Girls and Women are Under Diagnosed
The DSM-IV estimates that the ratio of boys with ADHD to girls was 4:1. For those in actual treatment in clinics, the ratio was 9:1. Clinicians who treat a girls with ADHD feel that many girls have been overlooked. Why is this?
The Squeaky Wheel Gets the Grease
Boys with ADHD are more likely to be disruptive in class and at home. Parents and teachers notice this and refer them for treatment. Girls with ADHD can be physically hyperactive, but are more likely to be quietly inattentive and disorganized. Adults are more likely than children to refer themselves for treatment.
Women Are Often Diagnosed in Adulthood
Sometimes we see a woman who brings her son in for treatment. While evaluating the child we take a thorough family history. As the mother tells her own story, she realizes that some of her difficulties are similar to her son’s. Whether she was hyperactive or just inattentive, the diagnosis was missed.
Signs of ADHD in Girls
Girls can manifest their ADHD in vastly different ways. In Understanding Girls with AD/HD, Nadeau, Littman and Quinn identify types of ADHD girls. Active girls may act like tomboys. They may socialize with boys. They are active, and may engage in impulsive escapades. Another group of girls shows their ADHD by talkativeness and excessive socializing. They too may become involved in risky behavior. Some girls with ADHD seem to fade into the background. They are shy and inattentive. They may have few friends and are more likely to be depressed. The last group is often escapes diagnosis until adolescence or adulthood. These are the very smart girls who have the ability to put in an extraordinary effort to hyperfocus. Adults see them as achievers but are often unaware of the anxiety and extreme effort the such girls use in order to compensate for their inattentiveness. Such girls are often anxious and self-critical.
Girls and women with ADHD (particularly if undiagnosed) are at higher risk for anxiety, depression, drug abuse and unplanned pregnancy. This makes treatment more complicated.
Early Diagnosis Is Important
The unique concerns of ADHD girls and women often respond well to treatment. Understanding one’s own ADHD is therapeutic in itself. Effective treatments include medication, psychotherapy, support groups and coaching.