Increasing Awareness: ADHD Symptoms In Girls & The Gender Diagnosis Gap
Medically reviewed by Melissa Guarnaccia, LCSW
Updated April 12, 2024by BetterHelp Editorial Team
Undiagnosed ADHD is not uncommon in children assigned female at birth because the symptoms of ADHD in women often manifest differently than for other genders. Inattentiveness, forgetfulness, and the tendency to daydream are a few examples of symptoms of ADHD in girls. However, due to sexism, a lack of research on ADHD in women, and stigma, these symptoms may be challenging to discuss with a mental health professional. For this reason, it can be helpful for parents to research the signs and symptoms early on using only high quality sources so they can best support their children
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Understanding attention deficit hyperactivity disorder in girls
ADHD symptoms in girls and women can look different than those experienced by young boys and men. Although the cause of these differences is unknown, it may be due to differences in how men and women are socialized and raised, as well as stereotypes. Some believe the symptoms are the same but manifest differently depending on gendered experiences.
Gender expectations may also play a role in distinguishing different presentations of ADHD symptoms. Because many girls and children assigned female at birth may experience social pressure to behave a certain way, they might seek alternative ways to manage their natural tendencies. Instead of fidgeting with a toy, a child might doodle in a notebook, "space out," or frequently play with their hair.
With these gender differences, girls and women with ADHD tend to experience symptoms related to inattention more frequently than hyperactivity, according to a study in BMC Psychiatry. Their experiences may be more difficult to spot from the outside. Girls or those assigned female at birth who live with ADHD may be wrongly labeled as "ditzy" or "unfocused" and are often characterized as "having their heads in the clouds." Because these symptoms may not be as disruptive to others as hyperactivity-related symptoms (such as interrupting or struggling to sit still), they often go unnoticed, overlooked, or downplayed.
Sexism in research on ADHD and neurodivergence
In the prior version of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-4, ADHD was a condition listed under the category of "Disorders Usually Diagnosed in Infancy, Childhood, and Adolescence." ADHD was not separated into three subtypes like in the DSM-5, originally labeled "ADD," if predominantly inattentive features were present. Studies at the time primarily examined ADHD in young white boys, claiming the condition was most common in males, whereas ADD may have been more commonly diagnosed in girls.
As boys were considered to experience more hyperactivity, their symptoms took center stage in research, which may have made ADHD seem like a boys disorder. At the time, ADHD research focused on what symptoms were most disruptive to parents, schools, and one's environment, not on what was healthiest or best for the child. ADHD was also not seen as a form of neurodivergence, as the neurodivergent movement was new. Instead, individuals were focused on "curing" ADHD in their young boys.
Girls with ADHD, who may have been labeled with an ADD diagnosis or ignored by doctors, may have gone through young life without professional support or accommodations, struggling with organization, inattentiveness, and a different mind. Without studies to showcase how these symptoms might present, doctors were ignoring them altogether. In addition, girls were less likely to be referred to a school psychologist, and boys were six to nine times more likely to receive a diagnosis. Psychiatrists who diagnosed ADHD in girls were less likely to prescribe ADHD medications to them. As there is no "gender-specific" treatment for ADHD, these assumptions could prove sexist and harmful to the mental health of girls, and many of these stereotypes and assumptions continue in the modern-day, leading women to be diagnosed with ADHD late in life instead of receiving support early on.
Parents catching ADHD symptoms in their young girls may be able to break the pattern and find support. Accommodation at a young age may increase a child's chances for success as an adult.
Behaviors that may indicate ADHD in girls
ADHD symptoms can be consistent regardless of the sex or gender of the person experiencing them. However, girls and others assigned females at birth may more commonly be diagnosed with the primarily inattentive subtype of ADHD (ADHD-PI).
Symptoms of ADHD-PI may include:
- Difficulty paying attention
- Avoiding tasks that require significant focus and mental effort, such as homework and chores
- Forgetfulness
- Making frequent errors at home or school
- Difficulty paying attention when spoken to
- Daydreaming or a seeming "disconnect" from reality or one's environment
- Poor time management and organizational skills
Although less common, girls can also be diagnosed with the primarily hyperactive and impulsive subtype of ADHD (ADHD-HI), which involves the following symptoms:
- Excessive talking, even when parents, other caregivers, and teachers have intervened
- Interrupting conversations or activities often
- Struggling to sit still, complete a task, or be patient
- Fidgeting
- Seems to always be "on the go"
Girls can also be diagnosed with combined-type ADHD, a combination of hyperactive, impulsive, and inattentive symptoms. Combined ADHD is the most common type of ADHD.
