Attention Deficit Hyperactive Disorder (ADHD) is a hidden disorder in girls. It is often diagnosed and seen as a boy disorder because of the hyperactivity its symptoms can cause. But there is another side to the disorder that gets ignored, inattention. This is the type of ADHD that often presents itself in girls. Because of this, many girls are left undiagnosed as the symptoms they show are not seen as the “classic” ADHD symptoms. And if a girl does present the classic ADHD symptoms, she is told, “you’re smart, why are you not applying yourself?” Girls, both younger and older, will be greatly impacted by their teacher's and caretaker's assumptions that they should be able to handle it all, which results in their self-esteem plummeting. When a child has low self-esteem, their mood and mental health suffer. The good news is that this is preventable with diagnosis, treatment, and awareness!
For every 3 boys diagnosed with ADHD in childhood, only 1 girl is diagnosed. This doesn’t mean that the actual prevalence of the disorder is 1:3; it means that our girls are going undiagnosed. This is more than likely because of the differences in the symptoms between boys and girls. The symptoms of ADHD can be:
Hyperactivity/Impulsivity:
Fidgeting, squirming in a chair, talking a lot, and having a difficult time staying quiet or sitting still. Impulsivity can be identified in children by an inability to take turns, interrupting others, or being accident-prone due to reckless behavior. These are all externalized behaviors that a teacher or caregiver would likely see, intervene, and suggest the parents talk to a professional.
Inattentiveness:
Daydreaming, making frequent mistakes, forgetting/losing things, distractibility, or avoidance of activities that require attention. As you can imagine, these internalized symptoms are more subtle and may be harder to spot for teachers and caregivers.
Hyperactivity and Impulsivity are clearly the symptoms that render diagnosis the quickest. These “disruptive” behaviors are more common in boys. A teacher will notify a parent of the disruptions to the classroom, which is likely the reason why boys are more often identified and evaluated for ADHD. Boys who demonstrate these symptoms, especially if they do not present with severity, are more likely to get a pass from other kids and teachers, because “boys will be boys” or after diagnosis, “he just has ADHD.” Girls who demonstrate these hyperactive and impulsive behaviors often get ostracized by teachers and peers.
All children with ADHD share strong risks of school failure, peer rejection, and substance abuse. But research shows that girls with ADHD are at an increased risk for these problems, as well as an increased risk for developing anxiety, mood disorders, self-injuring behavior, and eating disorders. This risk is more than likely because of their missed diagnosis and the impact it has on their peer relationships. To a young child, peer relationships are their world and have the biggest impact on their likes/dislikes and worldview.
Because of their struggles with peers and school, girls with ADHD feel discouraged. This greatly decreases their self-worth, mainly because the adults in their life don’t understand why they’re struggling. Their lowered self-worth leads to secondary symptoms such as depression, impulsive behaviors, and poor stress management. By the time these girls get to college, they may decide it is time to seek help. This means most women and girls aren’t being diagnosed until their 20s. It is important to address ADHD in girls as early as possible so that they can get the support to better manage their symptoms BEFORE these secondary symptoms arise. Early diagnosis and management of symptoms will lessen the likelihood of developing other mental health symptoms, such as anxiety or disordered eating.
If you have a girl in mind that you are wondering might have ADHD, take these into consideration:
Is her room messy and disorganized, even a few minutes after it’s been cleaned?
Does she frequently misplace or lose her backpack, keys, or phone?
Is she overly reactive? Does she cry or scream at the smallest provocation?
Does she make self-defeating statements, such as “I’m stupid,” or “No one likes me”?
Does she seem to have a hard time remembering where to go/which way to turn, even when it’s a route she has taken many times before?
Does she demonstrate frequent indecision, or just answer “I don’t know” to questions asked?
Does she avoid or refuse to attempt new things?
Does she fear getting in trouble, even when she has done nothing wrong?
Does she get frustrated with herself easily?
Is she always in a rush to get something done, even when there is plenty of time?
Is she fearful of speaking in public? Does her teacher comment that she never raises her hand in class?
Does she seem to talk a lot? Interrupting others in an attempt to get her point across?
Does she seem to have a random stream of thoughts? Does she seem to hop from one topic to another without a bridging statement?
If the girl in question has demonstrated multiple of the points above, then it’s possible that she has ADHD. It is very important that she be evaluated by a mental health professional, primarily a child therapist. Many Primary Care Physicians look for the “classic” symptoms of ADHD, as are typically demonstrated by boys. A child therapist will be able to help you delineate the symptoms of ADHD as it presents in girls, compared to the overlapping or secondary symptoms of anxiety, depression, and being socially withdrawn. A child therapist can also assist you in finding the solutions that work best for your family and your girls’ academic success and emotional well-being. Treatment of ADHD can include: play therapy, family therapy, support groups, occupational therapy, or medication. The sooner she is evaluated, the sooner she can get on the path to mental wellness!
You can support your ADHD daughter by setting her up for success. Encourage her to get involved with activities that focus on her interests, or social groups that allow for individual space (think: art classes, book clubs). Doing so will help her learn to feel safe and comfortable in a social setting, and give her a positive experience per se. You may be able to connect her with other girls (her age or older) who have ADHD and can be an advocate for your daughter as she grows. At home, you can make changes to your daughter’s routine to aide her in getting her homework done and staying on task. For example, if your daughter is social and talkative, she might benefit from a group study setting. Whereas other girls who are more introverted will likely benefit from a quiet place to do homework, without distractions. Give your daughter a way to see what she has in store for her. Some children benefit from having a visual chart that maps out their day, older children may benefit from the use of a planner or bullet journal.
Another strategy you can use to help your daughter achieve academic success is helping her practice asking for help. Girls with ADHD often minimize their struggles because they want to “fit in” or they are too embarrassed to ask for help, even when it is needed. You can help your daughter flex her asking-for-help muscle, by giving her concrete examples to use when advocating for herself; such as: “Can you say that again? I remember things better when I write things down” or “Please write that down for me, I comprehend better when I read it.” You know your daughter’s strengths and limitations best, and highlighting her strengths (creativity, intuition, curiosity) is one way to help your daughter see herself in a positive light. Demonstrating patience, consistency, and love for your ADHD girl will help her develop needed skills and keep her self-esteem intact.
ADHD in girls indeed looks different, but that doesn’t mean that it’s tough to diagnose or treat; it just means that we need to raise awareness. With so many other difficulties arising with the absence of a diagnosis, we need to get the word out in order to get the diagnosis for girls before those secondary symptoms arise. Remember that once your child is diagnosed, she still needs support. You are her ally. Allow her to flourish and thrive on what she does best, whether it’s her creativity or curiosity. Work with her needs and give her options to increase her peer connection and extra-curricular activities, much like you would do with a child who doesn’t have ADHD. Be a voice for your daughter, and don’t let her drown in a world that has ideals for how she should behave or learn! When we raise awareness, we are saving our girls from the mental torment of depression and self-deprecation and giving them a chance to achieve their highest potential!
Adapted from: Child Mind Institute; ADDitude
Downloadable Content:
ADHD pdf here
ADHD in Girls pdf here