How ADHD presents in girls

By Dr Linda Kelly

Talking about ADHD, the image that comes to mind is a hyperactive, restless boy. However, it’s become clear there’s a spectrum of clinical representations of ADHD compromising of inattention and hyperactivity symptoms co-occurring in an individual.

Boys are 3 times more likely than girls to be diagnosed with ADHD. Boys more commonly present with hyperactive and impulsive symptoms, which are more outward, obvious and disruptive than inattentiveness, which is more likely to be a symptom of ADHD in young girls. It’s estimated as many as 50 to 75% of cases of ADHD in girls are missed.

Girls often present with inattentive symptoms, which tend to be less unsettling and noticeable than hyperactive or impulsive symptoms. This means they’re less likely to be recognised as having ADHD at home and in the school environment, until symptoms affect academic and social progress later in life. The diagnosis may only be made much later in girls than boys.

Reasons for missed diagnosis

  • Non-recognition by health professionals, parents and teachers
  • Girls have fewer behavioural problems, and manage to maintain better academic performance for longer
  • Co-occurring conditions are often recognised more easily (such as anxiety and mood disorders) and the focus shifts to these symptoms, as opposed to the ADHD itself
  • Parents and teachers are able to accommodate and cope with symptoms such as disorganisation, forgetfulness and inhibited social behaviours better than disruption and hyperactivity

Recognising the difference 
In boys, ADHD symptoms are ‘external’ including aggressive, disruptive and impulsive behaviours and these are harder to accommodate as they affect those around them.

Common symptoms in girls with inattentive-type ADHD are distraction and daydreaming. Young girls with ADHD are often shy and socially inhibited. They miss social cues such as greetings and are often disorganised and forgetful, not remembering daily to-dos like brushing of teeth and hair.

At school, girls with ADHD forget homework and tests, and take longer to complete tasks. In turn, they receive criticism and negative feedback which affects self-esteem and causes further withdrawal and doubt of capabilities. Because of this, they underperform academically or manage to get by with average marks.

Girls with ADHD may appear socially immature and may not be as adept in social interactions as their peers. They’re also prime targets for bullies.

Consequences of a missed diagnosis 
Undiagnosed and untreated ADHD in girls can develop into psychiatric disorders including depression, anxiety, eating disorders, disruptive behaviour and substance abuse. It can lead to an unbalanced way of life where girls are unable to reach their goals or achieve success.

The possibility of ADHD-inattentive subtype should be considered where any co-occurring conditions are recognised. Teachers and parents need to be aware of inattentive symptoms that could be ADHD in girls. An accurate diagnosis and an effective treatment plan means a balanced, healthy and empowered life for young girls with ADHD.

PHZA/CONC/0517/0004b

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