ADHD in Girls

5 Common Questions

Attention Deficit Hyperactive Disorder, often referred to as ADHD, is one of the most common neurodevelopmental conditions found in children. The first thing that many people think of when they hear the term is a hyper child who has trouble focusing on the tasks in front of them; however, symptoms are more varied and complex than that – and are often misdiagnosed in female children. We’re here to discuss how ADHD presents differently in girls than in boys and how that might impact their daily lives.

By Anna Hill

How does ADHD present differently in girls compared to boys?

A common misconception about ADHD is that there is only one type. However, there are actually three: 

• Inattentive. This subtype presents most commonly through symptoms such as frequent distraction, poor concentration, and trouble with organizational skills.
• Hyperactive-impulsive. The hyperactive aspect of this subtype often displays itself through constant fidgeting, excessive talkativeness, and difficulties with slowing down or staying on task. The impulsive element of this subtype presents through symptoms such as constantly interrupting others or taking unnecessary risks. 
• Combined. This subtype is fairly self-explanatory. Those experiencing combination ADHD exhibit symptoms from both inattentive and hyperactive-impulsive subtypes. 

A child’s diagnosis regarding subtype depends on which symptoms they exhibit most prominently. “Of the three different subtypes of ADHD, girls will more often have the inattentive subtype,” says Dr. John Heise, who specializes in adolescent medicine at the Children’s Hospital at Erlanger. Girls are more likely to exhibit less disruptive symptoms of ADHD, and therefore aren’t always initially identified as someone who might have the disorder. “A girl may be chattier in the classroom but struggle to stay focused on tasks, whereas a boy may be out of his seat and disrupting the teacher during a lesson,” explains Megan McCullah Burrows, a physician assistant at Siskin Children’s Institute. 

What challenges do these differences present?

Because girls are less likely to exhibit the more disruptive and externalized symptoms than boys with ADHD, adults around them might be much slower to realize that there’s a problem. “Younger boys are more likely to be brought in for assessment due to hyperactivity or behavioral concerns, while girls are more likely to be missed at a younger age because, though they might not be paying attention, they likely aren’t getting in trouble in class as much,” says Dr. Heise. 

Unfortunately, these differences can result in a delay in diagnosis and treatment for girls with ADHD. Boys are currently diagnosed with ADHD at twice the rate that girls are, and undiagnosed ADHD can present many difficulties for girls. “In addition to a delay in diagnosis and treatment, social development and relationships may be affected as well,” Dr. Cindy Chestaro, a developmental pediatrician with Siskin Children’s Institute, explains. “Self-esteem in girls can be more affected than in boys, which may result in higher instances of anxiety and depression in adolescent years.” The challenges that ADHD can create for girls when it comes to concentration and organization can also negatively impact their grades in school, especially in older grades where the material can become very complex. 

Is ADHD treated the same way for girls as it is for boys?

Though ADHD frequently presents differently in girls than it does in boys, ADHD is first and foremost a neurodevelopmental disorder, and every subtype of it traces back to the same root issue – a neurochemical imbalance in the brain. Therefore, treatment is far more dependent upon the needs of the patient as an individual instead of their gender. “The American Academy of Pediatrics recommends a combination of medication and behavioral therapy for patients ages six and older,” says Burrows. “This medication may include a stimulant or non-stimulant prescription, or both.” It’s also important for healthcare providers to work with children to ensure that they find the right balance of medication, therapy, and their benefits vs. side effects to find an optimal treatment plan. 

What happens if ADHD is left untreated in girls?

As girls with undiagnosed ADHD get older, the growing awareness that they have to work much harder than their peers in school who don’t have ADHD can do significant damage to their self-esteem. “Furthermore, if girls with ADHD display hyperactive-impulsive symptoms, they are more likely to be seen as too talkative, forceful, or emotional,” shares Dr. Chestaro. Internalization of this can impact them negatively to the point of also developing mood disorders. “Girls with ADHD are 2.5 times more likely to develop depression or anxiety compared to girls who don’t have ADHD,” Dr. Heise explains. 

What steps should a parent take if they think their daughter might have ADHD?

If you notice that your daughter is struggling with any of these symptoms, don’t panic – there are many ways that you can help her. “First and foremost, celebrate your child’s unique traits and identify their strengths while supporting the differences and challenges that may come with an ADHD diagnosis,” says Dr. Chestaro. Try to learn as much as you can about the condition – that way, you’ll be able to better understand and support your child. “We would encourage parents of girls with ADHD to watch for symptoms of other co-existing conditions such as anxiety, depression, substance use, or eating disorders,” adds Burrows. “Girls are more likely to have these comorbidities than boys in their teen and adolescent years.” 

It’s also important to emphasize to your daughter that she should take an active part in her treatment. Encourage her to speak to her healthcare providers about her thoughts and feelings, as well as about what’s working for her and what’s not. This can help her feel more active in her treatment plan, which can lead to her taking a greater investment in it. 

“ADHD is a common disorder and is often easy to treat,” reassures Dr. Heise. If you think your daughter might be struggling with a type of ADHD, talk to her about it.