ADHD Presentation in Girls and Females

Understanding ADHD in females is essential as it often manifests differently than in males, leading to frequent underdiagnosis. Females with ADHD typically exhibit more inattentive symptoms, like daydreaming or seeming lost in thought, rather than the hyperactive behaviours more commonly seen in males or manifest hyperactivity in more subtle ways. They also tend to internalise their struggles, leading to issues like low self-esteem and anxiety, which are less visible and can mask ADHD symptoms.

Girls and women with ADHD often develop coping strategies to compensate for their difficulties. This might involve becoming perfectionists or overachievers, which can conceal their underlying challenges. Furthermore, societal expectations and stereotypes about ADHD being a predominantly male disorder contribute to its underrecognition in females.

Recognising ADHD in females involves looking for signs of inattention, subtle hyperactivity, emotional dysregulation, and challenges with executive functioning and social interactions. Girls with ADHD may struggle with maintaining friendships and underperform academically or professionally, despite their capabilities.

It's important to move beyond stereotypes to identify and support females with ADHD effectively. Early diagnosis and intervention can lead to significant improvements in their quality of life, self-esteem, and achievement.

The female presentation of ADHD, often subtler, can lead to many women and girls going undiagnosed or receiving their diagnosis much later in life.

Let’s take a closer look.

Differences between Female and Male Presentations of ADHD:

Inattention vs. Hyperactivity: While boys with ADHD might display more overt hyperactive and impulsive behaviours, girls are more likely to exhibit inattention. Girls with ADHD may be seen as daydreamers, often staring out of the window or seeming to be in their own world.

Internalisation of Symptoms: Girls are more likely to internalise their struggles, leading to symptoms such as low self-esteem, anxiety, and depression. These internal struggles are often less apparent to parents, teachers, and even clinicians, making the ADHD more difficult to recognise.

Socialisation and Coping Strategies: Girls often develop better coping and compensatory strategies to mask their ADHD symptoms. They might work extremely hard to keep up appearances, leading to exhaustion or a breakdown at a later stage due to the effort of keeping up.

Comorbidities: Women and girls with ADHD often have comorbid conditions such as anxiety, depression, or eating disorders. These can overshadow ADHD symptoms or be mistaken as the primary issue.

Expectations and Societal Norms: Societal expectations often lead girls to suppress hyperactive behaviour, making their symptoms less noticeable. Girls are often socialised to be more quiet and compliant, which can hide the underlying ADHD.

Why Female ADHD Often Goes Unnoticed:

Subtlety of Symptoms: The symptoms in females tend to be less overt, more nuanced, and often internalised. Without the disruptive behaviour often seen in males, their symptoms might not raise the same level of concern or attention. Girls often go unnoticed when it comes to ADHD because they display hyperactivity differently than boys. While boys may exhibit more overt signs such as blurting out answers or tapping their foot persistently, girls tend to show hyperactivity through excessive talking, fidget with their hands or be still and feel restless. In a classroom environment, this behaviour might be perceived as simply being talkative rather than an indication of hyperactivity, leading teachers to view them as less disruptive and subsequently less likely to refer them for ADHD evaluation. This difference in perception contributes to the underdiagnosis of ADHD in girls.

Misdiagnosis: Girls are more likely to be diagnosed with anxiety or depression. The overlapping symptoms of these conditions with ADHD can lead to misdiagnosis or an assumption that ADHD isn't the underlying or coexisting issue.

An online poll conducted by Harris Interactive, surveying 3,234 individuals including the general public, parents, teachers, and children with ADHD, reveals a significant recognition gap in diagnosing girls with ADHD. The poll found that 85% of teachers and over half of parents and the general public believe that ADHD in girls often goes unnoticed. Respondents cited that girls with ADHD tend to "suffer silently" or display fewer symptoms compared to boys, making it more challenging to identify the condition. Additionally, 40% of teachers noted they have more difficulty recognising ADHD symptoms in girls than in boys. This points to a widespread understanding that ADHD in girls is underdiagnosed and often overlooked.

Bias and Stereotypes: There's a long-standing bias and stereotyping of ADHD as a "boys' disorder". This leads to a lack of awareness among parents, teachers, and even healthcare providers about how ADHD can present in girls and women.

Compensatory Behaviours: Girls often develop compensatory behaviours to mask their ADHD. They might become perfectionists, overachievers, or develop elaborate organisational systems to cope with their inattention and forgetfulness. These behaviours can hide the struggles they are facing.

Later Onset of Noticeable Issues: While boys might show more behavioural issues early on, girls might only start to struggle when academic and organisational demands increase, such as during middle school, high school, or even later in college or the workplace.

How to Recognise ADHD in Females:

Inattention: Look for signs of inattention that might be impacting day-to-day life. This includes difficulty sustaining attention, making careless mistakes, seeming not to listen, or being easily distracted by extraneous stimuli.

Subtle Hyperactivity and Impulsivity: While they may not be overtly hyperactive, girls might exhibit restlessness, fidgeting, or an internal sense of restlessness. Impulsivity might show up in interrupting, impatience, or making hasty decisions.

Emotional Dysregulation: Many girls with ADHD experience intense emotions and might have a hard time regulating them. This can include mood swings, sensitivity to criticism, or sudden bouts of anger or frustration.

Executive Functioning Issues: This includes disorganisation, poor time management, difficulty in starting and completing tasks, forgetfulness, and a sense of being overwhelmed by daily tasks.

Social Challenges: Girls with ADHD might struggle with maintaining friendships due to impulsivity, oversharing, or not picking up on social cues. They might also withdraw socially due to fear of rejection or feeling different.

School or Work Performance: Despite being intelligent and capable, girls with ADHD might underperform academically or professionally. Look for discrepancies between their abilities and their achievements, or a decline in performance as demands increase.

Compensatory Mechanisms: Notice if there is an over-reliance on elaborate organisational systems, excessive list-making, or perfectionist tendencies that might be compensating for underlying inattention or forgetfulness.

Conclusion:

Recognising ADHD in females requires an understanding of how their symptoms manifest differently from males and an awareness of the subtleties that might mask their struggles. Many women and girls with ADHD remain undiagnosed or misdiagnosed, leading to years of confusion, underachievement, and a sense of being overwhelmed. By understanding the female presentation of ADHD, parents, educators, and healthcare professionals can better identify and support girls and women with this condition. Diagnosis and appropriate support can lead to significant improvements in self-esteem, academic and professional achievements, and overall quality of life. It's crucial to move beyond stereotypes and biases to provide the necessary attention and care to those who have been overlooked or misunderstood for so long.