Signs of ADHD in girls and those assigned female at birth can seem to overlap with "normal" childhood behavior. However, when these symptoms interfere with an individual's ability to function, learn, and form relationships, it may be valuable to seek professional guidance.
Symptoms of ADHD in school-age girls
Symptoms of ADHD in school-age girls and those assigned females at birth closely mirror the symptoms of other children in this age group or beyond. This means girls' symptoms may not differ, but the behavioral cues and information in their medical history that point to an ADHD diagnosis can change over time. For example, school-age children might sustain attention or manage organization and time management symptoms more frequently than others because they spend much of their time in the classroom or doing homework.
ADHD symptoms can impact functionality and behavior throughout a child's development. Keeping an eye out for symptoms that indicate a child might benefit from support can help them learn to navigate these challenges as they grow.
Subtle symptoms of ADHD in girls
For girls with the ADHD-PI subtype, symptoms are more related to inattention than hyperactivity, making detection challenging. The child's symptoms may be primarily internal, and without conversation and observation, a caregiver might not notice that their child struggles with attention at school or while working on chores. Instead, they might think their child is purposefully doing poorly or exhibiting executive malfunctions.
Forgetfulness, frequent mistakes on assignments, losing essential items consistently, and struggling to remember names may lead to an ADHD-PI diagnosis. However, note that some of the subtle symptoms of ADHD can also stem from another mental health condition or be a part of a child's journey toward maturity. ADHD symptoms are distinct in frequency, intensity, and ability to interfere with daily life. Meeting with a specialist who works primarily with girls with ADHD may be beneficial in determining a diagnosis.
Can you recognize ADHD in toddlers?
Diagnosing ADHD in toddler girls can be challenging. Children of any gender can display ADHD symptoms as early as two or three years old. However, toddlers have short attention spans, so it can be difficult to tell whether their behavior falls within the "normal" range.
Irrespective of the fact that it's often challenging to diagnose toddlers with ADHD, parents and the child's teacher can look for symptoms of ADHD that last for more than six months and prevent children from participating in age-appropriate activities.
Signs like sensory-processing difficulties, hyperactive behavior, having a hard time following multi step directions, and failure to develop expected cognitive or communication skills can be examples of symptoms to pay attention to.
Why are girls likely to experience undiagnosed ADHD?
Girls and those assigned females at birth are often diagnosed with ADHD at later ages than their peers. In some cases, symptoms change over time to become more noticeable, and a diagnosis isn't pursued until significant challenges in school, at home, or in an individual's personal life are noticed.
Teachers and other school personnel may be the first to detect warning signs and symptoms of ADHD. At this point, teachers may call a conference with parents to discuss their concerns and next steps. The school may recommend an evaluation or special testing to rule out other conditions and confirm a diagnosis of ADHD. Depending on the evaluation results, the school may determine that the child could benefit from accommodation in class.
Can girls with ADHD have comorbidities?
Some children with ADHD may be at higher risk for other mental health conditions; in some cases, these other challenges stem from a lack of adequate ADHD treatment. Frustrations that come with school challenges, homework, or mental health can cause children to experience social challenges and low self-esteem, which may lead to a big difference in grades, mood, and motivation. Changes like these have been linked to chronic health concerns like depression and anxiety.
When can girls with ADHD symptoms see a doctor?
When parents and teachers agree that they recognize ADHD symptoms in girls, they can make a detailed list or a helpful report of their concerns for the child's doctor. The doctor may ask questions and examine the child before assigning a diagnosis of ADHD. Note that your child may feel most comfortable meeting with a doctor of the same gender or someone who commonly treats ADHD in women and girls. Doctors are not immune to sexism, so finding someone who openly practices non-sexism and equal opportunity diagnostic practices can be essential.
The doctor may prescribe stimulant or nonstimulant medications and a treatment plan if a diagnosis is made. They may also suggest that a child start seeing a psychologist or therapist specializing in ADHD to further enhance their well being. Receiving professional support early in life can help a person with ADHD learn how to understand symptoms, find accommodation, and accept themselves. In addition, it can help young girls gain exposure to the neurodivergent movement and how this movement might apply to them.
