Girls with ADHD are often overlooked and misdiagnosed. Here’s how ADHD may present in girls.
At least twice as many boys are diagnosed with attention deficit hyperactivity disorder (ADHD) as girls, according to a CDC National Survey of Children’s Health (2003–2011).
There are several theories that try to explain this disparity. One of the most widely accepted explanations is that girls with ADHD are often overlooked and go years without a diagnosis. They are also at risk of being misdiagnosed with other mental health conditions.
ADHD in girls remains highly misunderstood but there are nuances to look out for.
Language matters
Sex and gender exist on a spectrum. We use “girls” and “boys” in this article to reflect the terms assigned at birth. However, gender is about how you identify yourself, independent of your physical body.
Here a deeper dives into gender as it relates to ADHD:
A girl with ADHD has the same condition as a boy with ADHD, although it may sometimes present differently.
Some of the core symptoms of ADHD include:
- inattention or distractibility
- restless energy
- talking too much or too fast
- forgetfulness or losing items
- making careless mistakes
- time management challenges
- difficulties with executive functioning like organization and planning
There are three different types of ADHD:
- inattentive
- hyperactive-impulsive type
- combined type
In
Girls with ADHD may also experience
- being disorganized or messy
- poor academic performance
- difficulties with peer relationships
- low self-esteem
- emotional hyperreactivity
- early sexual activity, according to ADHD Institue research
Some of the above are common across genders, not specific to girls only.
In general, girls with ADHD have more internalized behaviors. In other words, they may be more likely to blame themselves for their symptoms.
This can lead to a higher rate of co-occurring conditions like depression. Males, on the other hand, are more likely to have externalizing behaviors leading to co-occurring diagnoses like oppositional defiant disorder.
| ADHD in boys | ADHD in girls |
|---|---|
| More likely to have hyperactive-impulsive presentation | More likely to have inattentive presentation |
| Externalizing behaviors | Internalizing behaviors |
| Conduct issues are common | Emotional issues are common |
| Increased risk for school problems, relationship troubles, and substance use | Increased risk for school problems, relationship troubles, and substance use |
| Can be treated with medication, therapy, or a combination of both | Can be treated with medication, therapy, or a combination of both |
Boys are at least twice as likely to be diagnosed with ADHD. Some reports state that girls are
There are several different factors that contribute to this.
More inattentiveness
First, girls are more likely to have the inattentive subtype of ADHD.
Many adults are misinformed about how ADHD presents, and may only know about hyperactive symptoms.
When a boy with hyperactive-impulsive ADHD constantly interrupts or gets out of his seat in class, teachers and parents may wonder if he has ADHD. But a girl with inattentive ADHD, who forgets her homework, may simply be labeled as “spacey.”
Hyperactive symptoms also tend to be more disruptive to others than inattentive symptoms.
On top of this, girls are also more likely to internalize their symptoms — which means less acting out, and more emotional difficulties on the inside.
Lingering assumptions
Society still stigmatizes ADHD as a “boys’ condition,” and this implicit bias may cause girls to be underdiagnosed regardless of symptoms.
In an older study from 2004, teachers were more likely to refer fake student profiles to ADHD treatment if the “student” was a boy than if they were a girl. This was true even when the symptoms and descriptions listed on the profiles were exactly the same apart from sex.
Girls mask ADHD more
Girls are more likely to compensate for their ADHD symptoms than boys are. Many ADHD symptoms go against how girls are expected to behave in society, even today. For example, a boy may get away with being disorganized, but girls are often expected to be neat and orderly.
This often leads girls to try to hide or mask their ADHD symptoms. For example, they may try to develop close relationships with their teachers to make up for feeling like they’re falling behind at school.
Consequences of ADHD for girls
Living with ADHD can be a challenge. But when ADHD is undiagnosed and untreated (like it is for so many girls), life could be even more difficult.
Girls with undiagnosed ADHD may turn to internalizing behaviors. They may blame themselves for shortcomings like poor academic performance.
- low self-esteem
- co-occurring mental health conditions like depression and anxiety
According to
- vulnerability to bullying
- higher rate of school dropout
- sexually active at an earlier age
- high-consequence activities and more accidents
- employment problems as an adult
- self-harm
- higher rate of substance use disorder
- emotional dysregulation problems
Many of these risks are prevalent for boys with ADHD as well. For example, both boys and girls with ADHD experience a comparable risk of developing substance use disorder. However, girls are more vulnerable to many of these things, including low self-esteem, bullying, and emotional difficulties.
ADHD is a highly treatable condition, and certain treatment methods (like stimulant medication) have been found to be extremely effective. Both boys and girls with ADHD can go on to live successful, happy, and fulfilling adult lives if their symptoms are well-managed.
Some of the most common treatment types for ADHD include:
- stimulant medications
- behavior therapy
- parent management training
- non-stimulant medications
Treatment isn’t based on whether the child is a girl or a boy, but on the child’s individual symptoms. You can tell your child’s prescribing physician about all your concerns, and they can work together with you to find the best treatment option for your kid.
If you suspect your kid may have ADHD, then it’s important to get them evaluated for a diagnosis and next steps. Without the correct diagnosis, your girl may go through life not understanding why they feel so different from peers. She may start to blame herself, and develop low self-esteem.
ADHD in girls is highly misunderstood. But with the correct diagnosis and treatment, kids with ADHD can become happy, fulfilled, and successful adults. Getting an evaluation is the first step.