ADHD in Girls

ADHD in Girls: Why It’s Ignored, Why That’s Dangerous

Many young girls with ADHD — most with inattentive symptoms — are being drowned out by loud, hyperactive boys who demonstrate the condition’s stereotypical behavior. Learn how to recognize the mistaken, misunderstood symptoms of ADHD or ADD in girls, and turn around this unfair unbalance for your daughter or yourself.

A girl with inattentive ADHD daydreams in class

ADHD in Girls: Recognizing Key Symptoms

ADHD in girls — particularly if it’s the inattentive type of ADHD formerly called ADD — can look like this:

  • daydreaming quietly in class
  • feeling anxious or sad
  • exhibiting silliness or apparent ditziness
  • acting shy or inattentive
  • trouble maintaining friendships
  • picking at cuticles or skin
  • being a perfectionist

ADHD in Girls is Often Missed

Twenty-year-old Andrea Burns fits the description of ADHD in girls perfectly. She wasn’t officially diagnosed with attention deficit hyperactivity disorder (ADHD or ADD) until her freshman year at Indiana University, even though she showed obvious signs of ADHD in middle school.

After Burns nearly failed out of school, an academic advisor had her undergo a LASSI (Learning and Studies Strategy Inventory) screening to evaluate learning behaviors and academic achievement. The results indicated what she and her family had long suspected: ADHD.

“In high school, I had a tutor to help me with different subjects, but once I got to college, I was expected to do it all by myself. I was studying all of the time, but doing poorly on tests because I’d freeze up,” says Burns. “And I’d try to listen in class, but I had a hard time concentrating and focusing on what the teacher was saying. I’d take lots of notes, but when I reviewed them, I couldn’t make sense of what I wrote,” says the communications major, now entering her junior year.

[Self-Test: ADHD Symptoms in Women and Girls]

After a diagnosis of ADHD – Primarily Inattentive Type, Burns was prescribed ADHD medication. She saw almost immediate results: “I was finally able to focus during a lecture and take good notes, which helped improve my grades. For the first time I felt in control in the classroom.”

Burns is relieved to have identified the cause of her poor school performance, and happy she’s able to treat it. But it’s unfair that she, like so many other girls, suffered a decade or more with an untreated condition that can negatively impact life in so many ways. Why are girls being diagnosed so much later than boys, if at all? And what do teachers, pediatricians, and parents need to do to bring about a change?

Symptoms of ADHD in Girls

One of the key reasons girls are so often overlooked is that they exhibit hyperactivity differently than boys, according to Patricia Quinn, M.D., director of the National Center for Gender Issues and ADHD in Washington, D.C. “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,” she says. A girl who talks all the time is often viewed by the teacher as chatty, not hyper or problematic — and thus is less likely to be recommended for an evaluation.

Another reason that ADHD is often missed in girls is that they’re more likely than boys to suffer from inattentive ADHD. The symptoms of this sub-type (which include poor attention to detail, limited attention span, forgetfulness, distractibility, and failure to finish assigned activities) tend to be less disruptive and obvious than those of hyperactive ADHD. Put simply, a (hyperactive) boy who repeatedly bangs on his desk will be noticed before the (inattentive) girl who twirls her hair while staring out the window. “I believe I was overlooked for so long because I didn’t show hyperactivity the way my two brothers with ADHD have,” says Burns.

[Self-Test: Could Your Child Have Inattentive ADHD?]

Why ADHD in Girls Goes Undiagnosed

It comes as no surprise that a recent national online Harris Interactive poll reaffirms that, with respect to ADHD, girls have gone largely unnoticed. Dr. Quinn and Sharon Wigal, Ph.D., associate clinical professor of pediatrics at the University of California at Irvine, surveyed 3,234 people, including members of the general public (adults without ADHD whose children don’t have the condition), parents of children with the condition, teachers, and children with ADHD, ages 12 to 17. Among those polled, 85 percent of the teachers and more than half of the parents and the general public believe that girls with ADHD are more likely to go undiagnosed. They said that girls are more likely to “suffer silently” or show fewer symptoms. And four out of 10 teachers report more difficulty in recognizing ADHD symptoms in girls than in boys.

