ADHD In Girls - Signs and Symptoms Checklist

ADHD, or Attention Deficit Hyperactivity Disorder, is a neurodevelopmental condition characterized by persistent patterns of inattention, hyperactivity, and impulsivity. It is commonly diagnosed in children; it's estimated that between 2016 and 2019, 6 million US children were diagnosed with ADHD. Boys are diagnosed twice as often as girls – however, since girls often have different or more subtle symptoms than boys, they are at risk for missed diagnosis.

This is a major concern as untreated ADHD can have significant consequences on a girl's self-esteem, academic achievements, and mental health. This article aims to enlighten readers on the distinctive signs and symptoms of ADHD in girls and provide a comprehensive checklist for parents, educators, and health professionals.

The 3 types of ADHD

ADHD can be categorized into three types: Inattentive, Hyperactive-Impulsive, and Combined Type.

1. Inattentive ADHD is characterized by difficulty focusing, easily being distracted, forgetfulness, and struggling to stay on task. People with this type might appear to excessively daydream or otherwise seem "out of it." This type is more common in girls but it's often overlooked because they're not disruptive in class or at home and are not calling attention to themselves.

2. Hyperactive-Impulsive ADHD is what most people picture when they think of ADHD. Children with this type of ADHD are fidgety, have a hard time sitting still, act without thinking, have outbursts in class, and frequently interrupt others. They may do well when put in highly structured environments. It's easier to spot and usually diagnosed earlier because the symptoms are quite noticeable.

3. Combined Type ADHD includes symptoms from both of the above categories. 

Why is ADHD in Girls Often Overlooked?

ADHD in girls is often overlooked due to a complex mix of factors, including societal expectations, gender bias, and differences in symptom presentation. Let's explore the reasons behind this discrepancy in diagnosis and understanding.

ADHD Assessment Scale Uses Data From Boys 

Many of the assessment scales for ADHD were developed based on data from boys, which skews the diagnosis process. Boys are more likely to be diagnosed with ADHD than girls, with 13% of boys receiving a diagnosis compared to only 6% of girls. As such, the symptoms that girls experience, which often differ from those of boys, may not meet the traditional criteria, leading to misdiagnosis or overlooked symptoms.

Less Likely to Be Hyperactive

Girls with ADHD tend to be less hyperactive and more inattentive compared to boys. While boys may exhibit disruptive behavior, girls might appear shy, daydreamy, or in their own world. They might be dismissed as merely distracted or unmotivated, thus missing the underlying ADHD diagnosis, when in reality these behaviors are not completely under their control.

Coping and Compensating

Girls with ADHD often develop better-coping strategies than boys, such as painstakingly maintaining an organized environment or relying heavily on calendars and lists. They may also put tremendous effort into conforming to societal expectations and keeping up with their schoolwork. While these methods can be effective, they often mask the ongoing struggle these girls face, leading to delayed or missed diagnoses. 

Internalizing Symptoms

Girls with ADHD are more likely to internalize their symptoms. This means they may experience feelings of shame, guilt, or inadequacy, which can manifest as anxiety or depression. Because these conditions are also common in the general population, it can make it more difficult to identify ADHD as the root cause.

Hormonal Fluctuation

ADHD symptoms in girls can fluctuate due to hormonal changes, especially during puberty and menstrual cycles. This can make the symptoms appear inconsistent, contributing to misdiagnosis or underdiagnosis. These hormonal fluctuations can also lead to emotional dysregulation, often mistaken for typical teenage moodiness.

Teachers and Parents Less Likely to Refer Girls for Testing

Because girls with ADHD don't typically display disruptive behavior, teachers and parents may not notice the signs or attribute them to ADHD. They're less likely to be referred for testing, which means they miss out on crucial early interventions.

Understanding these reasons can help change the way we approach ADHD in girls, leading to earlier identification and intervention. Recognizing that ADHD may look different in girls is a crucial step in providing them with the support they need.

ADHD - A Checklist of Potential Symptoms

ADHD symptoms can vary widely from person to person, but the following checklist provides an overview of some common signs of ADHD in girls:

✔️ Inattention: Difficulty focusing, easily distracted, and daydreaming, sometimes seeming 'spacey' or lost in thought.

✔️ Disorganization: Trouble keeping track of assignments or belongings, messy room or workspace, struggles with time management, procrastinating on assignments.

✔️ Forgetfulness: Regularly forgetting to complete tasks, turn in homework, or attend appointments.

✔️ Difficulty completing tasks: Struggles to finish schoolwork, chores, or other tasks without constant reminders.

✔️ Emotional Sensitivity: Overreacts to small problems, difficulty handling criticism, frequent mood swings.

