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Taylor Zennie

Professor Vicki Stalbird

English 1201.223

26 March 2020

Girls and ADHD: They Need Help, Too

There are a lot of ways that having ADHD can negatively impact the quality of

someone’s life, from interfering with their academics, to affecting their relationships, both

personally and professionally. With such an intense impact on people, it seems easy to assume

that it would be hard to miss anyone with ADHD. Unfortunately, that’s untrue. Boys with

symptoms of ADHD are noticed at a much higher rate than girls, and are much more likely than

them to receive a diagnosis and treatment. It’s not just the medical community missing them,

either: parents and teachers are also guilty of overlooking girls with ADHD, even when their

symptoms are textbook. Those shortcomings can be linked to a lack of information and

education on what signs and symptoms to keep an eye out for with girls specifically. This leads

to girls with ADHD symptoms being frequently missed by the adults in their lives, and going

undiagnosed and untreated by medical professionals. By implementing more gender-focused

research, more persistent education on what signs to look out for, and preventative measures

to stop them from going unrecognized, there can and should be reform in the medical field that

bridges the gender gap between noticing, diagnosing, and treating girls with ADHD.

Within the last two decades, there has been a lot of research and investigation into

whether there is a gender bias when it comes to diagnosing girls versus boys with ADHD.

Through multiple studies, a trend has been brought to light that shows that girls are much less
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likely to not only be diagnosed with ADHD, but also to have their symptoms recognized as

symptoms at all. Psychologist Kathleen Nadeua says that “girls experience significant struggles

that are often overlooked because their ADHD symptoms bear little resemblance to those of

boys” (Crawford, “ADHD: A women’s issue”). This suggests that girls and boys experience ADHD

differently from one another, and that boys’ symptoms are the ones being recognized more. Dr.

Kathleen Nadeua goes on to make the claim, “Historically, research on ADHD has focused

almost exclusively on hyperactive little boys” (Crawford, “ADHD: A women’s issue”), which

means that since the only ones being researched are young boys, the only symptoms that

people know to look out for are those that boys show, excluding those with different

symptoms, like people with adult ADHD, or young girls.

Through lack of research over the symptoms of ADHD that girls experience, there then

comes a lack of diagnosis. According to Anne Walters, Ph.D., “It is estimated that half to three-

quarters of all women with attention-deficit/hyperactivity disorder (ADHD) are undiagnosed”

(“Girls with ADHD: Underdiagnosed and Untreated,” pp 8). According to Dr. Anne Walters, this

means that at least half of the girls and women with ADHD go most, if not all, of their lives not

knowing that they have the disorder. This is very worrisome, when the amount of medical bias

against girls with ADHD is also taken into account.

It’s harmful to girls to go undiagnosed, because they cannot get the help that they need.

Patricia O. Quinn, MD, and Manisha Madhoo, MD did a study over girls and women with ADHD.

They found that “[...] the disparity in diagnosis of ADHD between sexes, the bias in treatment

referral, and the reduced use of medication in female patients contribute to the underdiagnosis

and undertreatment of ADHD in this population” (“A Review of Attention-Deficit/Hyperactivity

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Disorder in Women and Girls: Uncovering the Hidden Diagnosis”). This is yet another instance

where the gender bias is shown not only to be proven, but is also shown to be harmful to the

girls who suffer because of it. There is no obvious reason for girls and women to be going so

underdiagnosed, outside of a gender bias that goes back as far as research into ADHD began.

The fact that an estimated minimum of half the amount of girls with ADHD go undiagnosed

shows the extent of how much reform is needed in the medical community, when they should

be getting help by those whose jobs it is to take care of them. Whether on purpose or

unintentionally, girls with ADHD are being hurt by the medical community, simply by not

receiving the same care and attention that boys with ADHD are getting.

