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Attention hyperactivity disorder, more commonly known as ADHD, is a disorder for which a lack of treatment can have a number of lifelong impacts. Usually, when people think of ADHD, they think of a little boy who can’t sit still. However, ADHD symptoms often look very different in girls, which means many will go years—if not a lifetime—without receiving a diagnosis or treatment.
“If the image you have in mind of ADHD is a hyperactive, restless boy, then a lot of girls are going to fly under your radar,” said Ari Tuckman, a psychologist and author of the book Success Strategies for Adults With ADHD.
The tendency to overlook girls with ADHD is thought to be due to misperceptions about what symptoms can look like, as well as social pressures, which often lead to girls working extra hard in order to fit in.
“They’re not causing a problem, they’re not disrupting the class, so teachers aren’t paying attention to her,” said Terry Matlen, a psychotherapist and author of the book Survival Tips For Women With ADHD. “The boys, on the other hand, are, and so the teacher notices.”
A missed diagnosis is also complicated by the fact that people with untreated ADHD often develop secondary issues, such as anxiety and depression, as well as eating disorders and substance abuse. This often confuses doctors who don’t know to look for ADHD as a primary cause.
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“It can take quite a bit of finesse on the part of a practitioner to sort that out,” Matlen said.
ADHD due to low levels of dopamine
ADHD is thought to be due to low levels of the neurotransmitter dopamine, as well as norepinephrine and serotonin. Kids with ADHD are constantly seeking stimulation, as a way of correcting for these deficits.
“Kids with ADHD are seeking dopamine, because their brain doesn’t produce what they need,” said Elaine Taylor-Klaus, who is the CEO of ImpactParents.com and author of the book The Essential Guide to Raising Complex Kids With ADHD, Anxiety and More.
In turn, this leads to a wide range of issues, such as difficulties directing their focus, issues following instructions, interpersonal difficulties due to missing out on social cues, or engaging in risky or addictive behaviors.
What this looks like can vary. For example, ADHD could look like a little boy who is constantly in motion, always seeking out something new. It can look like a little girl who can’t stop talking and is always volunteering as the teacher’s helper, as a way of being able to move around without getting in trouble. Or it can look like a little girl staring out the window, lost in her own imaginary world and who can’t seem to pay attention in class.
The three subtypes of ADHD
There are three main types of ADHD: hyperactive-impulsive, inattentive, and combined. For a child to be formally diagnosed, they have to display a certain number of symptoms—and they have to be severe enough to be impairing in multiple settings.
The first type, ADHD-Hyperactive-Impulsive, is the more stereotypical type. Kids with this type of ADHD have symptoms such as constant fidgeting, squirming, running, and climbing at inappropriate times, getting up often while seated, having trouble playing quietly, excessive talking, or talking out of turn. These are the kids who are always on the go.
“Girls who are hyperactive-impulsive tend to exhibit those behaviors by being chatterboxes,” Matlen said. “They might be talking too much to the kid next to them when they are supposed to be quiet, but it is still missed because most mental health professionals don’t know that could be a symptom of ADHD for a hyperactive girl.”
The second type, ADHD-Inattentive, looks quite different from the outside, as the symptoms relate to an internal restlessness, rather than the physical restlessness observed in the hyperactive-impulsive type. Kids with inattentive ADHD have a hard time paying attention to detail, often make careless mistakes, have a hard time paying attention and staying on task, struggle with listening, as well as following directions, and are distracted, forgetful, and unorganized.
“These girls have a very rich inner life,” Matlen said. “They could be writing poetry in their heads, they could be solving scientific problems, but they’re not listening to the teacher.”
The third type is ADHD-Combined, and it is the most commonly diagnosed type. Kids with this type of ADHD exhibit symptoms of both inattentive and hyperactive-impulsive type.
Look for signs of struggle and gaps in achievement
A classic sign of ADHD is a gap between what a child is achieving versus what they are capable of, as well as struggles that don’t quite reflect their ability. A lot of this is due to how much harder they have to work just to drown out the distractions and focus on the task at hand.
“When you are asked to focus in the classroom, what that means is you have to figure out what is important to pay attention to, and what is not,” Taylor-Klaus said. “You have to discern what is important, then you have to pay attention to what’s important, then you have to keep paying attention, you have to avoid distractions when they come up, and then you have to know when to stop paying attention and turn your attention to something else.”
For kids with ADHD, this is much harder than their peers. If a kid is spending all of their energy sitting when they have the urge to be moving, or paying attention instead of daydreaming, they have that much less energy to do everything else.
They are also more likely to miss important details during class, causing them to fall behind in spite of having the ability to understand and do the work. This often shows up in the form of missing homework, low test scores, and poor reading retention, due to an inability to focus on the tasks at hand.
For girls, they are often more likely to be willing to put in the extra work to try and make up for this, which can lead teachers to thinking everything is fine, without realizing what struggles are going on behind the scenes.
“The teachers may not know, but mom and dad know, because they see her melting down or grinding away slowly and inefficiently and painfully, until she hits a breaking point,” Tuckman said.
How girls internalize their ADHD symptoms
When it comes to ADHD in girls, one of the bigger differences is that girls are more likely to internalize their struggles. Whereas a boy with ADHD may cope by acting out, girls tend to cope in quieter ways that are more self-destructive.
“When we miss it, for girls, they end up taking it out on themselves,” Taylor-Klaus said. “They internalize it, that something must be wrong with them.” For girls who are diagnosed late, there is a higher incident of issues like eating disorders, cutting, suicidal ideation, promiscuity, and addiction.
Compared to boys with ADHD, girls with ADHD are far more likely to exhibit behaviors such as self-harm, which includes cutting or burning themselves; they are more likely to attempt suicide; and they have higher rates of anxiety and depression.
Diagnosis and treatment is critical
One of the misconceptions about ADHD is that it goes away once people reach adulthood. This is not true. For many, ADHD is a lifelong condition—one that requires treatment, which is often a combination of medication and therapy.
As a parent, it’s really important to provide a supportive environment for your child, in which they receive the treatment they need and learn the necessary coping skills.
“If you notice a behavior your child is exhibiting that makes you aggravated, angry or frustrated, don’t get furious, get curious,” Taylor-Klaus said. “If you start with the assumption that your child is lazy, rude or disrespectful, you’re probably missing that there is an underlying challenge they are struggling with. Kids typically aren’t lazy, rude or disrespectful; not on purpose.”
For parents who are hesitant about seeking an evaluation for your child due to any potential stigma associated with the label, Taylor-Klaus strongly urges you to reconsider.
“If they don’t get a real diagnosis, what they are going to get from school or themselves or other parents is a moral diagnosis of ‘bad’ or ‘wrong,’” she said. “They’re not bad or wrong. They’re struggling, and they need the adults in their life to help them.”
So as the adults, if you suspect your child may have ADHD, it’s critical to get them evaluated, so they can get the help they need.
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