When you think of the gender gap, you might first think about jobs and salaries, but you may be surprised to find out that this issue spreads to the diagnosis of ADHD as well. In the past, Attention Deficit Hyperactivity Disorder (ADHD) has often been viewed as an elementary-aged male disorder, causing girls and women to be overlooked when exhibiting the same symptoms. Some studies estimate that as many as 50% to 75% of girls with ADHD are missed. Worse, girls with ADHD are diagnosed on average five years later than boys — boys at age 7, girls at age 12. Girls with ADHD often go undiagnosed(opens in a new tab), resulting in years of frustration and struggling with something that is otherwise a very treatable condition.

Symptom Differences in Boys and Girls

Underdiagnosis of ADHD in girls often begins in childhood. Girls with ADHD tend to overcompensate or try harder to cover up their symptoms than boys, as girls learn from a young age to be “people pleasers” or to moderate their behavior to fit in.

There are 3 different types of ADHD:

• Hyperactive and Impulsive Type(opens in a new tab) ADHD - People with this type tend to need constant movement and tend to fidget and squirm. They may talk excessively, interrupt others, and struggle with self-control. This type is most commonly diagnosed in children and men.
• Inattentive Type(opens in a new tab) ADHD - People with the inattentive type tend to have difficulty sustaining attention, following instructions, and organizing tasks. They have weak working memory and are easily distracted by external stimuli. This type is more commonly diagnosed in adults and girls.
• Combined Type ADHD - People with combined type will demonstrate 6 or more symptoms of both types of ADHD.

Girls tend to display more inattentive symptoms like forgetfulness, problems with organization, and daydreaming, whereas boys display more obvious hyperactive symptoms like the inability to sit still in class or blurting things out. These disruptive symptoms are easily noticed by teachers and parents, while the inattentive, aloof symptoms in girls are often ignored.

While teachers are often the first to identify ADHD, they sometimes don’t suspect the disorder in girls. Socialized to please their teachers and parents, girls can be very good at compensating for the disorder, making it much harder to spot. When teachers do see it, girls’ behavior is often misunderstood as immaturity or lack of academic ability rather than as ADHD. Teachers may not report ADHD to parents as being a suspected cause.

How Girls Get Misdiagnosed

Girls are often misdiagnosed with anxiety, as those are the symptoms they show the most. Anxiety and depression can often be linked to the internalization of ADHD symptoms.(opens in a new tab) Many women find that they’ve been in therapy and prescribed mood medications for years, yet still, experience difficulty because their ADHD has not been addressed. Also, girls with undiagnosed ADHD are significantly more likely to experience major depression, anxiety, and eating disorders than girls without ADHD. At the time of diagnosis, the anxiety may have been building up over time due to the unrecognized ADHD. Identifying the underlying cause is crucial.

Hormones also play a role in fluctuating symptoms in anxiety and ADHD, which makes diagnoses more difficult. A growing number of studies show that sex hormones play a role in regulating communications between brain cells and can negatively affect executive function. For girls with ADHD, normal monthly fluctuations of hormone levels, especially during puberty, can significantly impact ADHD symptoms and contribute to a delayed diagnosis.

The presence of comorbid disorders(opens in a new tab) can also complicate the diagnosis of ADHD. Individuals with ADHD are more likely to have one or more comorbid conditions as well; at least 60% of patients with ADHD have another diagnosis. One study(opens in a new tab) finds that women with ADHD are at an even greater risk for several specific comorbid disorders including autism spectrum disorder, oppositional defiant disorder, intellectual disability, personality disorders, schizophrenia, substance use disorder, and suicidal behavior. These disorders may be the more obvious presentation and diagnosis, while comorbid ADHD is overlooked.

Signs You Should Get Your Daughter Evaluated for ADHD

Many circumstances could suggest you need to have your daughter evaluated for ADHD. Some things to look out for are:

• A Family History of ADHD - Both genetic and environmental factors can impact the development of ADHD. If other close family members have ADHD, you should consider getting your child evaluated, especially if they show symptoms.
• Problems in the Classroom - To address the issue of girls often being overlooked in the classroom for ADHD symptoms, it’s important to screen female students who may not be doing well or need extra help to perform in class. In a recent study(opens in a new tab), educational impairments and lower graduation rates were reflected in girls with ADHD compared to those without the disorder.
• Problems at Home or with Daily Activities - Many children will display inefficiency: homework or chores take longer than they should because they are easily distracted. Others will be forgetful of common items they always need (i.e. sports equipment) or will frequently misplace things (i.e. keys, phone, bank card).
• Problems Socially - Some tween and teen girls will struggle reading social cues and follow conversations. Peers may start to reject or isolate her. Conversely, she may have a lot of friends because she is fun to be around, but when she tries to organize activities, she seems anxious and indecisive.
• Risky Sexual Behavior - While risky sexual behavior and unplanned pregnancy are not typically caused by ADHD, these are risks associated with impulsivity(opens in a new tab). Impulsive behavior can often be a characteristic presented by young women with ADHD. In a survey(opens in a new tab) among teachers (grade 8 and above), more reported that they observed risky sexual behavior in girls with ADHD (44%) than in boys with the disorder (28%).

It’s important to be vigilant with your daughter and watch for signs of behaviors that could be the result of ADHD.

Effects of Being Undiagnosed or Misdiagnosed

There is an emotional cost that comes with being underdiagnosed, as it can result in mental health issues, lack of self-esteem, and more. Low self-esteem is more prominent in girls(opens in a new tab) with ADHD than boys with ADHD or girls without ADHD. Girls and women with ADHD often feel like something is wrong with them, and they try to hide their struggles from others.

Girls with ADHD also score lower(opens in a new tab) than boys with ADHD on screenings for mental well-being, relationships with parents, and relationships with others. Girls with the disorder can often have poor relationships with family and peers. They may even engage in maladaptive social behaviors such as aggression, which can cause an array of problems in relationships with other children and teens. If any of these problems arise, you may also consider testing your daughter for ADHD or other underlying causes, rather than only focusing on the behavioral problems themselves.

Being misdiagnosed can have detrimental effects on growing women. Struggling without support sets the stage for girls to grow up with educational and social difficulties. Many women go into adulthood and beyond without knowing the cause of their difficulties, and those who have flown under the radar with ADHD may experience an array of psychiatric problems.

It is important to have your child evaluated for ADHD if you notice even small behavioral or attentive differences. That way, she can begin receiving the support she needs to learn and grow with confidence. Capital Area Pediatrics offers expert mental health services, including learning and attention disorders, to diagnose and treat your child.

If your adolescent needs physical or mental health care, Capital Area Pediatrics offers top-tier pediatric care to families throughout Northern Virginia. Our dedicated team is committed to providing everything from learning and attention disorder services to sick visits. All of our providers and locations are accepting new patients and would be happy to reconnect with our existing families. Request an appointment online, or find a location near you today.