Girls and ADHD

Stereotypes of attention deficit hyperactivity disorder conjure images of “naughty” schoolboys. Looking past this is the key to ensuring girls living with ADHD are recognised and taken seriously

Attention deficit hyperactivity disorder is a condition that is relatively maligned in the wider world. According to the NHS, it can be categorised by two types of behavioural issue: inattentiveness, or hyperactivity and impulsiveness. Some people living with ADHD will experience both of these issues, but others will not. They note that the symptoms of ADHD are well-known in children and teenagers, and usually can be picked up on before the individual turns six, with noted behaviours being displayed in more than one location, for example, both at home and in school. The Royal College of Psychiatrists note that between three and six in every 100 school-aged children are living with ADHD. They also note explicitly that in children, boys are more likely to receive a diagnosis than girls, but clinics see equal numbers of adult men and women regarding diagnoses.

The NHS categorises inattentiveness - or difficulty maintaining concentration and focus - by a number of signs, including: having a short attention span, marking careless mistakes, being forgetful, finding it difficult to stick to tasks that are tedious or time consuming, having difficulty listening or carrying out instructions, constantly changing activities or tasks, and finding organising tasks difficult. They categorise hyperactivity and impulsiveness with the following behaviours: finding sitting still difficult (especially in calm surroundings), constant fidgeting, finding concentrating on tasks difficult, excessive movement, excessive talking, finding it difficult to wait their turn, acting without thinking, interrupting during conversations, and having little or no sense of danger. Children living with ADHD may also live with other conditions alongside their ADHD. The most common co-morbitities of ADHD per the NHS are anxiety disorder, oppositional defiant disorder, conduct disorder, depression, autism, sleep problems, dyspraxia, epilepsy, Tourette’s syndrome, and learning difficulties like dyslexia. Adults living with ADHD may also live with personality disorders, bipolar disorder, or obsessive compulsive disorder, and may also experience difficulties with social interaction or relationships. Much of the research regarding ADHD focuses on children, and the NHS notes that defining symptoms of ADHD in adults is more difficult due to a lack of research focused on adults, but changes are starting to be made, such as changes to the DSM-V which include diagnostic criteria for adults, which is helpful to professionals.

ADHD is pretty common - thought to be equally common in boys and girls. However, girls can experience missed or mixed diagnoses. In 1997, psychologist Stephen Hinshaw of the University of California, Berkley and his team began a study looking specifically at girls living with ADHD, and following them into adulthood, where they found that girls and boys had a similar experience of ADHD, but worked more to mask or internalise their experience. The NHS notes that girls are more likely to experience only inattentiveness, and are less likely to show “disruptive behaviour that makes ADHD symptoms more obvious”, resulting in diagnoses being missed. In 2020, Young et al noted that girls living with ADHD face the hurdle of gender bias on the path to diagnosis: “There is a strong public perception that ADHD is a behavioural disorder that primarily affects males. Hence the challenge is to raise awareness and provide training on the presence and presentation of ADHD in females to agencies that regularly interface with children, young people, and adults.” The stereotype of ADHD, as referenced by Psychiatry UK, is that of “naughty disruptive schoolboys bouncing off the walls,” but as they also note, ADHD is not gender biased. With this in mind, ADDitude Magazine lists a number of experience girls may have, knowing which could help more effectively recognise girls who are living with ADHD. These are: daydreaming in class, feelings of sadness or anxiety, exhibiting silliness, being shy or inattentive, difficulties maintaining friendships, picking at the cuticles or skin, and perfectionism. This is absolutely not to say that there is a separate ADHD for girls and for boys, or that girls will not experience any of the symptoms that are considered “traditional”, but that knowing these additional behaviours may help to recognise girls living with ADHD, and offer them the support that will encourage them to thrive.

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