ADHD and Girls
Differences in ADHD Presentation
ADHD doesn't always look the same in girls as it does in boys. While boys with ADHD are more likely to exhibit
hyperactive and impulsive behaviors that are easily noticed, like running, climbing, or being disruptive, girls often present with inattentive or internalized symptoms.
Inattentive Presentation: This is more common in girls and can manifest as being quiet, daydreamy, or "spaced out". They may forget instructions, misplace items, and struggle to start or finish tasks. Teachers might describe them as "quiet," "dreamy," or "a bit disorganized" rather than disruptive. *
Hyperactive Presentation: For girls, hyperactivity often shows up differently. They might be overly talkative, fidget in socially acceptable ways like twirling their hair, or be described as "lively" or a "social butterfly".
Masking: Many girls with ADHD are good at masking or hiding their symptoms to fit in and meet social expectations. This can lead to exhaustion, anxiety, and delays in diagnosis.
ADHD and Hormones
Hormones play a significant role in how girls and women experience ADHD. The majority of existing research on ADHD has been conducted on boys, who have more stable hormone levels, so the impact on girls is often overlooked.
Menstrual Cycle: The fluctuation of hormones, particularly estrogen and progesterone, throughout the menstrual cycle can impact ADHD symptoms. Estrogen affects dopamine levels, and when it drops (around day 14 and during the luteal phase), ADHD symptoms can worsen and medication may become less effective. This can lead to increased emotional volatility and executive function challenges.
Other Hormonal Changes: Other significant hormonal periods, like puberty, can also intensify symptoms, making inattention, impulsivity, and emotional swings more pronounced due to changes in estrogen and progesterone affecting dopamine.
Challenges in Diagnosis
The average age for a girl to be diagnosed with ADHD is 35. This late diagnosis is often due to several factors:
Cultural Factors: Girls are often expected to be quiet and compliant, so their struggles may be dismissed as "personality quirks". The stereotype of the "hyperactive boy" with ADHD means that inattentive or internalized symptoms in girls are often unrecognized.
Diagnostic Criteria: The symptoms and impact of ADHD must be observed across various areas of a person's life for a diagnosis. For younger girls, the impact may not be as obvious because they are able to overcompensate and mask their symptoms.
Misdiagnosis: Girls are often diagnosed with anxiety and/or depression before being diagnosed with ADHD, as many of the symptoms can overlap, such as fidgeting and restlessness.
High-Impact Strategies for Support
While ADHD is different for every person, there are various low-effort, high-impact strategies that can help support girls with ADHD.
Environmental Adjustments: Creating a sensory-supportive environment can help reduce overstimulation. This includes considering lighting, noise levels, and visual clutter.
Mindful Communication: Since many people with ADHD experience Rejection Sensitivity Dysphoria (RSD), it's important to communicate with care. Instead of labeling or criticizing, focus on finding solutions together. For example, instead of saying, "You're so disorganized," try, "How can we make this system work better for you?".
Practical Strategies: Providing support strategies for executive functions can be incredibly helpful. These include:
Cognitive Support: Using fidget toys or wobble cushions, allowing movement breaks, and using dictation or oral presentations.
Organizational Support: Chunking tasks into smaller steps, using visual timetables and checklists, and providing digital or physical reminders.
Social Support: Teaching social skills, like active listening and non-verbal cues, and helping them find activities that allow them to use their strengths.