Through numerous studies, it’s been found that not only are medical professionals more

likely to notice and diagnose boys with ADHD symptoms, but that parents fall into that pattern

as well. One study, “Do Different Factors Influence Whether Girls versus Boys Meet ADHD

Diagnostic Criteria? Sex Differences among Children with High ADHD Symptoms,” found that

“[...] referral based on parent concern requires recognition of impairment, yet parents appear

to be less able to spot impairment among girls” (Florence Mowlem, et al.). Since girls show their

symptoms differently than boys, they’re also less likely to be noticed by their parents.

Statistically, parents are more likely to pursue a diagnosis for boys, because parents are more

likely to spot the issues the boys are having. Boys are more likely to be referred to a specialist

and/or for testing specifically for hyperactivity or inattention, whereas with girls, they’re more

likely to have their issues brushed aside as “daydreams” or for being “lost in their heads.” Girls

and boys with ADHD both suffer from an inability to pay attention, hyperactivity, or both, but

boys are much more likely to have their issues associated with, and subsequently blamed on,
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the disorder. With boys, their issues are pinned on ADHD; with girls, their issues are pinned on

themselves. There are many ways that parents unintentionally brush aside their daughters’

ADHD symptoms, which can have a just-as-unintentional negative impact on their lives.

Girl with ADHD in a classroom. Digital image. Medical News Today. 2 January 2019. Web. 21

Janurary 2020. <medicalnewstoday.com>

Outside of both parents and medical professionals, the people who should be putting

the most time and effort into noticing and helping kids with issues like ADHD are teachers.

Unfortunately, research has found that teachers ranked even lower than parents did on

noticing ADHD symptoms in girls. A study, “Unseen and Stressed? Gender Differences in Parent

and Teacher Ratings of ADHD Symptoms and Associations With Perceived Stress in Children

With ADHD,” investigated the disparity between parents and teachers in relation to children
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with symptoms of ADHD. They found that “When comparing parent and teacher ratings on the

ADHD symptom scale in boys, no differences were found. In girls, parents rated higher than

teachers on inattention (t = 3.47, p = .002, respectively), on hyperactivity (t = 3.28, p = .004),

and on combined symptoms (t = 3.63, p = .002)” (Johan Isaksson, et al.). What this means is that

with boys, there is no notable disparity between parents and teachers in noticing and reporting

ADHD symptoms, but that with girls, parents, who struggle themselves with noticing symptoms

in their daughters, are still more likely to notice and report those symptoms than the child’s

teachers. These findings are especially worrisome because children with ADHD arguably

struggle the most with academics even with a diagnosis of the disorder, but they do much

worse with no diagnosis, because they aren’t accommodated the way that they should be in

order to be on even footing with their peers.

ADHD can interfere with a child’s ability to retain information taught to them; it can also

impact how long they can handle being sedentary for, how well they listen, how disruptive they

are to other students, how they handle tests, how well they can remember and focus on

schoolwork, both in and out of the classroom, and much more. Frequently, boys with ADHD are

classified as “class clowns,” and girls with ADHD are classified as “talkative.” Boys’

disruptiveness has a higher chance of being flagged as ADHD hyperactivity or inattentiveness,

while girls are either less likely to be disruptive to begin with, or when they are, their actions

are usually brushed aside as a simple cry for attention. Teachers being more likely to suspect

boys of ADHD than girls is an issue that desperately needs addressed, because going

undiagnosed can affect how well they perform in school.

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Going undiagnosed can have a negative impact on a girl’s life as she gets older, as well.

In a piece that Kelly Oakes did for BBC Future, she said, “For those whose symptoms are missed

as children, living with undiagnosed ADHD as they move into adulthood causes problems”

(“Why is ADHD missed in girls?”). Those problems can include secondary mental illnesses or

disorders, like depression, anxiety, or personality disorders, which can then mask or hide the

primary ADHD symptoms that might have been more obvious on their own. Girls with

secondary mental illnesses are much more likely to be diagnosed with those second illnesses

than they are to be diagnosed with their ADHD; it can almost be argued that those secondary

mental illnesses and disorders make it harder for their ADHD to be noticed and diagnosed.

