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 that mainly affects boys, it is now known that many girls have ADHD too. It is estimated that ADHD affects around 5% of children globally, with a male to female ratio of approximately 3:1. However, this may be skewed due to underdiagnosis in girls.
Girls with ADHD often present differently than boys and their symptoms are less outwardly obvious. As a result, their ADHD frequently goes unnoticed and undiagnosed. When ADHD is left untreated in girls, it can have significant consequences on their emotional well-being, academic performance, social lives and self-esteem. Early identification and treatment is key to improving outcomes. This article will explore how untreated ADHD tends to manifest in girls and the impacts it can have.
Symptoms of ADHD in Girls
The core symptoms of ADHD are inattention, hyperactivity and impulsivity. However, these symptoms may look different in girls compared to boys. Girls with ADHD are less likely to be disruptive and hyperactive. Instead, their symptoms are often predominantly inattentive. Here are some of the key ways ADHD symptoms can present in girls:
Inattention
– Difficulty paying attention to details and making careless mistakes
– Struggling to sustain focus during class, while doing homework or reading
– Appearing forgetful and losing things
– Failure to follow through on tasks and difficulty organizing
– Avoidance of activities requiring sustained focus
– Daydreaming frequently
Hyperactivity
– Restlessness and fidgeting
– Difficulty sitting still during class
– Feeling driven or on the go
– Talking excessively
– Running or climbing excessively when young
Impulsivity
– Interrupting others
– Blurting out answers before questions have been completed
– Difficulty waiting their turn
– Acting without forethought
– Difficulty thinking before speaking or acting
Why ADHD is Underdiagnosed in Girls
There are several key reasons why ADHD tends to be underdiagnosed in girls:
Symptoms are less outwardly obvious
Girls with ADHD are less likely to be disruptive and hyperactive. Their symptoms tend to manifest inwardly as distraction, disorganization and forgetfulness. This makes their struggles less obvious to parents and teachers.
Girls exhibit different ADHD behavior
While boys tend to externalize ADHD symptoms through impulsive, hyperactive and disruptive behavior, girls often internalize them. This results in anxiety, depression or withdrawal rather than behavioral problems.
Expectations for girl’s behavior
There are different behavioral and academic expectations placed on boys versus girls. Boys are often permitted to be more active and boisterous. Girls acting this way are seen as inappropriate and instead are expected to behave in a calmer manner. Therefore, a girl’s symptoms may be perceived simply as normal behavior for their gender.
ADHD criteria is based on male behavior
Much of the foundational research on ADHD focused on boys and men. Consequently, the diagnostic criteria are skewed towards hyperactive, disruptive and aggressive male stereotypical behavior. Girls who quietly struggle often slip under the radar.
Predominance of inattentiveness
Girls are more likely to present with inattentive symptoms while boys tend to exhibit hyperactivity and impulsivity. Inattentiveness and distraction can be easier to overlook than disruptive outbursts.
Academic Impacts of Untreated ADHD
When ADHD goes unrecognized and untreated in girls, it can significantly impact their academic performance and experience:
Lower grades
Inattention, disorganization and forgetfulness make it difficult for girls with ADHD to complete work efficiently, study effectively and keep up with assignments. This often leads to lower grades.
Underperformance
Girls with undiagnosed ADHD often underperform relative to their intellectual abilities. Their grades frequently do not reflect their true potential due to ADHD impairing their executive functioning skills.
Behavioral issues
While less overt than boys, girls’ ADHD symptoms such as talking out of turn, restlessness and impatience can still contribute to classroom behavioral problems. This can lead to reprimands, detention or suspensions.
High school dropout
The accumulating impact of ADHD on girls’ academic performance and motivation means up to 35% leave high school without graduating.
| Grade Level | % ADHD Students Receiving D or F Grades |
|---|---|
| 1st Grade | 10% |
| 2nd Grade | 25% |
| 3rd Grade | 30% |
Lower test scores
ADHD impairs girls’ ability to learn, retain and recall information. As a result, their scores on tests and exams tend to be lower than students without ADHD.
Greater schoolwork avoidance
Girls with undiagnosed ADHD may intentionally avoid schoolwork they find boring, draining or difficult. Procrastination and forgetting assignments can also contribute to schoolwork avoidance.
Poorer study skills
ADHD makes studying and completing homework more challenging. Girls may not develop effective study habits and skills due to difficulty with concentration, organization and motivation.
Lower self-esteem
Academic underachievement and struggles can significantly damage girls’ self-confidence and self-esteem over time.
