When asked to describe a typical child with attention deficit hyperactivity disorder (ADHD), most people would describe a young boy who climbs on things, is impatient and does not do what he is told. Few people would describe a bubbly young girl with lots of friends, who works hard to get good grades.
It may be, however, that the girl does experience ADHD symptoms that interfere with her daily life — and that these symptoms are overlooked by the adults around her.
Undiagnosed ADHD has long-term consequences including an increased likelihood of engaging in risky behaviours — such as unprotected sex and substance use — as well as academic underachievement and low self-esteem. Perhaps most alarmingly, girls who struggle with ADHD for a long period of time can suffer from mental health problems.
As a psychologist in clinical practice, I used to see many older girls and adult women with ADHD who had already been prescribed medication to treat anxiety and depression. Early diagnosis then is vital.
Assessment scales use data from boys
Individuals with ADHD exhibit three main clusters of symptoms: hyperactivity, impulsivity and inattention. Although three times as many boys are diagnosed with ADHD in childhood than girls, the diagnostic rates in adults are more equally divided between males and females. This suggests girls go unnoticed when they are younger.
As a disorder traditionally seen as affecting males, and with males referred more often for a diagnosis, research to assess ADHD has been based on samples largely consisting of boys. It has been argued that the rating scales developed to assess ADHD have been based on the behaviours observed in the mainly male research samples.
ADHD can look different in girls than boys. A boy who is hyperactive might have trouble sitting in his seat in the classroom — so he sits with one knee on the seat and one foot on the floor. It is likely, given his constant shifting and unequal balance on the seat, that the back legs of the chair will eventually lift up and the chair pitch forward causing the boy to fall to the floor.
In contrast, a hyperactive girl may be out of her seat but have taken on the role of classroom helper, wandering around to different desks. A teacher completing a rating scale might rate the boy higher on hyperactive questions than the girl because the second example is not seen as disruptive. Thus, girls do not score as high as boys on these scales and are underrepresented because they do not meet criteria for a diagnosis.
Not only do symptoms of ADHD look different in boys but boys also have a tendency to be more hyperactive and impulsive than girls. Because hyperactive and impulsive behaviours are more disruptive in the classroom, teachers are more likely to notice boys as a problem and refer them for attention challenges.
Lastly, symptoms of ADHD in girls are sometimes masked because they work hard to meet adult expectations. Without meaning to, adults have different expectations of girls than boys. In my clinical experience, adults expect girls to be tidy and organized, achieve good grades and to be easygoing. In turn, girls are more likely to want to obey social norms and not cause trouble. They will work extra hard to achieve success by staying up late to finish homework or tidying their rooms when asked.
Sometimes, when adults encounter girls who have difficulty meeting their expectations but the girls are agreeable, they excuse the behaviours by describing the girls as “ditzy,” “dramatic” or “artsy.”
Signs that your daughter might have ADHD
There are many symptoms of ADHD shared by both boys and girls. The following are examples of how they can manifest in girls:
- Homework takes longer than it should. She forgets about it or is distracted by surfing the internet or texting her friends and ends up staying up late the night before an assignment is due to finish it.
- She is an inefficient student. While she appears to study for tests, her performance does not seem to match the time spent studying.
- She has weak reading comprehension. She can get facts from a text but does not make links between the ideas she reads. She misses details in instructions on assignments and tests.
- She struggles with friendships because she does not read social cues or follow conversations. Peers start to reject and isolate her or make fun of her.
- She forgets things she needs (e.g. dance shoes or soccer cleats). This is a classic sign but agreeable girls with ADHD will often have friends or adults who compensate for them (for example sharing a pen because she doesn’t have one).
- She misplaces her things regularly (for example her phone, keys or bank card).
- She talks, and talks and talks.
- She does not run and climb about like boys but is the classroom helper and is social and chatty in class.
- She has lots of friends because she is fun to be around but when she tries to organize activities she seems anxious and indecisive. Her friends help her make decisions, find her things and keep her organized.
- She has great ideas and wants to start acting on them right away but does not finish projects or follow through.
- She is chronically late or is not ready when she needs to be.
- She channels hyperactivity by being involved in many extracurricular activities like swimming, school clubs and soccer.
- She does not seem to learn from consequences.
- She has wide swings in mood. One moment she is on top of the world and the next moment she is crushed because of a casual comment that is taken as harsh criticism.