Attention Deficit Hyperactivity Disorder (ADHD) has been recognized more frequently in boys than girls, and is diagnosed 2 to 9 times more frequently in boys than girls. The CDC reports that boys between the ages of 4 and 17 were more than two times as likely to have been diagnosed with ADHD as girls (13.3% compared with 5.6%). However, in adulthood, the number of men and women with ADHD is much more similar (5.4% for males compared with 3.2% for females). Studies suggest that females may be nearly as likely to have ADHD as males, but because their symptoms may look different, they are being diagnosed later or not diagnosed at all.

Why are girls with ADHD possibly underdiagnosed?

There may be many reasons for this. For one, there are no lab tests for diagnosing ADHD, regardless of the child being a boy or girl. Most diagnoses are made based on gathering information regarding the child’s functioning and behavior from parents and teachers, an overall medical evaluation to rule out other problems, and checklists that gather behavioral information about the child.

Also, the symptoms of ADHD are often different in girls than in boys, with boys’ symptoms appearing more obvious, which may be causing teachers and parents to overlook the signs in girls. For example, girls are more likely to show inattentiveness (not paying attention) compared with boys. Inattention may be harder to notice and less likely to be recognized by teachers because it tends to be less disruptive in the classroom.

Boys, on the other hand, are more likely to show hyperactivity (having trouble focusing and sitting still) and impulsivity (taking action without thinking), which may be more outwardly noticeable.

In addition, girls may learn to compensate for their symptoms for a period of time. For example, they are often able to complete their schoolwork in spite of their ADHD. However, they may get distracted, it may take them longer to complete it, or they may make careless mistakes in the process.

The impact of underdiagnosis

Since girls may not be diagnosed as often as boys, they are less likely to receive treatment. This can lead to delays in learning and social development in children who are untreated. These in turn may lead to difficulty with schoolwork, as well as a wide range of social issues such as difficulty forming friendships and participating in social activities.

Interestingly, girls with untreated ADHD may be more likely to blame and judge themselves for these problems, leading to a higher risk for low self-esteem than boys who have ADHD. They may also be more likely to have problems with substance abuse, eating disorders, and anxiety.

Untreated ADHD in girls can lead to problems in adulthood, leading to:

• Poorer academic performance.
• Antisocial behavior.
• Drug abuse.
• Driving issues.
• Poorer job performance.

ADHD signs and symptoms

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) (a reference book that lists the key signs and symptoms of a mental illness), symptoms of ADHD include 6 or more symptoms of inattention and of hyperactivity/impulsivity that last at least 6 months and that interfere with normal life. As stated earlier, girls are more likely to show symptoms of inattentiveness compared with boys. Symptoms of inattentiveness include:

• Failing to pay close attention to details or making careless mistakes in schoolwork, at work, or with other activities.
• Having trouble keeping their attention on tasks or play activities.
• Not seeming to listen when spoken to directly.
• Not following through on instructions and failing to finish schoolwork, chores, or duties in the workplace (losing focus, getting sidetracked).
• Having trouble organizing tasks and activities.
• Avoiding, disliking, or being reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
• Losing things that are needed for tasks and activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
• Being easily distracted.
• Being forgetful in daily activities.

Some examples of symptoms of hyperactivity include fidgetiness, talking excessively, and having difficulty waiting her or his turn.

What to do if you suspect your daughter shows signs of ADHD

Only a trained professional can diagnose and treat ADHD. However, if you think that your daughter may be affected by ADHD, there are several steps you can take to help your child. These include:

• Recognizing that the symptoms of ADHD are different in girls compared with boys and being aware of the symptoms of ADHD in girls.
• Looking for other signs such as:
  • Having other family members diagnosed with ADHD.
  • Issues with school such as lack of academic progress and increased need for oversight, extended time, or tutoring. Remember that girls may be able to compensate for their ADHD and work hard to maintain good grades. Getting good grades doesn’t rule out the possibility of ADHD.
  • Low self-esteem.
  • Poor peer relationships.
  • Risky sexual behavior in older girls.
  • School anxiety or complaints about headaches and/or stomach aches.
• Talking with your daughter’s teachers. They can give you feedback about how your daughter is functioning relative to the rest of the class. They can also be on the lookout for any signs of ADHD that your daughter may have in the classroom setting.
• Talking with your daughter’s pediatrician and sharing the information you’ve gathered regarding possible ADHD. He or she may refer you to a specialist in the diagnosis and treatment of ADHD.

Noticing the signs of ADHD in girls is the first step toward getting help. Be sure to talk to a healthcare professional to get a diagnosis and appropriate treatment. Doing so can have a significant, positive impact on her life.

Donna Palumbo, PhD, is a Medical Director at Pfizer.

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