Social Impacts of Untreated ADHD in Girls
In addition to academic struggles, undiagnosed ADHD in girls frequently affects their social lives and relationships:
Social difficulties
ADHD symptoms like inattention during conversations, interrupting others and impulsive comments can hinder social skills development. Some girls with undiagnosed ADHD have few friends and feel socially isolated.
Rejection by peers
Quirky behavior, emotional reactivity and interrupting can lead to peer rejection for girls with ADHD. They may be seen as odd and struggle to fit in.
Trouble reading social cues
Girls with ADHD often misread social cues and body language, contributing to interpersonal struggles. Their impulsivity may also lead to inappropriate social responses.
Greater conflict
ADHD symptoms like moodiness, irritability and temper outbursts can fuel conflict in relationships with classmates, friends and family members.
| Age Group | Percentage with No Close Friends |
|---|---|
| 6-8 years | 25% |
| 9-11 years | 35% |
| 12-14 years | 50% |
Higher risk of bulling
Difficulty regulating emotions and poorer social skills make girls with ADHD more susceptible to bullying, teasing and exploitation.
Emotional Impacts of Untreated ADHD
ADHD also takes a toll on girls’ emotional wellbeing when left undiagnosed and unmanaged:
Low self-esteem
The difficulties and underachievement resulting from ADHD often erode girls’ self-confidence and self-worth. By adolescence, many view themselves in an overwhelmingly negative light.
Mood disorders
Girls with undiagnosed ADHD have elevated rates of anxiety, depression, anger issues and emotional dysregulation. These mood disorders are exacerbated by ADHD impairments.
Emotional dysregulation
ADHD makes it harder for girls to control their emotions and reactions. This can manifest as emotional overreactions, irritability, and quickness to anger and tears.
Low motivation
The executive functioning deficits of ADHD undermine girls’ motivation and persistence. Simple tasks can feel draining or impossible to complete.
| Age Group | Percentage with Anxiety Disorder | Percentage with Depression |
|---|---|---|
| 6-8 years | 10% | 5% |
| 9-11 years | 25% | 10% |
| 12-18 years | 30% | 20% |
Negative thought patterns
The ongoing hardships faced by girls with undiagnosed ADHD often lead to habitual negative thinking and distorted thought patterns such as catastrophizing.
Low frustration tolerance
Struggles with distractibility, disorganization and impulsivity often translate to girls with ADHD having far less patience and tolerance for frustration. Minor setbacks lead to meltdowns.
Risk-Taking Behaviors
Impulsiveness combined with impaired judgment and decision-making abilities puts girls with untreated ADHD at higher risk for:
Substance abuse
Teen girls with ADHD are up to 5 times more likely to use alcohol, marijuana, cocaine or other drugs. Risk of substance use disorders is also elevated.
Reckless behavior
Sensation seeking and poor impulse control results in higher rates of reckless driving, sexual promiscuity, accidental pregnancy and petty crime.
Self-harm
The peak onset of self-injurious behaviors is between 14-24 years old. Girls with ADHD have a 4-fold increased risk of self-harm behaviors like cutting due to emotional dysregulation.
Eating disorders
ADHD is associated with a 2 to 3 times greater risk of eating disorders like anorexia, bulimia and binge eating. Impulsiveness around food intake often contributes.
| Risk-Taking Behavior | Odds Ratio in Girls with ADHD |
|---|---|
| Substance Use Initiation | 2.0 |
| Regular Cigarette Smoking | 2.9 |
| Reckless Driving | 1.7 |
| Accidental Injuries | 1.5 |
Why Treating Girls’ ADHD Matters
Identifying and treating ADHD early in life for girls is critical in order to:
Improve academic outcomes
Managing ADHD symptoms can help girls complete schoolwork, fulfill potential and gain admission into higher education.
Enhance social development
Treatment facilitates healthier peer relationships and social skills. Social difficulties and isolation are reduced.
Boost self-esteem
Academic success, social integration and building coping skills helps strengthen girls’ self-esteem and resilience.
Reduce emotional difficulties
Treating ADHD alleviates the severity of associated emotional issues such as anxiety, depression and anger.
Promote healthy choices
Treatment lowers impulsivity and improves judgment, allowing girls to make wiser choices around relationships, sex, substances and other behavior.
Improve quality of life
Taken together, properly treating ADHD helps girls maximize their potential, wellbeing and life opportunities.
Conclusion
ADHD often presents differently in girls than boys, leading to frequent underdiagnosis. When left untreated, ADHD negatively impacts girls across academic, social and emotional domains. It elevates their risk for issues ranging from substance abuse to eating disorders. Early identification and multimodal ADHD treatment incorporating medication, therapy, school support and skills training can markedly improve outcomes for girls. This enables them to thrive and reach their full potential.