Why ADHD diagnosis is mostly missed among girls?

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders of childhood, which includes attention difficulty, hyperactivity and impulsiveness.

ADHD comes in three types – inattentive, hyperactive/impulsive, or a combination of both. People with inattention may forget things, struggle with their organisation skills, and could be easily distracted. People with hyperactivity and impulsivity exhibit symptoms like struggling to stay sitting down, constantly fidgeting, and interrupting conversations.

ADHD often begins in people’s childhood. For those whose symptoms are missed in childhood, living with undiagnosed ADHD can cause problems in their adulthood. It can contribute to difficulty at work, low self-esteem and trouble in relationships.

Researchers have found that many more boys get diagnosed with ADHD than girls. But more girls have the condition than we identify and their struggle with undiagnosed ADHD can disrupt their whole lives.

Studies have found that one of the reasons why ADHD diagnosis in girls can be skipped is because boys and girls may exhibit the symptoms differently. In a study of 2,332 twins and siblings, researchers found that boys tended to have more extreme symptoms and a broader distribution of symptoms, in comparison to girls. Studies that look at who meets the ADHD criteria in the population, the ratio of boys to girls with ADHD could be anywhere between 2:1 and 10:1.

In another study on what differentiated both boys and girls who met the diagnostic criteria for ADHD, researchers also found that the parents seemed to play down symptoms of being impulsive or hyperactive in girls. On the other hand, they were found to play up similar symptoms of boys.

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Researchers have also noticed that girls could be better at compensating for their ADHD symptoms, compared to boys. “Girls are far less likely to bounce around the classroom, fighting with the teachers and their colleagues. A girl who did that would be so criticized by peers and other people that it is just far harder for girls to behave in that way,” says Helen Read, a consultant psychiatrist and ADHD lead for a large London NHS Trust.

She explains that girls are more likely to exhibit symptoms of hyperactivity by being over-talkative or rebellious, which may not be recognized by parents or teachers as signs of a medical condition.

According to experts, girls with ADHD are more likely to develop anxiety and depression later as adults.

Girls who have both inattentive and hyperactive symptoms (combined ADHD) are at a higher risk of doing self-destructive actions in adulthood. In a study started in the 90s, researchers followed 228 girls, 140 of whom had ADHD, for over two decades. When participants were on an average age of 19 and 25, researchers found that girls who had combined ADHD in childhood were at a higher risk of self-harm and attempting suicide.

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Adults with ADHD may have unpredictable behaviour and make impulsive or irrational decisions. They would often forget appointments and miss deadlines at work.

Treatments for adults with ADHD typically involve medication, education, skills training and psychological counseling. Following a combination of all these treatments is shown to get the most effective results. While these treatments may not cure the disease, it can help in management of symptoms.

Apart from treatment, knowing as an adult that the problems you’ve been facing throughout your life are not your fault and are caused by ADHD, can also be a huge weight lifted off your chest. Therapy that focuses on ways to better monitor your behavior can be very helpful in improving your relationships as well.