Signs and Symptoms of Undiagnosed ADHD in Girls
ADHD Support & Awareness
For over two hundred years we’ve known that some people are more easily distracted and have difficulty maintaining focus. We’ve known that symptoms of this condition are most likely to begin in childhood. And, until recently, we’ve incorrectly assumed that the condition now known as Attention-Deficit/Hyperactivity Disorder affects primarily boys.
We’re now beginning to understand the vast under diagnosis of ADHD in girls and women, and that’s largely due to the evolving research on the condition itself. As we’ve come to know better the various presentations of ADHD symptoms, it’s become apparent that generations of girls have gone undiagnosed because their symptoms weren’t consistent with the stereotype of a hyperactive, disruptive boy.
The 3 Presentations of ADHD
ADHD was first included in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders in 1968, when it was termed Hyperkinetic Reaction of Childhood. It was understood primarily as a disorder of excessive energy. Not until 1994 did the DSM-IV add the subtypes: predominantly Inattentive, predominantly Hyperactive-Impulsive, and Combined.
Three major types, or presentations, of ADHD include the following:
- ADHD, combined type. This, the most common type of ADHD, is characterized by impulsive and hyperactive behaviors as well as inattention and distractibility.
- ADHD, impulsive/hyperactive type. This, the least common type of ADHD, is characterized by impulsive and hyperactive behaviors without inattention and distractibility.
- ADHD, inattentive and distractible type. This type of ADHD is characterized predominately by inattention and distractibility without hyperactivity.
ADHD Prevalence in Girls and Boys
Recent ADHD research has begun to reveal a major diagnosis gap in girls and women. According to a 2021 review, ADHD affects girls at just under half the rate it affects boys, and this becomes closer to equal by adulthood. This review, led by Stephen P. Hinshaw, is just the most recent of a large body of work focused on ADHD in girls and women by Hinshaw since 2002.
In that year, Hinshaw’s groundbreaking study of preadolescent girls with ADHD revealed that girls with ADHD show predominantly inattentive and internalized symptoms. Boys, on the other hand, tend to display greater levels of hyperactivity, impulsivity and external symptoms. ADHD in girls was found to be correlated with speech and language problems, grade retention, adoption and abuse.
ADHD Signs and Symptoms in Girls
Hinshaw’s 2021 paper warned, “Clinicians may overlook symptoms and impairments in females because of less overt (but still impairing) symptom manifestations in girls and women and their frequent adoption of compensatory strategies.” In other words, girls’ symptoms aren’t as “loud” and noticeable as boys’ and girls may be culturally conditioned to behave more quietly and compliantly, anyway.
Girls with ADHD tend to display more symptoms of inattentiveness and mood issues than impulsive or hyperactive symptoms. Girls’ distractedness, anxiety and forgetfulness may be less easily noticed in a classroom situation than the vibrating energy of an untreated boy with ADHD. When girls do have hyperactive symptoms, they may be less obvious. According to Patricia Quinn, Director of the US Center for Gender Issues and ADHD, “In a classroom setting, a boy might continually blurt out answers or repeatedly tap his foot, whereas a girl might demonstrate hyperactivity by talking incessantly.”
Symptoms of ADHD in girls include:
- daydreaming and drifting off in conversation
- crying, getting irritated, and exhibiting more sensitivity than peers
- starting many tasks, but struggling to finish them
- seeming not to hear or remember instructions well
- getting easily distracted
- being exceptionally forgetful
- talking more than others her age, being “chatty”
- seeming “messy” or disorganized
- perfectionism and anxiety
The Dangers of Undiagosed ADHD in Girls and Women
When ADHD goes undiagnosed in girls, it doesn’t just impact academic and social outcomes. Research shows girls are more likely to internalize mistakes more than boys; each failed test, annoyed adult or missed deadline is more evidence of their failure and self-esteem plummets as a result.
We know that depression, anxiety, low self-esteem, eating disorders, and even teenage smoking are all more common in girls with ADHD, and that the damage continues into adulthood. A 2012 follow-up study of women who were diagnosed with ADHD in childhood found: “Girls with childhood ADHD maintain marked impairment by early adulthood, spreading from symptoms to risk for serious self-harm.” In fact, ADHD in girls is correlated in adulthood with more frequent instances of self-harm, intimate partner violence, unplanned pregnancy, and psychopathological comorbidities.
Untangling the gender differences of ADHD is just beginning, and future research and treatment needs to focus on treating ADHD across the lifespan for girls and women, with an eye to the unique psychological symptoms and risks.
If you suspect your child’s reading, math, or other academic progress has been affected by ADHD, reach out to discuss a Functional Literacy and/or Mathematics Assessment and the specific strategies and instruction your child needs.
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Did your child’s ADHD go undiagnosed for too long? What helped you finally identify it? Share your experience below!