Polled parents and teachers also said that, among children with ADHD, boys are more likely than girls to exhibit behavioral problems, while girls are more often inattentive or struggling with a mood disorder. Drs. Quinn and Wigal said these differences cause some girls with ADHD to slip through the cracks. “The failure to recognize ADHD symptoms in girls probably results in significant undertreatment,” they wrote. “…it is not a trivial disorder for them, and they are equally in need of professional care.”

Girls with ADHD Face Serious Risks

Another revelation from the Harris poll: Females may suffer more negative effects from their ADHD than their male counterparts. The survey showed that girls are more likely than boys to be asked to repeat a grade due to poor school performance. When a boy struggles, he’s more likely to be evaluated for ADHD or LD (and then diagnosed) than held back. But a teacher who observes a disorganized female student — one who can’t plan ahead, meet project deadlines, and so on — believes that she’ll benefit by being held back a year. “A year later, the girl is no better off because she still hasn’t figured out the source of her problems,” says Dr. Quinn.

The self-esteem of girls with ADHD also appears to be more impaired than that of boys with ADHD (which may explain why the survey found that girls were three times more likely to report taking antidepressants prior to being diagnosed). It’s not surprising, then, that the condition can take a toll on a female’s emotional health and general well-being. According to Dr. Quinn, girls with ADHD tend to have more mood disorders, anxiety, and self-esteem problems than non-ADHD girls. “They might get an A on a report, but because they had to work three times as hard to get it, they see themselves as not being as smart as other people,” she says.

Another reason that girls go undetected for so long has to do with how differently each gender approaches school. Dr. Quinn offers this example: “A male and female student with ADHD are assigned a long-term project. They each put off the work for weeks. Then, the night before the project is due, each remembers the deadline. Rather than attempt to get the work done, the boy decides to watch back-to-back episodes of SpongeBob. Meanwhile, the girl freaks out and tries to make a perfect project overnight. (Perfectionism is another common behavior in ADHD girls.) She demands that her mother help her while she stays up until 1 a.m. to finish her work. When she hands in the assignment the next day, the teacher has no clue that it was done at the last minute.”

Girls seem compelled to get their schoolwork done because our culture encourages them to be more socially conscious. They want to please more than boys, and they’re expected to do well in school.

Because grades K through six aren’t as challenging as higher grades, a girl with undiagnosed ADHD might do fine in elementary school — and then falter. “In middle and high school, the attentional demands are greater for a student, so she can’t get by working at 50 percent efficiency,” says Andrew Adesman, M.D., director of the division of behavioral and developmental disorders at Schneider’s Children’s Hospital in New Hyde Park, New York, and member of the national board of directors for CHADD. “And because the kids in junior high and high school more often change classes, teachers don’t have the time to get to know the kids and spot problems.”

Some girls also compensate by developing strategies that mask their ADHD. As mentioned earlier, it might be perfectionism. For instance, a girl might spend hours taking notes on each chapter she’s being tested on in order to assure a good grade. Or she might become obsessive-compulsive, checking and rechecking her backpack to make sure she has everything.

ADHD gender differences also show up outside the classroom. Research shows that girls with ADHD may be rejected more often by their peers than boys. The main reason is that, compared to boys’, girls’ friendships require greater sophistication and more maintenance. “Two boys can meet on the playground and start digging a hole to China with their shovels, and they’re instant friends. Friendship among girls is more complex, even at young ages. It requires picking up on social cues and bonding,” says Dr. Quinn.

With tendencies toward impulsivity, hyperactivity, and forgetfulness, it can be hard to keep your mouth closed, not to constantly interrupt, or to remember your best friend’s birthday. And when everyone in the group is admiring Jessica’s new earrings and the girl with ADHD blurts out something totally unrelated, the other girls look at her and wonder where she’s coming from. This kind of social awkwardness makes it difficult for a girl to feel good about herself and sustain relationships.

Unfortunately, these signs often aren’t enough to suggest ADHD. In the case of 14-year-old Danielle Cardali of Suffolk County, New York, it took two evaluations before her teacher and parents were able to pinpoint why her grades remained low. Being classified with ADHD in fourth grade, she was entitled to 45 minutes a day of one-on-one teacher time in a resource room. But real improvement didn’t come until seventh grade, when she was prescribed Strattera and Concerta. “After that first quarter on the medication, I got high C’s and low B’s,” says Cardali. “I seemed to have a better understanding of what was going on in class.”

