Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity and impulsivity that begins in childhood and can persist into adulthood. While ADHD has historically been perceived as a condition affecting mostly boys and men, it is now known that many girls and women have ADHD as well. However, the symptoms of ADHD often present differently in girls and can be overlooked or misdiagnosed.
Prevalence of ADHD in Girls
ADHD affects around 5-7% of school-age children. For many years it was believed boys were two to three times more likely to have ADHD than girls. However, more recent research suggests the actual ratio is much closer to 1:1. Some studies have found up to 50-75% of girls with ADHD are undiagnosed. There are several reasons why ADHD in girls is underdiagnosed:
- Girls tend to have less disruptive hyperactivity and more internalized, inattentive symptoms.
- Girls are better at compensating for their ADHD symptoms and “masking” their struggles.
- Diagnostic criteria and rating scales have been developed studying boys predominantly.
- Teachers expect boys to be more disruptive and struggle with self-control.
As a result, many girls don’t get diagnosed with ADHD until later childhood or even adulthood when their coping mechanisms begin to break down. Increased awareness of how ADHD manifests in girls is leading to more diagnoses.
Symptoms of ADHD in Girls
While the core symptoms of ADHD are the same in girls and boys, girls often exhibit them differently, especially in terms of hyperactivity. Common symptoms of ADHD in girls include:
Inattention
- Difficulty paying attention and staying focused
- Appearing “spacey,” daydreamy or “in a world of their own”
- Struggling to follow instructions or finish tasks
- Losing things frequently (toys, books, homework etc.)
- Forgetfulness in daily activities
- Difficulty staying organized and managing time
- Avoiding or disliking activities that require focus
- Underperforming or failing to live up to academic potential
Hyperactivity
- Fidgeting, squirming or excessive talking
- Restlessness or always being “on the go”
- Running or climbing at inappropriate times
- Difficulty playing quietly
Unlike boys, hyperactive girls are less likely to be disruptive in class or get in trouble for their behavior. Girls tend to have more internalized hyperactivity that isn’t always outwardly visible.
Impulsivity
- Interrupting conversations or intruding on others
- Acting recklessly without thinking
- Blurting things out
- Emotional reactivity and outbursts
- Difficulty waiting for their turn
Girls with ADHD may be more impulsive in terms of speech (e.g. interrupting others or monopolizing conversations) rather than actions. They tend to internalize their impulsivity more than boys.
Other Features of ADHD in Girls
In addition to the core symptoms, ADHD in girls can manifest in other ways:
Talking Excessively
Girls with ADHD tend to talk more than their peers and have trouble reading social cues about when to start and stop talking. They may tell long tangential stories oblivious to whether others are interested.
Low Self-Esteem
Struggling to meet expectations can take a toll on girls’ self-confidence. Girls with ADHD are at increased risk for depression and anxiety disorders.
Trouble with Friendships
ADHD symptoms like impulsivity, distraction and poor organization can make it hard for girls to maintain close friendships over time. They may have frequent conflicts with friends or get left out of social activities.
Underperformance at School
Inattentive girls with ADHD tend to underperform relative to their intellectual abilities. They may fail to complete work on time, lose assignments and score poorly on tests despite understanding the material.
Disorganization
Girls with ADHD often have extremely messy bedrooms, desks and backpacks. They misplace things constantly and struggle with time management.
Daydreaming
Girls with ADHD tend to daydream frequently and have difficulty staying grounded in the present moment. They may seem “spacey” or “in their own world.”
Behavioral Problems
Some girls do exhibit disruptive hyperactive-impulsive behavior. This includes aggression, defiance, tantrums and other conduct issues, especially in unstructured environments.
Why Do Girls Manifest ADHD Differently Than Boys?
There are several theories as to why ADHD manifests differently in girls:
Different Brain Development
Brain imaging studies show developmental differences between boys’ and girls’ brains in terms of maturation rate and neurotransmitter activity. This may contribute to different ADHD presentations.
More Reserved Temperaments
Girls are culturally conditioned to be well-behaved and passive. They exhibit less aggressive and disruptive behavior that would trigger an ADHD evaluation.
Better Verbal Skills
On average, girls develop stronger verbal skills earlier than boys. Girls are better able to articulate their thoughts and verbally compensate for ADHD challenges.
Better Executive Functioning
Executive functions like working memory, organization and emotional control tend to develop earlier in girls. Girls can better mask their ADHD struggles by relying on these skills.
Different Interests
Boys tend to prefer competitive group play that demands constant activity and focus. Girls prefer more sedentary activities and socializing where inattention is less conspicuous.
Increased Expectations
Girls face greater social pressure to conform, follow rules and please others. They work harder to hide their ADHD symptoms and imitate neurotypical peers.
Getting an ADHD Diagnosis as a Girl
Getting evaluated for ADHD typically involves:
Parent and Teacher Observations
Providing rating scales and questionnaires about the child’s behavior and development. Girls’ symptoms may be underreported since they aren’t outwardly disruptive.
Psychological Testing
Assessing intellectual ability, memory, learning disabilities, executive functioning, etc. This can identify cognitive difficulties associated with ADHD.
Medical Evaluation
Examining medical and family history to rule out conditions that mimic ADHD symptoms like thyroid disorders, seizures or sleep apnea.
DSM-5 Criteria
Determining if the patient meets diagnostic criteria for ADHD in the DSM-5 psychiatric manual – either predominantly inattentive, predominantly hyperactive/impulsive or combined presentation.
Since girls often fly under the radar, comprehensive evaluation is important for an accurate diagnosis. Providing examples of how ADHD symptoms impair schoolwork, social life and home functioning can aid the diagnostic process. Ongoing follow-up is also crucial to monitor for emerging symptoms as girls get older.
Treating ADHD in Girls
ADHD treatment focuses on minimizing symptoms, improving functioning and enhancing quality of life. Treatment options include:
Medication
Stimulant medications like methylphenidate (Ritalin) and amphetamines (Adderall) are first-line ADHD treatments. These help increase focus and self-control in 75-80% of patients. Some girls experience greater emotional side effects, so careful monitoring is needed.
Psychotherapy
Cognitive behavioral therapy helps teach coping strategies for ADHD symptoms. Social skills training can help girls learn to read social cues. Family therapy assists the whole family system.
School-Based Accommodations
IEPs and 504 plans provide accommodations like extended time on tests, reduced assignments, access to fidgets and alternative workspaces.
Lifestyle Changes
Regular exercise, limiting screen time, sufficient sleep, a healthy diet and social support all help reduce ADHD impairment. Organization systems at home and school are essential for girls.
Skills Training
Learning organizational skills, emotional regulation tactics, proper study methods and social grace can help girls compensate for their challenges. ADHD coaching is very beneficial.
With the right treatment plan tailored to her needs, a girl with ADHD can thrive socially and academically. Ongoing support helps boost her confidence and equip her for success.
Conclusion
While ADHD does not manifest identically in girls and boys, it causes significant impairment in both if undiagnosed and unmanaged. Increased awareness and proactive screening is necessary to catch more girls with ADHD earlier. Comprehensive treatment focused on girls’ specific deficits and strengths is the best way to prevent worsening symptoms and impairment over time. With proper diagnosis and care, girls with ADHD can flourish and maximize their full potential.