It’s only in recent years that ADHD is becoming better understood in girls and women. But we still have a long way to go, according to Terry Matlen, ACSW, a psychotherapist and coach who specializes in ADHD. She noted that we need to improve how we identify girls with ADHD, evaluate them and administer treatment.

In fact, the biggest myth about ADHD and girls is that girls don’t have the disorder in the first place. However, ADHD affects both girls and boys at roughly the same rate, said Stephanie Sarkis, Ph.D, a psychotherapist and author of several books on ADHD, including Making the Grade with ADDand Adult ADD: A Guide for the Newly Diagnosed.

Boys with ADHD tend to have a more obvious and classic presentation. They typically exhibit hyperactivity and impulsivity. In short, they stand out more.

Girls, however, are harder to spot because they internalize their symptoms and usually don’t exhibit behavioral problems at school, said Matlen, also author of Survival Tips for Women with AD/HD.

Girls “are more likely to be daydreaming, staring out the window, twisting their hair,” Matlen said. They might even be seen as airheads, she said. They might be labeled as lazy or a poor student who doesn’t try hard enough, she said.

“Parents hear, ‘If she’d only try harder. She has the ability [but] she just chooses not to use it,” Matlen said. But ADHD has nothing to do with laziness or lack of effort.

Quite the opposite, “these girls are bright students who are simply very distracted by their rich, inner lives,” she said.

“Girls with ADHD are generally not diagnosed until much later if they are smart, if they have structure and support from family [and] if they are inattentive,” according to Sari Solden, LMFT, a psychotherapist and author of Women with Attention Deficit Disorder and Journeys Through ADDulthood.

In fact, they might not be diagnosed until college or when they start working or have a family, she said. That’s because these girls try to overcompensate by overworking, she said.

“At some point they hit a wall and are unable to meet the increased demands on their attention or executive functioning, [and] their compensations break down.” Still, even then, their ADHD may remain undiagnosed.

Solden noted that because these girls’ symptoms may not fit the typical ADHD profile, they might instead be diagnosed with “the resulting depression and anxiety.”

Myths About Girls with ADHD

Myths about girls with ADHD abound. Here are three more myths followed by the facts.

1. Myth: If girls do have ADHD, they only have the inattentive type.

Fact: The inattentive type of ADHD does seem to be more common in girls with ADHD. But, as Matlen said, “they are out there!” “They might instead be considered “tomboys,” as they cartwheel their way to school and climb trees after school,” she said.

Socialization may explain why girls don’t exhibit hyperactivity in the classroom, according to Sarkis. “It is thought that one reason girls exhibit less hyperactivity in class may not have to do with the disorder itself – rather, girls may have been socially conditioned to speak out less in class and be less ‘disruptive,’” she said. Matlen agreed. “Society allows for girls to be passive and quiet,” she said.

It’s also important to note that “[inattentive] girls suffer as much as hyperactive boys who, with their external behaviors, are picked up more quickly by school staff and parents,” she added.

2. Myth: Girls with the inattentive type of ADHD don’t need stimulants.

Fact: Many medical professionals think that stimulants only treat hyperactivity, Matlen said. However, stimulants can help with symptoms of inattention and distractibility, she said. Treating any disorder with medication requires careful consideration. But it’s important for parents and practitioners to know that stimulants can successfully treat these very disruptive symptoms of ADHD.

3. Myth: Girls are less likely to have oppositional defiant disorder (ODD) than boys.

Fact: According to Sarkis, there is actually a 50 percent rate of co-occurrence between ODD and ADHD. And “that rate is the same regardless of gender,” she said. For instance, she cited this study, which found no gender differences for ODD – and no differences for general anxiety disorder, major depressive disorder, dysthymia and separation anxiety disorder.

Warning Signs in Girls with ADHD

Because ADHD can manifest differently in girls, Matlen shared several warning signs that a girl might have the disorder.

At school, girls might excessively daydream; have poor grades even though they’re capable of better work; and forget or not finish up assignments, especially projects that have many parts. Hyperactive girls might exhibit “Chatty Cathy” behaviors, such as “non-stop talking and bossiness.”

Girls might also have few friends and be described as “loners.” They might easily tune out and be “spacey,” she said. They might have a messy bedroom and experience more emotional outbursts than kids their age. They’re also more likely to “feel overwhelmed and internalize that into anxiety [and] fears,” Matlen said.

While there’s been much progress in understanding and treating girls with ADHD, there’s still more work to be done. Whether you’re a teacher, parent or mental health professional, getting educated on how ADHD manifests in girls can help you provide truly helpful support.