According to Dr. Nadeu, “Girls with untreated ADHD are at risk for chronic low self-esteem,

underachievement, anxiety, depression, teen pregnancy, early smoking during middle school

and high school” (Crawford, “ADHD: A women’s issue”). Going undiagnosed can also lead to

impulsivity issues, or an inability to think about repercussion, which can lead to self-destructive

behavior.

The effects of going undiagnosed can have serious negative impacts on one’s life,

beyond simply not knowing that they have ADHD and being unable to seek treatment because

of that. According to an article that looked at the correlation between social impairment and

girls with ADHD, “The current findings indicate that, like their male counterparts, girls with

ADHD are at high risk for social impairment, and that such impairment cuts across multiple

domains of social functioning” (Greene, “Social Impairment in Girls With ADHD: Patterns,

Gender Comparisons, and Correlates”). As the article states, like boys, girls with ADHD are very

likely to have some sort of social impairment; unlike boys, since girls are less likely to be
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diagnosed with ADHD, they’re also less likely to know why they’re having trouble interacting

and relating to their peers the way that others can. Not knowing a reason why one is different

from others can lead to a skewed perspective of one’s self that can follow them for the rest of

their life.

I, personally, was not diagnosed with ADHD until I was 20 years old. Going through my

childhood with the disorder, not knowing I had it but still suffering from issues that almost

always only come from having ADHD, negatively impacted my life in several different ways. Like

other girls who go through school with the disorder that isn’t recognized for what it actually is, I

suffered greatly academically. I was unable to retain the information I’d just been taught long

enough to do my homework, and I also never fully grasped the idea of repercussions, from not

doing my homework as well as various other things, because I was incapable of thinking about

anything outside of what was happening in that exact moment. My report cards frequently had

comments from my teachers that said things all along the lines of, “She’s very bright, but easily

distracted, and has issues being distracting to her classmates.” None of my teachers identified

my issues academically as those of ADHD—they simply thought I was another talkative, over-

excitable child, until I got old enough to learn to focus my inability to focus on quieter, more

subtle things, like reading books during class, or doodling on my worksheets.

It wasn’t just my academics that suffered, either; I was nearly incapable of making

friends, and ever worse at keeping them for longer than a few months. Throughout elementary

school, I was lucky to have one friend each school year, and they never lasted longer than that

year. I had issues relating to my peers, on both an emotional scale and an intelligence scale. I

wasn’t good at knowing how much energy was too much, or how much talking was too much.
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Those issues followed me into my teenage years, all the way to adulthood. I was barely able to

graduate high school, because I struggled so bad with my ADHD that I didn’t even know I had.

Once I got diagnosed, I was able to get proper treatment, with medication and behavioral help,

which allowed me to pursue a higher education. I still struggle because of my ADHD, but

knowing that I have it makes it easy for me to pinpoint what issues are being caused by it, and

how to try to combat them with methods intended specifically for ADHD management. My

diagnosis changed my life for the better, in countless ways.

Most girls aren’t that lucky, though. Patricia O. Quinn, MD, has found that, “Even if a

woman is fortunate enough to be correctly diagnosed as having ADHD, treatment regimens are

usually composed of recommendations established by those experienced in treating

elementary school–aged boys” (“Treating Adolescent Girls and Women with ADHD: Gender-

Specific Issues”). Even if they’re able to get a diagnosis, treatment is based heavily off of what

medical professionals have found works best for young boys with the disorder, because they’re

the ones being the most diagnosed and researched when it comes to it. Since girls experience

ADHD differently than boys, treatment used for boys won’t work as well on them. In order to be

able to treat them, there must be enough reform in the medical community for decent enough

strides to be taken.

There has to be an acknowledgment of the gender-bias by the community before there

can be any real change. Luckily, there are several people within the medical community pushing

for a change to be made. Ortal Slobodin and Michael Davidovich’s study, “Gender Differences in

Objective and Subjective Measures of ADHD Among Clinic-Referred Children,” made a

statement that said, “Our findings may encourage clinicians and researchers to consider using
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gender-specific norms and guidelines when assessing symptoms of ADHD (Hasson and Fine,

2012),” which shows that with some reform and effort, medical professionals can help bridge

the gender gap of ADHD diagnosis. Once that happens, parents and teachers can be taught

what signs and symptoms to keep an eye out for, so that no kid under their care goes

wrongfully undiagnosed.

