strategies under stress may affect risk.
But self-harm should never be assumed to be “an ADHD symptom.” It requires direct assessment of what is happening, how often it occurs, what triggers it, and whether suicidal intent is present.
Suicide risk should be taken seriously
A well-known longitudinal study followed girls diagnosed with ADHD in childhood into early adulthood and found elevated rates of suicide attempts and self-injury, particularly among those with combined-type ADHD in childhood.
That finding is important, but it does not mean every ADHD girl is at high suicide risk.
Risk assessment should focus on the individual girl: current depression, hopelessness, suicidal thoughts, previous attempts, self-harm, access to lethal means, substance use, trauma, interpersonal loss, family history, and protective relationships.
When suicidal thoughts or behavior are present, the response should be direct and clinically appropriate—not delayed because a girl appears high functioning in other areas.
Substance use can become a coping strategy
Some adolescents use alcohol, nicotine, cannabis, or other substances to change how they feel.
An ADHD girl may describe substances as helping her:
- feel less socially anxious
- slow down racing thoughts
- feel more comfortable around peers
- reduce restlessness
- escape shame or sadness
- sleep
- feel less overwhelmed
That does not make substance use inevitable or effective. It does mean treatment is stronger when adults understand what the substance is doing for the girl instead of treating use only as rule breaking.
Peer rejection and bullying matter
Research on girls with ADHD has found increased peer rejection and victimization.
Repeated exclusion can affect confidence, anxiety, depression, and how safe relationships feel. If a girl is struggling emotionally, it is worth asking not only about symptoms but also what is happening socially.
Related: ADHD Girls: Friendships, Belonging, and Social Stress
Emotional dysregulation can increase risk during intense moments
Some risk occurs not because a girl planned an action for a long time, but because distress became intense and the gap between feeling and acting became very short.
That is one reason regulation support and safety planning should include concrete ways to create time and distance during high-intensity moments.
Related: ADHD Girls and Emotional Regulation
Do not reduce everything to ADHD
An ADHD girl may also have:
- major depression
- an anxiety disorder
- trauma-related symptoms
- an eating disorder
- autism
- learning differences
- sleep disorders
- substance-use problems
- family or relationship stress
Each concern deserves proper assessment and treatment.
At the same time, ADHD should not disappear from the formulation. Executive-function difficulties, sleep disruption, impulsivity, social experiences, stigma, and the effort of coping can affect how distress develops and how easy it is to use safer strategies.
What support should include
Depending on the girl and the level of risk, support may include:
- direct assessment of suicide and self-harm risk
- treatment for depression, anxiety, trauma, eating problems, or substance use
- ADHD treatment
- environmental accommodations
- reliable access to trusted adults
- a concrete safety plan for periods of high distress
- reducing shame and punitive responses
- improving sleep
- addressing bullying or unsafe relationships
- making coping strategies easier to access when executive functioning is low
A safety plan that is too complicated to use during distress is not a useful safety plan.
What parents and clinicians should ask
Do not ask only, “Is she okay?”
Ask specific questions:
- Have you been feeling hopeless?
- Have you thought about hurting yourself?
- Have you wished you were dead or not here?
- Are you using anything to help yourself cope?
- What happens when things feel unbearable?
- Who do you feel safest telling when things get bad?
- What makes it easier or harder to ask for help?
Direct questions about suicide do not create suicidal thoughts. They give a young person a clearer opportunity to tell the truth.
A girl should not have to become visibly unsafe before adults believe she is struggling
Strong school performance, politeness, or apparent competence should never be used as evidence that serious distress cannot be present.
Look at functioning, effort, mood, sleep, relationships, self-talk, and changes from her usual baseline.
Research behind this page
- Hinshaw et al., 2012 — 10-year follow-up of girls with ADHD into early adulthood
- Hinshaw et al., 2022 — ADHD in girls and women: underrepresentation, longitudinal processes, and key directions
- Young et al., 2020 — Females with ADHD: expert consensus statement
If a child or teenager is in immediate danger, has made a suicide attempt, or cannot stay safe, seek emergency help immediately.