About 12% of children in the United States between ages 3 and 17 have been diagnosed with attention deficit-hyperactivity disorder (ADHD). But there are twice as many boys diagnosed as there are girls diagnosed with ADHD. Most often, boys with ADHD are quickly recognized because of their inability to sit still or manage impulsive actions, particularly in classroom settings, where the behavior is a distraction.
ADHD diagnoses for girls are often delayed, sometimes significantly, due to their quieter presentation. Girls are more likely to have what’s known as “inattentive forms of ADHD,” says Dr. Ashok Shimoji-Krishnan, a clinical psychiatrist for children and adolescents at Kaiser Permanente Capitol Hill Medical Center.
For boys and girls alike, ADHD is a disorder of the brain’s frontal lobe, which, under normal conditions, helps us pay attention, manage impulses, regulate activity and complete tasks. As a result, people with ADHD tend to present as disorganized and distracted or are more apt to take risks.
Left untreated, ADHD can raise a girl’s risk of mental health challenges, impulsive behaviors and substance use, Shimoji-Krishnan cautions. Treatment can come in a variety of forms—counseling, medication, or behavior therapy.
What ADHD looks like in girls
Teachers and parents are less likely to identify the quiet, daydreaming girl next to her loud, attention-seeking brother. Inattentive ADHD can look like an inability to pay attention in class, making small mistakes or forgetting assignments.
Girls with ADHD may be disorganized, or they may try to hide their struggles by being hyper focused on organization. Other signs may include:
- Excessive talking.
- Risk-taking or impulsive behavior in peer or romantic relationships.
- Emotional outbursts.
- Irritability.
- Anxiety.
- Emotional withdrawal.
“Girls tend to internalize more of their symptoms, feeling as though they’re suffering fatal character flaws,” says the psychiatrist, “while boys often quickly understand that it’s a struggle in the brain.”
“At first, girls may come in with mental health issues like anxiety and depression. We find out where it’s coming from, often because they couldn’t stay on task at school or turned in incomplete work. The grades suffer, and now they’re anxious about school,” Shimoji-Krishnan says.
Diagnosis and treatment
ADHD’s root causes have yet to be determined, but it’s likely a combination of environmental and genetic factors, explains the doctor. No one has yet to pinpoint a gene or chromosome responsible, he says, and there’s no clear evidence that dietary choices impact ADHD.
After an evaluation by a qualified health care professional, treatment is often a combination of prescription medication along with behavioral therapy sessions. “Stimulant medications can help promote better focus and attention,” Shimoji-Krishnan says. It’s important to talk with your child’s doctor about what the right approach is for your individual child.
Parents can also learn about and experiment with behavioral supports. Building a structure and organizational system that involves consistent routines for daily life can help to support ADHD within the home. Chore charts can offer bite-sized visual reminders of what needs to be done each day, whether it’s taking the dog for a walk or taking out the garbage.
“Have the chore chart visible so the whole family knows what tasks need to be completed,” Shimoji-Krishnan says.
ADHD in school and social life
“Due to inattention and distractibility, it’s easier to make a small mistake such as forgetting to carry the one on a math problem,” Shimoji-Krishnan says. “Over time, that can easily evolve into a girl believing she’s not good at school or avoiding subjects considered to be difficult.
Parents should consider asking about school accommodations. The American Academy of Pediatrics recommends that a school accommodation plan (such as a 504 plan or an Individualized Education Plan, or IEP) be part of an ADHD treatment plan for school-aged children.
“Even if you feel like your child can manage without it, an accommodation plan will give you strategies to access a year or two down the road, as a safety net. If your child starts struggling in school performance or with behavioral issues, you have that in your back pocket,” says Shimoji-Krishnan.
Socially, girls can feel wounded by social exclusion that occurs after missing subtle body-language cues. “They get the idea that they can’t make friends, and don’t know how to be a good friend. That isolation raises the risk of being picked on,” he says. Because of this, a girl with ADHD may avoid female friendships altogether.
To determine whether your daughter might need an assessment, Shimoji-Krishnan suggests observing how she gets along with others and whether she can focus in class. Talk to other parents and your child’s teacher. New evidence suggests earlier diagnosis can help mitigate many of the negative outcomes for girls.
In fact, girls can blossom when ADHD is caught early rather than later in life when they may already be struggling with careers and relationships, says the physician. After getting treatment for ADHD, anxiety and depression often fade for most.
“They quickly realize they’re not less intelligent or flawed – their brains just weren’t allowing full understanding,” says Shimoji-Krishnan.
Early recognition and support can help girls with ADHD build confidence and succeed at school, at home, and throughout life.