The gender gap of noticing, diagnosing, and treating ADHD in children is negatively

impacting girls who aren’t receiving the care and help they deserve. The medical community

needs reform to make that gap smaller, and parents and teachers need to become more

informed of warning signs that the young girls under their care might be suffering from ADHD.

With those issues addressed, the percentage of girls with ADHD who go undiagnosed will go

down drastically, while improving their quality of life greatly.

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Works Cited

Crawford, Nicole. “ADHD: A women’s issue.” American Psychological Association. February

2003. https://www.apa.org/monitor/feb03/adhd Accessed 2 March 2020.

Girl with ADHD in a classroom. Digital image. Medical News Today. 2 January 2019. Web.

<medicalnewstoday.com> Accessed 3 March 2020.

Greene, Ross W., et al. “Social Impairment in Girls With ADHD: Patterns, Gender Comparisons,

and Correlates.” Journal of the American Academy of Child & Adolescent Psychiatry, vol.

40, no. 6. ScienceDirect. http://sinclair.ohionet.org:80/login?

url=https://search.ebscohost.com/login.aspx?

direct=true&db=edselp&AN=S0890856709604755&site=eds-live Accessed 3 March

2020.

Isaksson, Johan, Vladislav Ruchkin, and Frank Linblad. “Unseen and Stressed? Gender

Differences in Parent and Teacher Ratings of ADHD Symptoms and Associations With

Perceived Stress in Children With ADHD.” Journal of Attention Disorders. 2016. SwePub.

http://sinclair.ohionet.org:80/login?url=https://search.ebscohost.com/login.aspx?

direct=true&db=edsswe&AN=edsswe.oai.DiVA.org.uu.299000&site=eds-live Accessed 2

March 2020.

Mowlem, Florence, et al. “Do Different Factors Influence Whether Girls versus Boys Meet ADHD

Diagnostic Criteria? Sex Differences among Children with High ADHD Symptoms.”

Psychiatry Research, vol. 272. Science Citation Index.

http://sinclair.ohionet.org:80/login?url=https://search.ebscohost.com/login.aspx?

direct=true&db=edswsc&AN=000460994400108&site=eds-live Accessed 2 March 2020.

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Oakes, Kelly. “Why is ADHD missed in girls?” BBC Future. 3 June 2019.

https://www.bbc.com/future/article/20190530-why-is-adhd-missed-in-girls Accessed 3

March 2020.

Quinn, Patricia O., and Manisha Madhoo. “A Review of Attention-Deficit/Hyperactivity Disorder

in Women and Girls: Uncovering the Hidden Diagnosis.” PubMed Central. 13 October

2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195638/ Accessed 2 March

2020.

Quinn, Patricia O. “Treating Adolescent Girls and Women with ADHD: Gender-Specific Issues.”

Journal of Clinical Psychology, vol. 61, no. 5, May 2005. Psychology and Behavioral

Sciences Collection. http://sinclair.ohionet.org:80/login?

url=https://search.ebscohost.com/login.aspx?

direct=true&db=pbh&AN=16700007&site=eds-live Accessed 3 March 2020.

Slobodin, Ortal and Michael Davidovitch. “Gender Differences in Objective and Subjective

Measures of ADHD Among Clinic-Referred Children.” Frontiers in Human Neuroscience,

2019. Science Citation Index. http://sinclair.ohionet.org:80/login?

url=https://search.ebscohost.com/login.aspx?

direct=true&db=edswsc&AN=000504736200001&site=eds-live Accessed 3 March 2020.

Walters, Anne. “Girls with ADHD: Underdiagnosed and Untreated.” Brown University Child and

Adolescent Behavior Letter 34, no. 11. November 2018. Professional Development

Collection. http://sinclair.ohionet.org:80/login?

url=https://search.ebscohost.com/login.aspx?

direct=true&db=tfh&AN=132308266&site=eds-live Accessed 2 March 2020.