✔️ Impulsivity: May blurt out comments without thinking, have difficulty waiting for their turn, or act without considering consequences.

✔️ Struggling socially: Difficulty maintaining friendships, may be prone to social isolation due to misunderstandings or conflicts.

✔️ Quiet or withdrawn: May seem shy or uninvolved in group settings, often preferring solitary activities.

✔️ Low self-esteem: Often feels inadequate or compares self negatively to peers.

✔️ Underperformance in school: Despite being capable and intelligent, consistently underperforms in school due to inattentiveness, missed homework, disorganization, or lack of focus.

✔️ Hyperfocus: Becomes extremely absorbed in specific tasks or interests that they enjoy, to the detriment of other activities.

✔️ Internal restlessness: May not exhibit overt hyperactivity, but feel an internal sense of restlessness or fidgeting.

✔️ Difficulty sleeping: About 70% of kids with ADHD have sleep problems, so check for trouble falling asleep or staying asleep, and inconsistent sleep patterns.

Possible Complications Of Undiagnosed ADHD In Girls

Undiagnosed ADHD in girls can lead to various complications that ripple throughout their lives, affecting their mental health, self-perception, and overall well-being. Here are some potential consequences that can stem from this untreated condition.

Anxiety and Stress

Girls with undiagnosed ADHD often live in a state of chronic stress and worry, experiencing constant internal struggles to maintain the semblance of 'normalcy.' They may feel overwhelmed by everyday tasks that others handle with ease, and this constant effort can lead to heightened anxiety levels.

Depression

Feeling 'different' and not understanding why can be an isolating experience. Girls with undiagnosed ADHD may internalize their struggles, blaming themselves for their difficulties, and interpreting their struggles as personal failures. Over time, these feelings can evolve into depression, a severe mood disorder that can affect all aspects of their life.

Low self-esteem

Repeatedly facing criticisms for being forgetful, disorganized, or 'daydreamy' can chip away at a girl's self-esteem. When ADHD remains undiagnosed, these girls may start believing they're less capable or intelligent than their peers, leading to a negative self-image that can persist into adulthood.

Increased Risk of Eating Disorders and Substance Abuse

In a bid to gain control over their lives or to cope with the emotional distress from their undiagnosed ADHD, girls might resort to harmful coping mechanisms. This can include developing eating disorders or using substances as an escape.

Treating and Supporting ADHD in Girls

Get an Assessment from Your Pediatrician

The first step to treating ADHD in girls is getting an accurate diagnosis. If your child is exhibiting symptoms of ADHD, a pediatrician is the first point of contact. The pediatrician will conduct a comprehensive assessment that includes gathering information about your child's behavior at home, school, and other social environments. They might also use specific questionnaires and checklists designed to evaluate ADHD symptoms. It's vital to provide as much information as possible, including any concerns raised by teachers or other caregivers.

Medication for ADHD

Medication is a key component of treatment for ADHD, depending on your child's age. Stimulant medications, such as methylphenidate (Ritalin, Concerta) and amphetamine-based drugs (Adderall, Vyvanse), are commonly used and have been shown to be effective in controlling ADHD symptoms. They work by increasing the brain's levels of dopamine and norepinephrine, which help regulate the prefrontal cortex, which controls higher function tasks like attention and behavior.

Non-stimulant medications like atomoxetine (Strattera) and guanfacine (Intuniv) may be prescribed when stimulants are not effective or cause unwanted side effects. It's important to note that while medications can be highly effective, they should be used under a doctor's supervision, and side effects should be closely monitored.

Support and Coaching

Beyond medication, behavioral interventions are also crucial in managing ADHD. This might involve working with an ADHD coach or therapist, who can provide strategies to help your child with organization, time management, and social skills. Support groups, both for parents and for the child, can also be beneficial.

For parents, these groups provide a platform to share experiences and learn coping strategies. For girls with ADHD, these groups offer an opportunity to connect with others who understand their experiences, reducing feelings of isolation.

Teachers can also provide classroom accommodations to help your child stay focused and succeed academically. Remember, the goal is to provide a comprehensive support system for your child to manage their ADHD effectively.

ADHD Signs and Symptoms in Girls: The Ultimate Guide

In summary, understanding and managing ADHD in girls requires an attentive approach to its unique symptoms. Diagnosis involves a detailed assessment, followed by a comprehensive treatment plan that can include medication and behavioral support. The next steps for parents suspecting ADHD in their children include documenting concerning behaviors, seeking professional assessment, and exploring treatment options. Most importantly, remember you're not alone, and support is available.

If you suspect your child may have ADHD, don't hesitate to schedule your ADHD screening with a Juno pediatrician today. Early intervention can profoundly impact your child's journey.