We are only just beginning to understand more about ADHD in girls. In fact, boys are three times more likely to be diagnosed with ADHD as compared to girls. Perhaps this is because more boys have ADHD or perhaps it is because we are less likely to recognize and address the symptoms of ADHD that girls typically display.
In her article, Girls with ADHD: Overlooked, Underdiagnosed, and Underserved, Anita Gurian, Ph.D., clinical assistant professor of Child and Adolescent Psychiatry at the NYU School of Medicine, provides the two case scenarios below and asks readers to guess which child is more likely to be referred for an evaluation.
Alice, a bright 4th grader, is quiet and well behaved in class. Her academic work is just about on grade level. She chooses to sit in the back of the classroom and much of the time she's doodling in her notebook. Asked to complete a written assignment, Alice works diligently at first, but then she becomes distracted by noise outside the window and loses track of her assignment. The unfinished work then gets stuffed into her messy backpack and is rediscovered several weeks later.
Tom, also a bright 4th grader, has trouble remaining seated. He's always fidgeting with his pencils and anything else on his desk. He shouts out answers and constantly interrupts his teacher with comments and requests to go to the bathroom. Tom's academic work is less than expected for his age and capability.
Who do you think is more likely to be referred for an evaluation? Obviously, Tom’s behaviors are more disruptive and are thus more likely to receive attention.
Alice, on the other hand, is probably more likely to be labeled as a daydreamer, spacey, disorganized, maybe even lazy, and her difficulties are less likely to be addressed. Unfortunately, Alice may drift through the school years without intervention -- less likely to reach her full educational potential, frustrated at herself, struggling with self-esteem issues and perhaps even anxiety and depression.
“Most of the research has been done with boys, and as many as 50% to 75% of girls with ADHD are missed,” says Dr. Gurian who notes that boys are generally diagnosed around age 7, while girls are typically diagnosed around age 12. In other words, if these girls do receive a diagnosis, it occurs on average five years later than boys.
Girls are also more likely to display the “predominately inattentive type” of ADHD and symptoms may increase during the middle and high school as demands and responsibilities at school increase and social issues become more complicated.
If a girl does have the hyperactive/impulsive aspect of ADHD, her symptoms may still present a bit differently than in boys. She may be hyper-social, hyper-talkative and verbally impulsive -- interrupting others, talking excessively, changing topics again and again during conversations, and saying or blurting out words without thinking about their impact on others. She may also be overemotional, a “drama queen,” and easily excitable.
Possible Signs of ADHD in Girls
What are some of the red flags or warning signs that parents and teachers should be aware of related to girls and ADHD?
- Difficulty maintaining and shifting focus
- Easily distracted
- Disorganized and “messy”
- Difficulty completing tasks
- Slow to process information and directions (It may even appear that they aren’t hearing you)
- Often late (poor time management)
- Verbally impulsive (blurts out, interrupts others)
- Easily upset, over-reactive
Girls who are persistently having difficulties in these areas should be referred for an ADHD evaluation. If ADHD is found to be the cause of the symptoms, simple interventions can be put in place including behavior management techniques, organizational strategies, medication, counseling and support.
Often times, simply understanding ADHD’s impact in one’s life relieves girls of a huge burden and frees them from the damaging labels of “spacey,” “careless,” “unmotivated,” “stupid” or “lazy.” They simply have ADHD, strategies can be put in place to make life a little easier, and their future feels much brighter.
Anita Gurian, PhD. Girls with ADHD: Overlooked, Underdiagnosed, and Underserved. NYU Child Study Center. New York.