As a society, we always expect young girls to be shy, quiet, and emotional. But what happens when some of these little girls aren’t just exhibiting “girly” traits but symptoms of inattentive (non-hyperactive) ADHD? This article, written by Alexa Mendez, explores how ADHD manifests itself differently in girls than in boys, and how this, coupled with male-centric diagnostic criteria for ADHD, has harmed neurodivergent girls in the long run. Neurodiversity is defined by Merriam-Webster as “individual differences in brain functioning regarded as normal variations within the human population.” In other words, neurodiversity encompasses individuals whose brains we do not regard as typical. Examples of neurodiverse individuals are those with dyslexia, Tourette’s syndrome, autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD; Weathington). Many neurodivergent individuals are diagnosed at an early age, but those who are assigned female at birth (AFAB) and have ADHD may go their entire childhood without a diagnosis due to stereotypical gender norms. The ratio of boys to girls diagnosed with ADHD during their childhood is unclear, but it falls somewhere between 2:1 and 10:1 (Mowlem et. al.). It is estimated that 50-75% of girls with ADHD go their whole lives undiagnosed (Parker Gordon). Many young girls receive a late diagnosis or no diagnosis at all because their symptoms are simply viewed as the personality traits of a girl. Thus, their parents are less likely to be concerned and therefore less likely to bring their child to get screened. That said, there are still different ways that ADHD can manifest itself in girls versus boys. The most common sign of ADHD in girls that is less present in boys is a type of ADHD called inattentive ADHD, formerly known as attention deficit disorder (ADD; Logsdon). This means that they’re more likely to be shy, daydream, and have trouble focusing on tasks at hand. In attempts to compensate for their inattention, young girls are more likely to hyperfocus on activities for which they have a knack. Other major symptoms that are more prominent in girls are constant fidgeting and lack of impulse control, i.e. being talkative, blurting out answers, and frequently getting off-track during conversation (Low). A girl who constantly fidgets and keeps her body occupied is normally just viewed as a tomboy since she likes physical activity. In addition, hyper-talkative girls are deemed as emotional, while shy, reserved girls are paid no mind since docility and shyness are viewed as inherently feminine traits (Low). Studies have shown that parents are more likely to find the “masculine” ADHD symptoms more problematic than their “feminine” counterparts, making them more likely to bring their son with ADHD to a doctor than their daughter. One study done by King’s College London found that only 65% of girls who met the Parental Account of Childhood Symptoms (PACS) diagnostic criteria for ADHD had a formal diagnosis, while all of the PACS-diagnosed boys in the study had a formal diagnosis (Mowlem et. al.)
Ever since ADHD began being talked about in mainstream medical spaces, males have been used as the framework for ADHD diagnostic criteria, and have also been the focus of academic literature about ADHD, which ended up being drastic for female diagnosis. Diagnostic criteria for ADHD diagnosis also involves parent and teacher referral, and since hyperactivity is more present in boys, their parents and teachers are more likely to show concern (Mowlem et. al., Crawford). Psychologist Dr. Kathleen Nadeau states that one of the most common ways for girls to be diagnosed with ADHD is actually for them to become mothers. When their child— more often than not, a son— gets diagnosed with ADHD, the mother begins to realize that she exhibited similar symptoms as a child and seeks out a diagnosis herself (Crawford). It is currently not known why ADHD manifests itself differently in girls than in boys, but overall, the main reason for the sex disparity in ADHD diagnosis is the inherently male-centric diagnostic criteria. Hyperactivity is a big part of the diagnosis of ADHD, but there are people who have inattentive ADHD, the majority of whom are girls. It has been proven that undiagnosed ADHD can lead to several negative sequelae, ranging from frustration at daily activities to anxiety, depression, eating disorders, and drug usage (Crawford, Parker Gordon). It has also been reported that girls with ADHD are three to four times more likely to attempt suicide, and two to three times more likely to engage in self-harm (Hamilton). These effects are only worsened when ADHD is left undiagnosed and therefore unmedicated. The solution to the sex disparity in ADHD diagnosis would be to first and foremost rethink the diagnostic criteria. Not all people with ADHD are hyperactive, and this misconception is disproportionately affecting girls. Furthermore, more research needs to be done specifically concerning girls with ADHD as opposed to boys, who are the main subject of ADHD literature. Works Cited: Crawford, Nicole. “ADHD: A Women’s Issue.” American Psychological Association, Feb. 2003, www.apa.org/monitor/feb03/adhd. Hamilton, Audrey. “Girls With ADHD at Risk for Self-Injury, Suicide Attempts as Young Adults, Says New Research.” American Psychological Association, Aug. 2012, www.apa.org/news/press/releases/2012/08/girls-adhd. Logsdon, Ann. “Symptoms of Attention Deficit Disorder Without Hyperactivity.” VeryWell Mind, 9 Apr. 2021, www.verywellmind.com/add-and-attention-deficit-disorders-2161810. Low, Keath. “20 Signs and Symptoms of ADHD in Girls.” VeryWell Mind, 18 Nov. 2020, www.verywellmind.com/adhd-in-girls-symptoms-of-adhd-in-girls-20547. 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, 2019, pp. 765–73. Crossref, doi:10.1016/j.psychres.2018.12.128. “Neurodiversity.” Merriam-Webster.com Dictionary, Merriam-Webster, https://www.merriam-webster.com/dictionary/neurodiversity. Accessed 10 Apr. 2021. Parker Gordon, Jerisha. “Attention Deficit Hyperactivity Disorder (ADHD) in Girls: Symptoms, Treatments, and More.” Healthline, 7 Apr. 2016, www.healthline.com/health/adhd/adhd-in-girls#Understanding-ADHD-in-girls. Weathington, Leia. “Understanding the Different Types of Neurodiversity & Their Strengths.” Daivergent, 3 Mar. 2020, daivergent.com/blog/types-of-neurodiversity.
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