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ADHD and its symptoms are most often associated with boys. This blog therefore focuses on complications in diagnosing girls with ADHD, recognising gender (referring to differences in display of symptoms) and treatment options for girls with ADHD.
ADHD and its Symptoms
Attention Deficit Hyperactivity Disorder (ADHD) is a common disorder affecting children. Such children are likely to be restless, have trouble maintaining focus and may act on impulse.
While many children may appear hyperactive, have difficulty waiting their turn, or tend to fidget, children with ADHD experience noticeably greater hyperactivity, impulsivity and inattention that is not expected for their developmental stage. Such symptoms are usually visible in children before the age of 6 and are likely to exist across contexts (i.e in school and at home).
There are three main subtypes of ADHD:
- Predominantly Inattentive Type
- Predominantly Hyperactive/impulsive type
- Combined type
The symptoms defined above appear differently in girls than in boys and therefore are likely to either be undiagnosed or misdiagnosed in the former. According to a study in 2018, boys are twice more likely to receive an ADHD diagnosis in childhood than girls. However, although boys are more likely to receive an ADHD diagnosis, this does not mean that they are more susceptible to the disorder.
Unseen Struggles of Girls with ADHD
The symptoms of ADHD in girls are likely to be less obvious and therefore may not fit the common stereotypes associated with ADHD, resulting in challenges with diagnosis. Usually, girls tend to exhibit the inattentive form of ADHD and are less prone to displaying disruptive symptoms.
Recognising the Signs
A 2019 study found that ADHD girls are more likely to have the Predominantly inattentive type ADHD. Thus, they may appear to have the following symptoms:
- Spending hours doing homework but forgetting to submit it the next day
- Sitting quietly in class but not being able to pay attention
- Frequently losing things
- Trouble making or keeping friends
- Difficulty completing tasks
- extreme focus on things that interest them
In summary, girls with ADHD may appear distracted, lost in their own world, or forgetful rather than overtly disruptive. Consequently, caregivers often fail to establish the connection, particularly when hyperactive or disruptive behaviour is not present.
Diagnostic Challenges
For many years, ADHD diagnoses were primarily associated with hyperactive and impulsive behaviour, focusing on a predominantly male population. The early research, shaped by data from this group, laid the foundation for ADHD studies, and subsequent diagnostic criteria were developed based on these findings. In 1980, revisions to the diagnostic criteria acknowledged the potential for inattention without hyperactivity, leading to an increase in ADHD diagnoses among girls (Anastopoulos, Barkley and Shelton, 1994).
Despite these changes, the current diagnostic manual still classifies ADHD with Disruptive Behavior Disorders of Childhood, underscoring the persistence of an overrepresentation of "male" behaviour (Bruchmüller, Margraf and Schneider, 2012).
Unique Complications for Girls with ADHD
As established above, ADHD often has a different presentation in girls given the rather internalised symptoms. ADHD thus impacts academia which in turn affects their self-esteem. Moreover societal norms about gender roles adds yet another layer of complexities for girls with ADHD.
Academic Challenges
A fundamental challenge faced by children with ADHD encompasses difficulties in attention/focus, memory, learning, organising, and planning—essential skills for academic achievement.
Girls dealing with ADHD often exert additional effort behind the scenes to match their peers, unaware of the underlying neurodevelopmental condition.. As the academic workload intensifies, girls with ADHD progressively lag behind, lacking the capacity to meet increasing demands.
This can lead to significant damage to their evolving sense of self-worth, competence, and confidence, perpetuating a harmful cycle of escalating academic challenges and diminishing self-assurance.
Despite prior accomplishments, many girls are advised that they can perform better and simply need to exert more effort. This often leaves girls with ADHD feeling invalidated, frustrated, and misunderstood.
Social and Emotional Impact
The distinctive challenges confronted by girls with ADHD are also shaped by societal expectations (Grskovic and Zentall, 2010). There persists an expectation for females to embody traits such as tidiness, organisation, compliance, cooperativeness, and sensitivity towards others. However, their unpredictable executive functions frequently impede their attempts to align with these societal norms.
The rapid and dynamic verbal exchanges among peers can be overwhelming for those with slowed processing. The inability to grasp subtle cues and jokes leads to a sense of exclusion. Despite a yearning for peer acceptance, they grapple with the pressure to conform, often experiencing the feelings of being overlooked and misunderstood.
In contrast to boys who may externalise blame, girls tend to internalise their feelings of being different. When they impulsively express their frustrations, they often face exclusion from their peers.
Self-Esteem and Identity
Girls frequently internalise feelings of frustration, shame, self-blame, anxiety, and depression (Gilbert and Irons, 2009). They may present an outward appearance of doing well even when facing difficulties. Many girls tend to withdraw, experience low self-esteem, and develop a sense of hopelessness regarding potential improvements. Consequently, girls with ADHD become susceptible to various risk factors, including mood disorders, eating disorders, smoking, substance dependence, risky sexual behavior, reckless driving, self-harm, and suicide (Tung et al., 2016).
Navigating Treatment Options
The approach to ADHD treatment varies for each child. Typically, effective treatment entails a combination of strategies and necessitates a collaborative effort involving your child’s therapist, teacher, and parents.
Therapy provides a secure environment to:
- Practice communication, organisation, and interpersonal skills
- Learn and adopt new behaviours
- Receive support in accepting and managing challenging and overwhelming emotions
You may book an appointment with Rocket health’s qualified and ethical therapists. Additionally, therapists may suggest family therapy or parent training, offering valuable skills for parenting a child with ADHD. This includes practices such as structuring daily activities.
Depending on the severity of your child’s symptoms, the therapist may recommend consultation with a psychiatrist to explore potential medication options. While not always deemed necessary, ADHD medication can be beneficial in alleviating severe symptoms, significantly enhancing daily functioning and overall quality of life.
Empowering girls with ADHD
Rebuilding the self-esteem of girls with ADHD is key in empowering them. One way of doing so is by utilising a strengths based approach. Girls suffering from ADHD tend to conceal, downplay, or offset their challenges, feeling too ashamed to seek assistance, even when it's genuinely needed. Thus, collaborating with them to foster a comfort level in seeking help may in turn empower them.
References
Anastopoulos, A., Barkley, R., & Shelton, T. (1994). The history and diagnosis of attention deficit/hyperactivity disorder. Therapeutic care and education, 3, 96-96.
Bruchmüller, K., Margraf, J., & Schneider, S. (2012). Is ADHD diagnosed in accord with diagnostic criteria? Overdiagnosis and influence of client gender on diagnosis. Journal of consulting and clinical psychology, 80(1), 128.
Gilbert, P., & Irons, C. (2009). Shame, self-criticism, and self-compassion in adolescence. Adolescent emotional development and the emergence of depressive disorders, 1, 195-214.
Grskovic, J. A., & Zentall, S. S. (2010). Understanding ADHD in Girls: Identification and Social Characteristics. International journal of special education, 25(1), 171-184.
Tung, I., Li, J. J., Meza, J. I., Jezior, K. L., Kianmahd, J. S., Hentschel, P. G., ... & Lee, S. S. (2016). Patterns of comorbidity among girls with ADHD: a meta-analysis. Pediatrics, 138(4).
Young, S., Adamo, N., Ásgeirsdóttir, B. B., Branney, P., Beckett, M., Colley, W., ... & Woodhouse, E. (2020). Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/hyperactivity disorder in girls and women. BMC psychiatry, 20(1), 1-27.
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