Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. While ADHD is typically associated with young boys exhibiting disruptive behaviors, it affects girls as well, just often in different ways.
How common is ADHD in girls?
ADHD affects around 5% of children globally. However, it is estimated that ADHD is underdiagnosed in girls by a rate of 3:1 compared to boys. This means that while ADHD is diagnosed in 9.5% of boys, only 2.5% of girls receive a diagnosis. Some key reasons why ADHD may be missed in girls include:
- Girls tend to exhibit less disruptive, hyperactive symptoms
- Girls are more likely to present with inattentive symptoms rather than hyperactive/impulsive symptoms
- Girls tend to be better at compensating for their ADHD symptoms and ‘masking’ their struggles
- Diagnostic criteria and screening tools have traditionally been based on how ADHD presents in boys
As a result, many girls go undiagnosed and do not receive the support they need in school, at home, and in social settings.
How do ADHD symptoms differ in girls?
While the core symptoms of inattention, hyperactivity, and impulsivity occur in both boys and girls with ADHD, research shows some key gender differences in how ADHD tends to present:
Inattentive symptoms
- Girls are more likely to exhibit inattentive symptoms and have the inattentive-predominant presentation of ADHD
- Symptoms may include:
- Difficulty paying attention to details
- Forgetfulness
- Difficulty following instructions
- Losing items
- Being easily distracted
- Difficulty focusing on tasks
Hyperactive/Impulsive symptoms
- Boys tend to exhibit more hyperactive/impulsive symptoms
- Girls may exhibit symptoms like:
- Fidgeting/squirming
- Difficulty sitting still
- Excessive talking
- Interrupting others
- Rushing through tasks
- However, girls’ symptoms tend to be less overt and more internalized
Social challenges
- Girls with ADHD are more likely to have problems with peer relationships and friendships
- They may struggle with:
- Social cues
- Regulating emotions
- Reading social situations
- This can lead to social isolation, anxiety, and depression
Why are girls often overlooked for ADHD?
There are several key reasons why ADHD in girls is under-identified:
Gender biases
- Historical biases that ADHD is a “boy” problem
- ADHD seen as linked to disruptive behaviors more common in boys
- Girls better able to compensate for symptoms initially
Diagnostic criteria and tools
- Based on male-centric research
- Emphasize disruptive symptoms vs. inattention
- Don’t account for more subtle symptoms in girls
Societal expectations
- Girls expected to be well-behaved, quiet in class
- Symptoms like disorganization, forgetfulness often overlooked
- Girls hold themselves to high standards, “work harder” to compensate
How does ADHD impact girls?
When undiagnosed and unsupported, ADHD can profoundly impact girls’ quality of life and long-term outcomes:
Academic struggles
- Inattention leads to poor classwork, disorganization
- Bright girls may underperform relative to potential
- Higher dropout rates in high school
Anxiety and depression
- Chronic academic and social struggles lead to poor self-esteem
- Feelings of being “different” from peers
- Social isolation and loneliness
Risky behaviors
- Impulsivity increases substance abuse risk
- Hyperfocus on pleasurable activities like binge-eating
- Higher rates of sexual promiscuity, teen pregnancy
Table summarizing differences in how ADHD presents in girls vs. boys:
| Girls | Boys |
|---|---|
| Inattentive symptoms more common | Hyperactive/impulsive symptoms more common |
| Internalized symptoms | Externalized symptoms |
| Social difficulties | Disruptive behaviors |
| Anxiety, depression | Conduct disorder, oppositional behaviors |
| Underestimate their symptoms | Overestimate their abilities |
Getting assessed and treated
The first step for girls exhibiting symptoms of inattention, disorganization, hyperactivity or other ADHD red flags is to get properly evaluated by a psychologist, psychiatrist or pediatrician. Diagnosis should involve:
- ADHD screening checklist for parents and teachers
- Interview with the girl to understand her symptoms and challenges
- Assessment for comorbid conditions like learning disabilities, anxiety, depression
- Neuropsychological testing
- Review of the girl’s medical, developmental and family history
If an ADHD diagnosis is confirmed, a combination of medication and behavioral therapies is recommended to manage symptoms. For girls, treatment should especially focus on building self-esteem, social skills training, organizing and study skills. With the right support, girls with ADHD can thrive academically and socially.
Key Takeaways
- ADHD often presents differently in girls with less externalized hyperactivity
- Inattentive symptoms and social challenges are more common in girls
- Gender biases mean ADHD is underdiagnosed in girls
- Untreated ADHD leads to substantial academic, social and mental health problems
- Assessment tools tuned for girls’ symptoms are needed to improve detection
- A combination of medication, therapy and skills training helps girls manage ADHD
Conclusion
ADHD does tend to present differently in girls than boys, with less overt hyperactivity and more struggles with inattention, disorganization, internalizing symptoms, and social difficulties. Due to biases in diagnosis criteria and societal pressures, ADHD is widely underdiagnosed in girls. Raising awareness of how ADHD manifests in girls and optimizing assessment tools will help millions of girls get the support they need to succeed academically and in relationships. With appropriate treatment, girls with ADHD can thrive and harness their tremendous potential.