The three main types of attention deficient hyperactive disorder are hyperactive-impulsive, inattentive, and a combination.
The CDC also estimate that in the U.S., boys are almost 3 times more likely to be diagnosed with ADHD than girls are. This has led to the mistaken belief among many parents, caregivers, and teachers that ADHD is a "boys' disorder" that rarely occurs in girls.
The Child Mind Institute claim that girls may remain undiagnosed because their symptoms are different to boys and do not tick the more obvious signs and symptoms boxes.
The main signs and symptoms of ADHD can apply to both boys and girls, but the following symptoms are particularly associated with girls:
A lack of concentration or being easily distracted may be a symptom of ADHD for 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 at school. However, if they find something interesting, they may be completely absorbed by it.
- Distractibility: Girls with ADHD may be easily distracted by what is happening outside, or by their own thoughts.
- Hyperactivity: Although some girls are excessively active and fidgety, like boys, others are quieter in their movements. They may fidget, shuffle in their chairs, or doodle.
- Impulsivity: Girls may be overemotional, 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.
How symptoms can change over time
Girls with ADHD who are not diagnosed with the disorder until adulthood are at risk of developing other conditions. They are also more likely to face one or more of the following challenges:
- Low self-esteem
- Coping strategies driven by unregulated emotion instead of problem-solving logic
- A tendency to attribute success and difficulties to external factors such as luck or chance instead of seeing their own actions as responsible
- High levels of stress
- Anxiety disorder
Possible complications if left untreated
Dr. Ellen Littman, co-author of Understanding Girls with ADHD, says if a girl with ADHD is left undiagnosed or untreated as she enters adolescence and young adulthood, she will almost inevitably encounter a "range of adjustment problems."
This can lead to one or more additional disorders, such as depression, anxiety, or 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.
According to Dr. Kathleen Nadeau, "Girls with untreated ADHD are at risk for chronic low self-esteem, underachievement, anxiety, depression, teen pregnancy, and early smoking during middle school and high school."
She adds that, in adulthood, they are more likely to face, "divorce, financial crises, single-parenting a child with ADHD, never completing college, underemployment, substance abuse, eating disorders, and constant stress due to difficulty in managing the demands of daily life."
This can lead to underachievement in various aspects of life.
Early warning signs
Early signs that a girl might have ADHD include the following:
- Difficulty keeping track of school assignments and deadlines, even if the girl is making great effort to stay organized
- Frequently running late, despite efforts to stay on schedule
- Having trouble getting to sleep at night and getting up in the morning
- Jumping from one topic of conversation to another without warning
- Often interrupting people when they are talking
- Inattentiveness at school and at home
- Forgetting what she has just read or been told by another person
Risk factors for ADHD
A number of factors may put a child or adolescent at greater risk of developing ADHD.
- 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
- High consumption of refined sugars and food additives in diet
How is ADHD different in girls?
Regular exercise and time spent outdoors may help to manage ADHD 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.
When to see a specialist
If caregivers think that a girl has ADHD, they should consult a pediatrician, family practitioner, or nurse practitioner.
Some pediatricians have specialist training in behavior and development, and many have at least a special interest in the area. Other specialists include child psychiatrists, psychologists, and occupational therapists.
Other useful contacts may be found through:
- Officials at the child's school
- A local parent support group
A doctor may prescribe medication, psychotherapy, or both, but caregivers can also encourage the girl to manage her ADHD in a number of ways.
- 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 diet affects 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 will probably need support to help her regulate her own behavior.
Bipolar and anxiety disorder may have similar symptoms to ADHD.
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 she loves and prioritizing those
Other conditions with similar symptoms
ADHD can be difficult to diagnose, partly because a range of other conditions have similar symptoms.
These conditions include:
- 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.