Attention deficit hyperactivity disorder (ADHD) is often more challenging to detect in girls than in boys, according to Julia Schechter, a clinical psychologist at the Duke Center for Girls & Women with ADHD. Undiagnosed girls face elevated risks of negative outcomes, including relationship issues, eating disorders, and self-harm.
Diagnosis Rates
Recent years have seen an increase in ADHD diagnoses among adult women, bringing their rates closer to those of men. However, a significant disparity remains in children, with boys diagnosed at least two to three times more frequently than girls.
Reasons for Underdiagnosis in Girls
ADHD in girls and women commonly presents as inattentiveness, characterized by difficulty focusing, easy distraction, and organizational challenges. Conversely, boys and men with ADHD more frequently exhibit hyperactivity and impulsivity, such as fidgeting and difficulty staying seated. While girls can also display these hyperactive symptoms, they are less commonly reported. Research indicates that hyperactivity in girls may manifest as hyper-verbal tendencies, such as excessive talkativeness.
Additionally, girls may mask or downplay their symptoms. It is hypothesized that strong social pressures lead them to suppress internal restlessness or physical activity. Consequently, their less obvious or familiar symptoms often result in them not meeting existing diagnostic criteria.
Diagnostic Criteria and Research Limitations
Concerns exist regarding the diagnostic criteria for ADHD, as most studies informing these criteria primarily included male participants. This limitation means the full spectrum of symptoms across genders may not be adequately captured. More scientific research is needed to understand how ADHD symptoms present in all individuals. A circular problem exists: researchers need to study more girls, but finding and enrolling diagnosed girls is difficult due to their lower diagnosis rates.
Girls with ADHD frequently experience more co-occurring psychiatric conditions, such as depression and anxiety, compared to girls without ADHD and even boys with ADHD. These co-occurring conditions can complicate the diagnostic process and influence research participation, as some studies exclude individuals with these conditions to isolate ADHD symptoms. Future research should include these girls to potentially refine diagnostic criteria and better understand symptom presentation and functional impairment.
Risks of Undiagnosed ADHD
Untreated ADHD can be problematic for anyone, but girls and women face distinct risks. They are more prone to social difficulties, including bullying, and have a higher risk of relationship problems, such as intimate partner violence. They are six times more likely to experience teenage pregnancy and twice as likely to engage in self-harm. Data also indicate higher rates of eating disorders, suicidal ideation, and suicide attempts. While both sexes with ADHD have an increased risk of premature death, this tendency is slightly more pronounced in women.
Improving Treatment and Awareness
Addressing these issues requires increased funding for scientific research and improved access to diagnostic tools. Some evaluation tools compare female patients' scores with female-specific data, but these are often proprietary, costly, and unavailable in primary-care settings.
Increased awareness among healthcare providers is crucial. When a girl presents with anxiety, an ADHD assessment should also be considered due to the frequent comorbidity of these conditions. Even when diagnosed, girls are less likely than boys to receive ADHD medication, despite evidence suggesting equal effectiveness in girls and women. Reasons for this prescribing pattern are unclear and may include less overtly disruptive symptoms in girls, provider biases, or co-occurring conditions overshadowing ADHD treatment.
Further research is needed to understand how medications affect girls and women and to develop tailored psychosocial and behavioral interventions. These interventions could consider factors such as tracking symptom connections with hormonal fluctuations or integrating management strategies for both ADHD and co-occurring symptoms like anxiety.