Underdiagnosed ADHD in girls

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Diagnosis of attention deficit hyperactivity disorder (ADHD) in a child is often based on the stereotypical symptoms – hyperactivity and impulsiveness. However, girls with ADHD often present with different, more easily dismissed, characteristics. This means that many children with ADHD are overlooked and unfortunately experience negative consequences from not receiving appropriate support. Increasing awareness of how ADHD can present in girls is key to ensuring that treatment is available to anyone who needs it.

The usual perception of attention deficit hyperactivity disorder (ADHD) is of a boy who’s restless and disruptive. 58% of the general public and 82% of teachers believe that ADHD is more prevalent in boys than in girls. The truth is that ADHD is not gender biased – girls are just as likely to be affected by the condition as boys. However, girls most often present with a different type of ADHD that means they’re less likely to be loud and hyperactive. This combination of misinformation about what ADHD looks like and who it’s likely to affect means that boys are around three times more likely to receive an ADHD diagnosis. Some studies estimate that 50-75% of girls with ADHD are never diagnosed.

What is ADHD?

Contrary to popular belief, ADHD is not a mental health issue, a behavioural disorder, or a learning disability. ADHD is a neurodevelopmental disorder, estimated to affect around 8.4% of children and 2.5% of adults. In particular it impacts on the brain’s executive functions, including working memory, impulse control, and organisation. Despite its name, ADHD is less about an attention deficit and more about attention dysregulation – individuals with ADHD can’t control their focus or self-motivate. The causes of ADHD are not yet fully understood, but it is clear that there’s a large genetic component.

Types of ADHD

There are three types of ADHD: primarily hyperactive-impulsive type, primarily inattentive type, and combined type. The hyperactive-impulsive type has those symptoms most associated with ADHD in young boys. Children with this type often have an overabundance of energy, which may result in impatient or even reckless behaviour. The inattentive form is most commonly exhibited in girls, and is characterised by difficulties in paying attention, daydreaming and forgetfulness. The combined type displays all of these symptoms. ADHD can improve with age and treatment or get worse with the increasing pressures of adulthood, and the type of ADHD can change over time.

The causes of ADHD are not yet fully understood, but it is clear that there’s a large genetic component. VectorMine/Shutterstock.com

ADHD in girls

Girls most often exhibit the symptoms of inattentive type ADHD, and may come across as being distracted or disorganised. This can sometimes be referred to as ADD, or ADHD without hyperactivity. When girls do show symptoms of hyperactivity it can appear as being talkative, and therefore easily dismissed as just chatty. Another frequently overlooked characteristic of ADHD in girls is emotional dysregulation. In both children and adults ADHD can result in stronger emotional reactions to even minor challenges. In girls this can look like frequent crying and experiencing more (even contradictory) emotions simultaneously. Emotional dysregulation was considered a major factor in the diagnosis of ADHD, but towards the end of the 20th century there was a shift towards focussing on traits that could be measured in a clinical setting, and so emotional dysregulation was phased out of medical descriptions.

“Increasing awareness of how ADHD
can present in girls is key to ensuring
that treatment is available to anyone
who needs it.”

Girls can also develop strategies to mask or compensate for their ADHD, such as perfectionism or obsessive-compulsive disorder. These coping strategies – perhaps in combination with social expectations for “ladylike” behaviour – mean that girls with ADHD may perform well in school, particularly if they’re naturally bright. This can make getting a diagnosis more challenging if parents and teachers aren’t aware of a problem.

A neurodevelopmental disorder, ADHD is estimated to affect around 8.4% of children.

Why diagnosis is important

Girls with ADHD may need more support than their male counterparts because they often blame themselves for their perceived shortcomings. While boys tend to express their frustrations through acting out, girls commonly internalise this behaviour. Girls with ADHD tend to experience low self-esteem, and are therefore at risk for developing other conditions such as depression, anxiety, and eating disorders. Sadly, as adults, women with ADHD are more likely to experience chronic sleep-deprivation, self-harm, or attempt suicide. Increasing awareness of how ADHD can present in girls is key to ensuring that treatment is available to anyone who needs it. In particular, parents and teachers should be informed about the range of symptoms that could indicate ADHD so that support can be provided from an early age. Early ADHD diagnosis could improve the quality of life of girls everywhere.

Josie Wyatt is a freelance writer based in Scotland.

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