In some cases, a parent will stumble upon ADHD after a learning disability is discovered. (They often co-exist, which is why it’s important when testing for one also to screen for the other.) That was the case with 7-year-old Allison Isidore of Montclair, New Jersey. Her mom, Liz Birge, had an opportunity to see her daughter at work in the classroom for 45 minutes once a week, when she volunteered to assist in a writing workshop. Liz discovered that her first-grader was having a great deal of trouble matching sounds to letters and that she showed no interest in trying to write. Testing revealed that Allison has both a learning disability and ADHD.

Helping Girls with ADHD

If parents suspect that their daughter has ADHD (or a learning disability), Drs. Quinn and Wigal urge them not to wait, even if teachers haven’t expressed concern. As mentioned earlier, teachers usually look for hyperactivity, disorganization, or forgetfulness as the signs of ADHD before recommending an evaluation. But the way ADHD often expresses itself in girls — excessive talking, poor self-esteem, worrying, perfectionism, risk-taking, and nosiness — is seldom read as such [see Easy-to-Miss ADHD Symptoms In Girls].

Your daughter’s pediatrician may be able to do an evaluation (if your daughter is an adolescent, find out first if the doctor is comfortable working with teens), but it’s best to work with an ADHD specialist. Make sure the evaluating clinician takes a thorough medical history (including family history, due to the high heritability of ADHD). The doctor should also work with your child’s school to obtain more information about her behaviors. “And since adolescents are a great source of information about their own experience, encourage a teen to talk directly with her doctor,” advises Dr. Wigal.

Ultimately, for a girl suffering from ADHD, an official diagnosis can be welcome news. “Everyone presumes that a diagnosis of ADHD is a stigma,” says Dr. Quinn. “In fact, 56 percent of the girls in our survey said that they felt better after finally having a name for what they felt. Only 15 percent said they felt worse. For most, it was a relief to find out they weren’t lazy, crazy, or stupid.”

More good news: Parents of girls diagnosed with ADHD are more likely to seek treatment than parents of boys diagnosed with ADHD, because only the more severe cases are diagnosed. “Girls may be at a slight advantage over boys in one sense,” wrote Quinn and Wigal in the Harris survey paper. “Once they are suspected of having ADHD, their parents tend to be more willing to seek medical advice.” And that bodes well for girls.

[Self-Test: Could Your Daughter Have Rejection Sensitive Dysphoria?]

10 Comments & Reviews

  1. I hope not to sound too ‘whataboutish’ but for me as a man suffering exactly the symptoms described as the ‘girly’ type of ADHD, an additional step was needed to get correctly diagnosed, the step of realizing that this is my type of ADHD and these are the means I need to fight my condition no matter of the gender.
    Unfortunately I don’t know how we can best tackle that issue, but for any boy suffering from anything that’s considered a ‘girls’ issue (vice-versa), don’t let that stop you from getting the help you need.

    1. came down to comments section to say much the same thing – really I think over time we will see that it’s not got a lot to do with gender. I don’t like the stereotypes here – IMO it should be an article about how PEOPLE with visible hyperactive traits drown out PEOPLE with invisible inattentive traits…

      I don’t think you should hesitate to put forward such an opinion as that shown by your comment. Bravo!