For more information, check out the National Center for Girls and Women with ADHD, founded by Dr. Patricia Quinn.
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Mental health for women and teenage girls with ADHD
Finding support for ADHD can be challenging. You may struggle to find in-person experts or specialists in your area who meet your needs. In these cases, you might consider an online therapy platform like BetterHelp for adults or TeenCounseling for those aged 13 to 19.
With an online therapy platform, clients can choose the gender of their therapist, the modalities they'd like to partake in, and their goals for therapy. In addition, you may find it easier to find a therapist specializing in ADHD, as you're not limited to therapists in your immediate area.
Online therapy has proven to be successful at treating ADHD. One 2022 study found that online behavioral intervention could effectively improve ADHD symptoms related to attention deficit and social functioning in adults and children. It also noted that online options might make it easier to support families of those with ADHD by making care and resources more available.
Takeaway
Girls and children assigned female at birth experience ADHD and its symptoms differently than their peers. However, the diagnosis of ADHD in young women and girls is often impacted by bias in the medical industry, and left undiagnosed, they do not receive the treatment they need to cope with ongoing symptoms. Understanding the symptoms of ADHD and how they present in girls can help caregivers and parents seek support early on. With proper care, children with ADHD may manage their symptoms effectively and achieve proper accommodation. If you want to learn more about ADHD as a parent or an adult diagnosed with this condition, you can also contact a therapist online or in your area at any time for support.
Frequently asked questions
Read more below for answers to questions commonly asked about this topic.
What Are The Signs Of ADHD In A Girl?
The signs of attention-deficit hyperactivity disorder (ADHD) in girls may include daydreaming, perfectionism, poor self-esteem, shyness, lack of attention, and skin picking, among others. They may also make seemingly careless mistakes at school, find it difficult to complete tasks, and have underdeveloped study skills. Girls with ADHD may also be easily distracted and find it challenging to interact with other girls.
At What Age Do ADHD Symptoms Appear In Girls?
There isn’t always an age difference when it comes to the onset of ADHD symptoms. According to the Mayo Clinic, symptoms tend to begin before the age of 12, and in some children, the symptoms are noticeable by age 3.
What Age Does ADHD Peak In Girls?
Although girls may have symptoms at a younger age, the inattentive type of ADHD may be more noticeable at age 8 or 9 when they go to school.
How Do They Test Girls For ADHD?
According to the Centers for Disease Control, there is “no single test to diagnose ADHD, and many other problems, like sleep disorders, anxiety, depression, and certain types of learning disabilities, can have similar symptoms.” A healthcare provider or mental health professional may ask about a girl’s symptoms and compare them to those listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
What Triggers ADHD In Girls?
Researchers believe that ADHD may be due to a combination of genetics and environmental factors. For example, trauma to the brain and prenatal exposure to tobacco or alcohol may be factors.
What Does Untreated ADHD Look Like In Girls?
Untreated ADHD in girls may look like inattentiveness. They may have different ADHD symptoms from those of boys. For example, they may be shy and tend to daydream in class. However, different symptoms can appear in each individual, and this can vary according to the type of ADHD a person experiences.
What Are 3 Warning Signs Of ADHD?
The following are three possible warning signs of ADHD:
- Difficulty focusing
- Lack of organizational skills
- Impulsivity
What Are The 3 Main Symptoms Of ADHD?
As mentioned above, impulsivity and trouble focusing tend to be the three main symptoms of ADHD. Problems with impulse control may include being verbally impulsive in social situations. Symptoms tend to begin before age 12 and can continue into middle school and even into adulthood.
How Do They Test For ADHD?
There is not a single test for ADHD, but a health care provider or mental health professional can compare your symptoms to the criteria for ADHD listed in the DSM-5.
What ADHD Is Most Common In Girls?
Inattentive ADHD tends to be more common than the hyperactive type in girls. Hyperactive impulsive symptoms are perhaps what most people imagine when they think of ADHD, but these symptoms can be less common in girls. There are treatments available, including therapy and stimulant and non-stimulant medications. Peer-reviewed studies show that medications for ADHD can lead to significant improvement.
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