ADHD Weekly, March 2, 2023

Congress first designated March as National Women’s History Month in 1987—a month to remember and celebrate the often overlooked historical achievements of American women. Historically, too, women and girls have been overlooked when it comes to evaluation and treatment for ADHD. Research focused on ADHD in boys, while the experiences of girls were ignored or dismissed. Girls today are half as likely to be diagnosed with ADHD than boys.

The historical lack of research on and consideration of females with ADHD has contributed to the large number of girls who silently struggle. Many of them may be misdiagnosed with another condition that shares similar symptoms or they remain undiagnosed until adulthood. Focusing on ADHD during Women’s History Month presents an opportunity to raise awareness of how ADHD uniquely affects girls and women. It reminds us of the work that still needs to be done to make sure every female who needs help and support receives it.

“If we are recognizing the accomplishments of women and the adversity women have had to face, it’s important to remind ourselves of how the diagnosis and treatment in women has lagged that of men,” says Maggie Sibley, PhD, clinical psychologist at Seattle Children’s Hospital and a member of CHADD’s professional advisory board. “We still have a lot further to go in terms of making advancements in the adequate care of women with ADHD compared to men with ADHD.”

A look back

The early diagnostic criteria emphasized the symptoms of hyperactivity, which tend to show up earlier and more often in boys. Girls more commonly display the symptoms related to inattention, and so they did not appear to fit the model created when researchers observed ADHD in boys. For girls and women, the natural hormone fluctuations can play a role in symptoms and can affect sleep, mood, and thought processes says Ellen Littman, PhD, a clinical psychologist.

“For many girls, behavioral issues blossom around puberty, as estrogen levels increase,” Dr. Littman says. Therefore, girls may not show symptoms of hyperactivity until their tween years.

Cultural expectations for boys and girls are another contributing factor, according to Dr. Littman. Many girls internalize their struggles, while boys tend to display their emotions outwardly. Girls will spend years trying to compensate for their symptoms, and the stress of doing so can lead to issues with self-esteem, anxiety, and depression. Girls may not receive a diagnosis until they reach adulthood when their responsibilities increase—at home, at work, and in social activities—making their ADHD symptoms unmanageable.

“ADHD symptoms in girls are uniquely associated with virtually every domain of impairment—from academic engagement/learning to friendships with peers, strained family relationships, self-concept, vocational achievement and ultimately, suicidal thoughts and behaviors,” writes researcher Stephen P. Hinshaw, PhD, and colleagues in his annual review of research on girls with ADHD. These widespread effects illustrate the importance of early intervention for girls and women with ADHD.

Bridging the gap

Dr. Sibley says better education for healthcare providers can bridge the gap between the numbers of girls and women who have been diagnosed and those who are yet to be evaluated. Educating providers specifically on what ADHD in girls looks like and what it doesn’t look like is important in reaching and helping struggling women and girls.

“We need more research on girls and women with ADHD so we can create a knowledge base where one is currently lacking,” she says.

Given the lack of research on the experiences of girls, it may be challenging to find a doctor who understands the unique issues girls with ADHD face. Dr. Sibley recommends that you first talk with your primary care doctor or your daughter’s pediatrician, letting them know that you suspect ADHD may the cause of these difficulties. If the medical professional thinks the question of ADHD needs to be investigated further, she says, they can refer you to a specialist.

As telehealth becomes more prevalent and standardized, more options are available for diagnosis and treatment. Dr. Sibley says she is hopeful that better education, research, and greater awareness will help girls with ADHD receive a more timely diagnosis and better treatment options before greater difficulties and health concerns occur.

“We are in a moment that will go down in history as the time when we started to break gender barriers in terms of adequate healthcare for women with ADHD,” Dr. Sibley says. “A lot is changing, a lot is being revealed by research, and a lot of experiences are being shared online. In the next ten years there will be a lot of advances. We will be able to conduct new research and provide training for providers to get women the care they deserve.”

Learn more about ADHD in women and girls:

• Women and Girls with ADHD
• Principles for Parenting a Girl with ADHD
• The Secret Life of Girls With ADHD
• Inattentive Women with ADHD
• Girls Need Support When It Comes To ADHD
• Raising Girls with ADHD
• Gender Myths & ADHD
• Number of Women, Girls Filling ADHD Prescriptions Increases
• CHADD Podcasts: Women and Girls with ADHD Playlist

Join the discussion: How can professionals better identify and assist women and girls who have ADHD?