ADHD in Girls
ADHD in Girls
ADHD in Girls
The early data also revealed that boys’ hyperactivity decreased significantly following puberty. As a
result, it was assumed that ADHD symptoms appeared by age seven and were limited to childhood.
We now know that the developmental trajectory for girls is the opposite of boys. Since girls’ symptoms
intensify as estrogen builds in their systems, problems rarely surface by age seven. This is yet another
way in which the current criteria make the diagnosis of girls less likely. Indeed, for girls, puberty signals
an escalation of symptoms such as emotional reactivity, anxiety, and mood swings. These changes are
intensified monthly, when shifting premenstrual estrogen levels can trigger an emotional roller coaster.
While girls generally mature faster than boys, girls with ADHD experience significant lags in social and
emotional maturity compared to non-ADHD peers. Many girls with ADHD tend to be hyper-talkative,
hyper-social, and hyper-emotional, rather than hyperactive. Physical restlessness often manifests in
fidgeting with hair or nails, rather than leaving their seats.
They can appear to be passive students—daydreaming, dreading being called on, often responding, “I
don’t know.” Unlike their more disruptive male counterparts, they’re reluctant to draw attention to
themselves and ask for help. Consequently, their intellect and abilities are often underestimated.
Because they invest tremendous psychic energy in self-control at school, they often really let loose at
home.
DIFFICULT BALANCING ACT
For girls with the disorder, ADHD is a constant challenge to regulate their responses. When their brains
are optimally aroused with stimulation from the environment, they focus incredibly well (e.g., when
they’re engaging with social media). Sometimes seeking greater stimulation, sometimes avoiding it, their
hyper-sensitive physiology is difficult to balance.
When overstimulated, they may become irritable, impatient, and yell, “leave me alone!” When
understimulated, they may become lethargic, unmotivated, and complain that they’re bored.
Seeking “high stim,” many girls impulsively turn to food, caffeine, tobacco, alcohol, drugs, sex, and other
high-risk activities.
Through painful trial-and-error, they discover the right balance of healthy stimulation that allows them
to be successful.
Society’s expectations also contribute to the unique challenges girls with ADHD face. Females are still
expected to be neat, organized, compliant, cooperative, and sensitive to others. However, unpredictable
executive functions often thwart their best efforts to behave in ways society expects.
The fast-paced verbal interplay of peers may be daunting to those with slowed processing. Missing
subtle cues and jokes, they feel excluded. Craving peer acceptance, they struggle to conform, yet often
feel ignored and misunderstood.
While boys often externalize blame, girls internalize their shame about feeling different. When they do
express their frustrations impulsively, peers ostracize them. Self-esteem suffers as they obsess about
fitting in, and often they choose to hide. When they do successfully compensate, it’s at the emotional
cost of anxious and depressive feelings.
Children of above average intelligence, with few hyperactive/impulsive symptoms, typically pose no
behavior problems in the classroom and often work hard to hide their ADD (ADHD) struggles. This
pattern of working hard to hide ADHD struggles is especially true for gifted females. These children often
do well in elementary school, where their intelligence more than compensates for the challenges posed
by ADD (ADHD).
For some bright students, their unraveling begins in middle school when the demands for productivity,
independence, and organization increase dramatically. This is a time when there is a sharply increased
demand on the “executive functions” of the brain.
Other students with ADD (ADHD) continue to earn high grades through high school. While their grades
may look good, their behind-the-scenes behaviors tell a different story of chronic anxiety, all-night study
sessions, homework that takes hours longer than their gifted non-ADD(ADHD) counterparts, struggles
with procrastination, and last-minute completion of papers and projects.
Some students with ADD (ADHD) may not encounter significant struggles until they are away at college
— where the structures, routines, and supports of home are suddenly missing.
The more academically inclined and more intelligent the student with ADD (ADHD), the later he or she
will encounter serious challenges). Some go as far as graduation from medical school, but are unable to
pass their medical boards; others complete all requirements for a Ph.D., but never complete the
dissertation. And many pass these hurdles, only to encounter significant struggles around executive
functioning as they pursue a career in law, medicine, science or other professional pursuits.
Many gifted students with ADHD are told by professionals that an ADHD diagnosis is impossible given
their high level of achievement. This sad, but common occurrence — a denial of the possibility of ADHD
— results in many gifted individuals never receiving treatment that can help them to feel and function at
their best. Although achievement may be high, what is often ignored is the very high price paid to do so
— including chronic anxiety, sleep deprivation, neglected relationships, non-existent social life,
disorganized living environment and nagging self-doubts.
Inattentive only: The person has difficulty paying attention but does not tend to be disruptive.
Hyperactive and impulsive: The person may be able to focus well, but their hyperactive and impulsive
behavior can cause disruption in a classroom, for example.
Combined inattentive, hyperactive and impulsive: The person has all the above symptoms.
The following symptoms are particularly likely to affect girls:
Inattention: Girls with ADHD may find it hard to concentrate. They may be unable to focus for long
enough to complete a task at home or school. However, if they find something interesting, they may be
wholly absorbed by it.
Distractibility: Girls with ADHD may be easily distracted by what is happening outside, or by their own
thoughts.
Hyperactivity: Some girls with ADHD tend to move around and fidget, like boys, but others are quieter in
their movements. They may fidget, shuffle in their chairs, or doodle.
Impulsivity: Girls may experience strong emotions, and this may leave them unable to slow down or to
think about what they say. It can be hard for them to know what is and is not socially appropriate, and
this can lead to difficulties in making and keeping friends.
Executive malfunctions: Organizational skills may pose a challenge. Girls with ADHD may have poor time
management skills, and they may find it hard to follow multi-step directions or complete a task. They
may often lose items, such as a phone or important papers.
difficulty keeping track of school assignments and deadlines, even if they are making a great effort to
stay organized
appearing to “daydream” and therefore missing out on information in class or other situations
forgetting what they have just read or what another person has just said
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Risk factors
Some factors that may increase the risk of developing ADHD include:
someone in their biological family having ADHD or another mental health disorder
premature birth
environmental toxins
Boys are more likely than girls to receive a diagnosis of ADHD, but this may be because the condition
often presents differently in girls.
The symptoms may be less obvious, and they may not fit the common stereotypes associated with
ADHD.
Research indicates that while most boys with ADHD tend to express their frustration physically and
verbally, girls are more likely to internalize their anger and pain.
Research conducted by Dr. Stephen Hinshaw, author of The ADHD Explosion, concludes that girls with
combined-type ADHD (hyperactive-impulsive and inattentive) are significantly more likely to self-harm
or attempt suicide.
However, around 40 percent of girls outgrow their hyperactive and impulsive symptoms in adolescence.
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If a parent or other caregivers think that a girl has ADHD, they should consult a pediatrician, family
doctor, or pediatric nurse practitioner.
Some pediatricians have specialist training in behavior and development, and many have at least a
particular interest in the area. Other specialists include child psychiatrists, psychologists, and
occupational therapists.
A doctor may prescribe medication, psychotherapy, or both. However, parents and other caregivers can
also encourage the girl to manage her ADHD by:
learning more about nutrition and how eating habits affect ADHD symptoms
encouraging rest and sleep
establishing simple and predictable routines for meals, homework, play, and bed
supporting time management by setting an alarm clock to time activities and deadlines
As the girl enters adolescence and becomes more independent, she may need support to help her
regulate her own behavior.
understanding and accepting her challenges instead of judging and blaming herself
identifying the sources of stress in daily life and making changes to lower stress levels
learning to ask clearly for structure and support from family and friends
focusing on the things and activities she loves and prioritizing those things