Girl ADHD: Why do girls often get diagnosed later or not at all?

When most people think of ADHD, the stereotype of a boy bouncing off the walls often pops into their mind. But this stereotype gets in the way of girls obtaining timely and full diagnoses. In fact, girls are half as likely to get an accurate diagnosis in childhood, and if they are diagnosed, they receive a diagnosis, on average, 7 years later than boys. The amount of growth and change that is missed during that window is mind boggling! So, let’s get to the tricky questions; why is girl ADHD overlooked so often and what can we do about it? 

Why ADHD Symptoms in Girls Are Often Overlooked

The squeaky wheel gets the… diagnosis. Kids and teens who exhibit more of the disruptive behavioral and emotional patterns associated with ADHD – like impulsive behaviors, hyperactivity, intense difficulty following directions and completing tasks, and emotional reactivity – are more likely to be diagnosed with ADHD earlier in childhood. Honestly, this is because they are more likely to be causing frustration and ire among the adults in their lives. Kids and teens who have a more inattentive profile; who might have intense difficulties with regulating attention but look more ‘zoned out’, can’t keep track of tasks, dates and materials, and are turning intense emotional reactions inward are overlooked, often because they are not disruptive.

Common Signs of ADHD in Girls

One of the ways we can all do better in supporting neurodivergent girls is to amplify the girl ADHD profile. Although there are certainly ADHD girls who do present as hyperactive, it is less common. Additionally, hyperactive symptoms in girls look a bit different from boys; boys often exhibit physical hyperactivity while girls are more likely to be hyperverbal, or very talkative, rather than physically dysregulated. The ADHD girl tends to experience more inattentive symptoms, like ‘day dreaming’ or ‘zoning out’. They are having trouble sustaining attention and concentration, and this is often impacting learning, hearing directions and completing tasks, but doesn’t result in the outward hyperactive or disruptive behaviors. Instead ADHD girls are often quietly disorganized, forgetful, easily derailed or distracted from tasks or during conversations, they may hop from activity to activity, have trouble remembering steps in routines, and experience internal restlessness. Girls also tend to use their strengths to hide symptoms or compensate for the difficulties ADHD causes. This results in misdiagnosis and under-diagnosis.

The Long-Term Impact of Undiagnosed ADHD in Girls

Learning to mask and compensate for neurodevelopmental differences is exhausting and stressful! Resultantly, girls with ADHD are more likely to experience anxiety and mood troubles. Unfortunately, these anxiety and mood troubles are often seen as the primary issue, leaving ADHD unrecognized and untreated. 

What is especially tricky is that inattentive symptoms don’t really get better with age without intervention, so ADHD girls tend to struggle for a long time, often being told they just aren’t trying hard enough. The longer term impact of underdiagnosis is substantial; girls and women with ADHD may be at higher risk for additional negative outcomes such as anxiety, depression, eating disorder, suicidal thoughts, suicidal attempts, and even shorter life expectancy, compared to boys and men with ADHD. The long-term consequences of undiagnosed ADHD are well established and highlight why correct diagnosis and treatment are so important. 

How to Get an ADHD Evaluation for Yourself or Daughter

The first stop on the path to a correct diagnosis is often your primary provider or pediatrician. However, pediatricians and primary care providers report varying levels of confidence in diagnosing and managing ADHD. Their hands are often tied by the pressure to move through office visits quickly, and they do not have the means to test for ADHD beyond questionnaires. There is no one biological test for ADHD. Their reluctance to throw a diagnosis on neurodivergent symptoms is completely understandable; primary care physicians and pediatricians’ expertise covers such a wide range of knowledge and they refer out to specialists for many specific health and development related issues. In fact, many pediatricians report feeling that their training offered very limited training in developmental-behavioral pediatrics and psychiatry and readily refer out to psychologists for testing and treatment. So, while your first stop may be to discuss concerns with your primary care doctor or pediatrician, they will likely refer you to a specialist for evaluation and treatment. As you move through an evaluation for ADHD, it’s good to know what a complete diagnostic evaluation should include. For more information on full neurodiagnostic testing click here.

What to Expect From a Comprehensive ADHD Assessment

Because symptoms of ADHD overlap with anxiety, mood troubles, and other neurodivergent learning profiles and disorders, a full assessment is often warranted. It’s important that co-occurring differences or disorders are identified and treated alongside ADHD when present. This typically includes an hour long intake, review of medical and academic records, standardized measures of brain functioning across many areas of functioning as well as several types of standardized questionnaires. Testing should take several hours (4-6 hours, sometimes more) and should result in a lengthy report that explains all of the evaluation data as well as a clear path of recommendations.  

A word of caution; general screening measures are an ok place to start, but are often not a good measure of ADHD and co-occurring conditions and disorders. Gender differences among symptoms of ADHD is part of the reason general screenings and short questionnaires often just don’t cut it when it comes to getting an accurate diagnosis. 

No matter where you are in your or your loved one’s journey of diagnosis, we are here to help. We provide comprehensive evaluations that set individuals and families on the path of success with accurate diagnoses, as well as clear, evidence-based recommendations and follow up treatment.

For more information on neuropsychological testing at Monarch Behavioral health click the link here: https://www.mbh-mi.com/testing/general-information/

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