ADHD in girls: How is it different?
The Centers for Disease Control and Prevention (CDC) note that, in 2016, 9.4 percent of 2 to 17-year-olds in the United States had received a diagnosis of attention deficit hyperactive disorder (ADHD) at some time.
This included 14.5 percent of 5 to 17 year-old boys between 2014 and 2016 and 6.5 percent of 5 to 17-year-old girls. In other words, boys are more than twice as likely as girls to receive a diagnosis of ADHD.
This has led to a mistaken belief among many that ADHD is a "boys' disorder" that rarely occurs in girls.
According to the Child Mind Institute, girls may remain without a diagnosis because their symptoms are often different from boys and do not tick the more obvious signs and symptoms boxes.
Symptoms in girls
A girl with ADHD is more likely to have a attention deficit problems than hyperactivity.
There are three types of ADHD:
Inattentive only: The person has difficulty paying attention but does not tend to be disruptive.
Hyperactive and impulsive: The person may be able to focus well, but their hyperactive and impulsive behavior can cause disruption in a classroom, for example.
Combined inattentive, hyperactive and impulsive: The person has all the above symptoms.
The main signs and symptoms of ADHD can apply to both boys and girls, but according to some studies, girls are more likely to have the inattentive form.
Any symptoms of hyperactivity and impulsivity that girls do experience will present differently to how they present in boys.
The following symptoms are particularly likely to affect girls:
Inattention: Girls with ADHD may find it hard to concentrate. They may be unable to focus for long enough to complete a task at home or school. However, if they find something interesting, they may be wholly absorbed by it.
Distractibility: Girls with ADHD may be easily distracted by what is happening outside, or by their own thoughts.
Hyperactivity: Some girls with ADHD tend to move around and fidget, like boys, but others are quieter in their movements. They may fidget, shuffle in their chairs, or doodle.
Impulsivity: Girls may experience strong emotions, and this may leave them unable to slow down or to think about what they say. It can be hard for them to know what is and is not socially appropriate, and this can lead to difficulties in making and keeping friends.
Executive malfunctions: Organizational skills may pose a challenge. Girls with ADHD may have poor time management skills, and they may find it hard to follow multi-step directions or complete a task. They may often lose items, such as a phone or important papers.
A review of studies published in 2014 suggests that women and girls with ADHD are more likely to have internal symptoms that are not visible to others. They may also develop better coping strategies than boys with the same condition. As a result, teachers, pediatricians and others who would typically notice the signs of ADHD in a boy often miss them when observing girls.
How symptoms change over time
If a girl has ADHD but does not receive a diagnosis until adulthood, she may be at risk of developing other conditions or facing other challenges, such as:
- having low self-esteem
- developing coping strategies driven by unregulated emotion instead of problem-solving logic
- tending to attribute success and difficulties to external factors, such as luck or chance, instead of seeing their own actions as responsible
- having high levels of stress
- developing an anxiety disorder
- experiencing depression
Dr. Ellen Littman, co-author of Understanding Girls with ADHD, says that if a girl with ADHD does not receive a diagnosis or have treatment as she enters adolescence and young adulthood, she will almost inevitably encounter a "range of adjustment problems."
Girls with ADHD can experience low self esteem and they might find it harder to achieve their full potential.
ADHD may have associations with one or more additional disorders, such as:
- an eating disorder, such as bulimia
Women with ADHD are more likely to engage in high-risk sexual behavior and to develop substance addiction, according to Dr. Littman.
Other problems that girls and women with ADHD may experience include:
- chronic stress
- a higher risk of stress-related diseases such as fibromyalgia, a disorder that causes tiredness and pain
- low self esteem
- anxiety and depression
These factors can lead to work and relationship problems and underachievement in various aspects of life.
Early warning signs
Early signs of ADHD in girls include the following:
- difficulty keeping track of school assignments and deadlines, even if they are making a great effort to stay organized
- regularly running late, despite efforts to keep on schedule
- appearing to "daydream" and therefore missing out on information in class or other situations
- jumping from one topic of conversation to another without warning
- frequently interrupting people when they are talking
- being inattentive at school and home
- forgetting what they have just read or what another person has just said
Some factors that may increase the risk of developing ADHD include:
- someone in their biological family having ADHD or another mental health disorder
- maternal drug use or smoking during pregnancy
- premature birth
- maternal exposure to environmental poisons during pregnancy
- environmental toxins
- certain food additives in the diet
How is ADHD different in girls?
Boys are more likely than girls to receive a diagnosis of ADHD, but this may be because the condition often presents differently in girls.
The symptoms may be less obvious, and they may not fit the common stereotypes associated with ADHD.
Research indicates that while most boys with ADHD tend to express their frustration physically and verbally, girls are more likely to internalize their anger and pain.
Research conducted by Dr. Stephen Hinshaw, author of The ADHD Explosion, concludes that girls with combined-type ADHD (hyperactive-impulsive and inattentive) are significantly more likely to self-harm or attempt suicide.
However, around 40 percent of girls outgrow their hyperactive and impulsive symptoms in adolescence.
Video: ADHD and stigma in girls
In this video, Dr. Hinshaw talks about how the stigma of ADHD can affect girls and the importance of seeking treatment.
When to see a specialist
If a parent or other caregivers think that a girl has ADHD, they should consult a pediatrician, family doctor, or pediatric nurse practitioner.
Some pediatricians have specialist training in behavior and development, and many have at least a particular interest in the area. Other specialists include child psychiatrists, psychologists, and occupational therapists.
Other useful contacts include:
- officials at the child's school
- a local parent-support group
Treatment for girls
A doctor may prescribe medication, psychotherapy, or both. However, parents and other caregivers can also encourage the girl to manage her ADHD by:
Girls with ADHD may benefit from playing team sports.
- encouraging her to exercise or play a team sport
- providing regular opportunities to spend time outdoors and in nature
- learning more about nutrition and how eating habits affect ADHD symptoms
- encouraging rest and sleep
- establishing simple and predictable routines for meals, homework, play, and bed
- acknowledging and rewarding small achievements
- exploring professional treatment options
- reading relevant research, books, or articles
- finding suitable group behavioral therapy
- supporting time management by setting an alarm clock to time activities and deadlines
As the girl enters adolescence and becomes more independent, she may need support to help her regulate her own behavior.
This may include:
- understanding and accepting her challenges instead of judging and blaming herself
- identifying the sources of stress in daily life and making changes to lower stress levels
- simplifying her schedule as much as possible
- learning to ask clearly for structure and support from family and friends
- scheduling daily "time out" for herself
- developing healthy self-care habits, such as cooking nutritious meals
- going to bed at a regular hour to ensure there is enough time to sleep
- focusing on the things and activities she loves and prioritizing those things
Conditions with similar symptoms
ADHD can be challenging to diagnose, partly because some other conditions may have similar or overlapping symptoms.
- autism or Asperger's syndrome
- anxiety disorder
- bipolar disorder
- food allergies or sensitivity
- hearing impairments
- iron deficiency anemia
- lead toxicity
- nutritional deficiencies
- seizure disorders
- sensory disorders
- sleep disorders
It may be necessary to rule out these conditions before diagnosing ADHD.