Why ADHD in Girls Often Goes Undiagnosed

You're not alone if you believe boys are more likely than girls to have ADHD. Even doctors used to think so. It turns out, however, that ADHD may just look different in girls, and the signs are easy to miss.

According to the CDC, about 6 million children ages 3-17 in the United States have ADHD. By some reports, boys are 2-3 times more likely than girls to receive a diagnosis of ADHD. However, that gap narrows to just a couple of percentage points in adulthood.

So, because ADHD begins in childhood and never really goes away, are girls overlooked in their early years? Ongoing research suggests that may be the case, in part because girls tend to manifest ADHD differently than boys.

At Garland Pediatric Practice in Garland, Texas, Phani Bodavula, MD, FAAP, and his team manage all levels of pediatric health care, from newborn through 19 years. One of Dr. Bodavula's many specialties is diagnosing and treating ADHD. Here is what our team says about the nuances of diagnosing ADHD in girls versus boys.

Diagnosing ADHD

Attention-deficit/hyperactivity disorder (ADHD) is a chronic condition usually diagnosed after children enter school, when behavioral patterns often become more noticeable. These patterns may indicate a problem but are often difficult to discern.

Consider how focus changes with age:

• An energetic toddler moving from one activity to another at the speed of light is typical.
• A 7-year-old can usually focus on a school topic or activity for about 15 minutes.
• A first-grader with ADHD can find it impossible to stay focused for those same 15 minutes.

On the other hand, a child or teen with ADHD may become overly focused on one portion of an assignment or activity, making it impossible to finish on time. Your child may, for instance, be more interested in setting up their workspace than starting or completing a project.

Dr. Bodavula cautions that "people develop at different stages; everyone is prone to occasional distractibility" and restlessness. That's why he and other professionals focus on patterns, not random incidents, when considering an ADHD diagnosis.

Why ADHD is sometimes missed in girls

There are three subtypes of ADHD: inattentive, hyperactive/impulsive, and combined type. Girls are more often diagnosed with predominantly inattentive ADHD. This type is less outwardly disruptive than hyperactivity or impulsivity and sometimes easier to miss.

Symptoms mistaken for personality

• Daydreaming, forgetfulness, and shyness, while frequent components of inattentive ADHD, are often attributed to personality.
• Girls with hyperactivity are often described as "tomboys" because they climb, run, and jump more than their peers.

Coping mechanisms that mask symptoms

Girls tend to develop coping mechanisms that can hide their symptoms. For example:

• Your daughter may start a conflict to distract you from asking more questions about a problem.
• She may spend extra time getting her homework "perfect" or checking and rechecking the day's schedule to ensure she's staying on track.

Unfortunately, she may still forget to turn the assignment in, or become overly anxious about the day's routine, leading to tantrums or tears.

Overall, girls tend to withdraw and internalize their problems, while boys may be more prone to acting out their frustration.

Whatever the case, "no matter your gender, misdiagnosed or poorly managed ADHD can cause significant social and emotional problems," including isolation, depression, anxiety, and self-medicating behaviors.

Treating ADHD

Children with ADHD respond well to a comprehensive treatment plan that includes home, school, and medical support. Depending on your child's evaluation, Dr. Bodavula may recommend:

• Cognitive behavioral therapy (CBT)
• Medications
• Improved nutrition
• Daily exercise
• Limiting screen time
• Developing daily routines for homework, bedtime, etc.
• Social skills training
• Parental education and support

There's no cure for ADHD, but early diagnosis and comprehensive treatment significantly reduce its long-term effects on your child's physical, mental, and emotional well-being. In addition, many people eventually "outgrow" their ADHD symptoms once they develop a healthy coping and support system.

Key takeaways

• ADHD often looks different in girls, which can lead to it being overlooked in childhood.
• Girls are more often diagnosed with predominantly inattentive ADHD, which is less disruptive and easier to miss.
• Symptoms like daydreaming, forgetfulness, and shyness are frequently mistaken for personality, and coping mechanisms can mask the signs.
• Diagnosis focuses on consistent patterns, not occasional distractibility or restlessness.
• Early diagnosis and a comprehensive treatment plan significantly reduce ADHD's long-term effects.

When to call us

For more information about ADHD in children, schedule an evaluation at Garland Pediatric Practice today. Call the office or request an appointment online.