Attention-deficit/hyperactivity disorder, or ADHD, has been typically associated with young disruptive boys. More recently, there has been evidence suggesting that this stereotype is not accurate: The massive difference in ADHD diagnosis rations between men and women seems to be, at least partially, both a lack of symptom recognition and a referral bias for women (Young et al., 2020).
It is more and more accepted that girls and women with ADHD show a somewhat different set of behaviors, symptoms and other co-occurring diagnoses when compared with men with ADHD. As a result, they are less and less likely to be identified and referred for an assessment. As an unfortunate consequence, their needs are less likely to be met.
According to the consensus statement that aimed to bridge this gap (Young et al., 2020), there are some key elements in the ADHD presentation of women:
- When inattentive, girls and women with ADHD may look like being easily distracted, disorganized, and overwhelmed. To an external observer, they may look like they are not trying hard enough or like they are unmotivated.
- ADHD symptoms may become more obvious later in life, usually after a transition, when demands change or increase (e.g. going to college). For this reason, adult women may become aware of their difficulties and proceed to self-referrals.
- Gender biases in both teachers and parents seem to affect how likely is for a girl to be referred. This means that girls may be ignored, while the same behaviors, exhibited by boys, would lead to an assessment referral. At the same time, less overt symptoms are less likely to lead to a referral, which means that girls exhibiting inattention are often missed.
- Secondary symptoms (symptoms stemming from ADHD), like low mood, emotional lability, emotional dysregulation or anxiety may be especially common and more severe in girls and women with ADHD. These are often mistaken for primary conditions instead of byproducts of something else.
- Social problems may impact the quality of life severely, as girls with ADHD are vulnerable to many forms of bullying.
- Girls with ADHD are at high risk of school dropout, low self-esteem and accidents.
Currently, it is not known how often girls and women get misdiagnosed. Girls and women may develop compensatory and coping behaviors that may mask their difficulties, which may delay time to referral even more. Being aware of common signs can both help provide the right support and seek appropriate services.
If your child is exhibiting any of the above-mentioned signs and this is impacting their everyday life, it may be a good idea to seek professional help.
If you think that you can benefit from professional support on this issue you can reach out here.
Elena Marinopoulou is a Behaviour Analyst with Willingness Team. She works with children and adults and has a strong interest in parent training, sleep and feeding issues, as well as Acceptance and Commitment Therapy.
References:
Young, S., Adamo, N., Ásgeirsdóttir, B., Branney, P., Beckett, M., & Colley, W. et al. (2020). Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women. BMC Psychiatry, 20(1). doi: 10.1186/s12888-020-02707-9