      1. I do agree that there should be more attention given to boys with ADHD that have the inattentive subtype. But as a 28 yr old woman with that very subtype, I think it’s irresponsible to say that doctors should ignore the gender predisposition. Yes of course boys and men experience this too. It just happens to happen far more frequently in girls than boys. It’s the very reason why we get undiagnosed. I was diagnosed sometime earlier this year by my therapist that my husband suggested I see for my negative childhood, which I was diagnosed with PTSD as well. I have had issues most of my life, I struggled in school because I was sitting in my chair twirling my hair or drawing, and daydreaming. I’d also put everything off until the last minute. In fact, once in 5th grade I didn’t complete a math test, so my teacher sat me down and didn’t let me leave for recess until I did the test. I sat there not doing it, she left to go to the bathroom eventually, and when she came back I was gone, test was finished, all answers were correct. Ever since I started going to school when I was 5, my mom knew there was something up with me. She asked teacher after teacher, adhd parent after adhd parent, none of them said I should be evaluated. One school however had me evaluated by their counselor, they said I didn’t have adhd. So I went completely undiagnosed, untreated through my childhood and part of my adulthood. My mom also grew up with the classic 70’s midwestern republican blue collar “my way no highway option” parenting. Guess what I got. Combine the concept that a child should always do what a parent tells them without question, and that it’s completely ok to tell an adolescent girl that they’re fat with a girl with adhd, you have a recipe for disaster. There was all kinds of different arguments, screaming matches, getting slapped across the face, punched in the stomach, being told you’re worthless, and that you should just die so that you can stop wasting the earth’s air that would have been spared if my mom just got me diagnosed. I’m sorry for the rant, but sure a small handful of boys have my kind of adhd that gets unnoticed at first. But Luki_riesen was still diagnosed a lot sooner than I was. Sure it sucks that it took a little longer, but be thankful you didn’t suffer a hellish childhood before you were diagnosed.

      2. Thanks for your reply. I appreciate what you said and the energy it took to say it. I don’t think making comparisons or assumptions is healthy and I can’t respond in that manner when I wanted to point out the objectivity of the prejudice – I’m not talking about individual cases cos I’d be here all day… and you say for me to be thankful that I didn’t suffer a hellish childhood before I was diagnosed… well you don’t know me so please let’s keep the anecdotes objective if we want them to be useful to other parties.

  2. luki_riesen and rothl4444

    It was extremely helpful for me as a mom to a young girl to come to this page. I had just come from the page describing behaviors of ADD, ADHD and the inattentiveness subversion. For each list I could see more that were not true than were true.

    It linked here. On this list and the linked to quiz about girls behaviors I see more than 2/3 of the descriptions sound like my daughter. As well as the comments about the higher incidence of a linked mood disorder.

    Please don’t let your whataboutism cloud the fact that for someone with little experience with these types of behaviors will find these generalizations very helpful in deciding to get help for our kids, ourselves or our loved ones.

  3. I have many of the symptoms of adhd like daydreaming in class then getting in trouble by the helper because i didnt pay “attention” but i get easily distracted, another symptom is definitly being shy i cant talk to the lunch room ladies, the teachers or other people , i cant make eye contact with people at all, i cant close my mouth of a reason i have to keep it open or smiling, i do pick my skin A lot thats why i used fake nails to stop biting and picking, i am a perfectionist nut once i turn it in i realize its all wrong and i have to do it all over again, Nut it frustrates me and i cry in my head because i got made fun of my 3rd grd teacher because i needed a bunch of help and since that i began hiding my real personality because i used to be bullied a lot but my real personality is acting like a little kid and watching peppa pig,spongebob,bubble guppies, but i have to hide my real personality or ill get bullied and i cry very easy but instead i cry in my head like once in my high school like 2 weeks ago my science teacher told me ill have to talk to him if i didnt have anyone to help me and i began crying in my head for no reason. i dont like being mean to people but thats the personaitly i have to be in school because im scare the teachers and students r going to make fun of me at my school aka high school rn..,

  4. I was drowned out by loud people at home and at school. I was also bullied and teased a lot, too, and I’m just now pondering this duality between both standing out and being drowned out. Teachers told my mom I daydreamed a lot, and also that I was “a real chatterbox,” at least in elementary school. Which was it? Could I be both? Incidentally, I was finally tested for ADHD this summer, and the results didn’t support a neurological basis for my symptoms. In other words, the tests didn’t confirm that I had ADHD of any type. Frankly, I find this hard to believe :). So I’m really struggling with this article. Anyway, thanks for putting some focus on the topic.

  5. I have read most of the comments and they all have a valid point based on the commenters personal experience. The article was very informative and validated many of my personal struggles both academically and in my career. There are many articles about ADHD in male vs female to be scrutinized however this specific article was concerned with female issues. Which is great because that was what I was looking for- not one that dealt with ADHD issues in general. The first comment were disappointed that the article was specific for female issues. The title should have been an indication just like if I read an article titled “Swimming” I should not expect to see information on “Kayaking”! There are probably 10 general articles to every 1 that deals with female ADD/ADHD issues. No offense intended! THANK YOU for the very informative article!!

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