“Rather than troublemakers, girls with ADHD tend to be daydreamers.”

Jennifer Rainey Marquez, WebMD

Believe it or not, there are significant differences in how Attention Deficit Hyperactive Disorder (ADHD) appears in boys and girls. The Centers for Disease Control and Prevention says boys are three times more likely to receive a diagnosis of ADHD than girls. But it isn’t because boys are more susceptible. It’s because the symptoms present much more subtly with girls, making them harder to see.1

ADHD–Diagnosis is the Problem

ADHD is the most commonly diagnosed mental disorder of boys. Boys with ADHD are typically hyperactive, have trouble paying attention, and appear unable to control their impulses. The truth is ADHD affects children and teens of both genders and can continue on into adulthood.2

“One of the key reasons girls are so often overlooked [not diagnosed or referred for diagnosis] is that they exhibit hyperactivity differently than boys…”

Patricia Quinn, M.D., Director of the National Center for Gender Issues and ADHD in Washington, D.C.

Boys with ADHD usually show externalized symptoms, such as obvious distractibility and impulsivity. Girls’ ADHD symptoms, however, are largely internalized. These symptoms typically present as quiet inattentiveness and low self-esteem. And boys with ADHD tend to be more physically aggressive, while girls with ADHD are more aggressive verbally.3

Sadly, since girls with ADHD have less problematic or socially disruptive behavior, with less noticeable symptoms, their difficulties with ADHD are quite often overlooked and do not receive the referrals for the treatment they need just as much as do boys with ADHD.3

Boys with ADHD externalize their frustrations…but girls with ADHD usually turn their pain and anger inward.”

Health Line

This puts ADHD girls at high risk for severe depression, anxiety, and eating disorders, causing significant problems both personally and socially, just like boys, but in a totally different way. Girls with ADHD often display the inattentive aspects of the disorder, being withdrawn, having low self-esteem, being quietly inattentive, and struggling with staying focused. Girls suffering from ADHD are unlikely to be disruptive but will miss assignments, be forgetful, or just seem spacey. Girls with this disorder are more often than not to be considered to be lazy or to have a learning disability.3

Girls with Undiagnosed and Untreated ADHD Face Serious Consequences

A Harris Poll recently revealed that girls because of their teacher’s misperception of what is causing them to struggle academically, are more likely to be asked or required to repeat a grade than boys with ADHD. When they can’t learn the material, when they don’t test well, when they can’t seem to get organized, when they can’t meet deadlines, etc, the most common response is to have such girls perform a “do-over.” A year later, the performance is no better, but the student is now more frustrated, anxious, and has an even poorer self-image.4

“A year later, the girl is no better off because she still hasn’t figured out the source of her problems [ADHD].”

Patricia Quinn, M.D.

Some undiagnosed ADHD girls overcompensate and develop other dysfunctional behaviors, including obsessive-compulsiveness. Some develop annoying behaviors, like incessant talking and interrupting conversations, that makes it even harder to have positive social relationships.4

Treatment Options…Much the Same for Both Boys and Girls

The most successful treatment options for ADHD in boys and girls is similar. Overall, a combination of medication and behavioral modification work best.3

“…a combination of medicine and therapy work best.”

Timothy J. Legg, PhD

Regardless of the medicational prescription, behavior modification is the only non-medical treatment for ADHD with a large scientific evidence base. Behavior modification is effective at improving a child’s academic performance and family relationships. There is no evidence that other psychological treatments, including cognitive behavioral therapy, family therapy, or conventional talk therapy, are effective for ADHD.5

What Is Behavior Modification?

Behavior modification is the use of positive reinforcement or rewards and mild punishment to shape behavior. The role of medication in the overall treatment is to decrease ADHD symptoms so that therapists and their ADHD clients can more easily focus on learning and practicing coping and symptom-controlling strategies. Such combined treatment reduces symptom severity and allows for greater and greater functioning.5

1 “How ADHD is Different in Girls,” Jennifer Rainey Marquez, WebMD.
2 “Attention Deficit Hyperactive Disorder (ADHD),” WebMD, 2017.
3 “Recognizing Symptoms of ADHD in Boys and Girls,” Healthline.
4 “ADHD in Girls and Women,” ADDitude Magazine, 2018.
5 “Psychosocial Treatments for Children with ADHD,” Children and Adults with Attention Deficit Hyperactive Disorder.

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