Female Factor—Why ADHD is often overlooked in girls

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Female Factor
Why ADHD is often overlooked in girls by Catherine Winters

Many girls who could benefit from treatment for attention deficit hyperactivity disorder (ADHD may be falling through the cracks. Here, psychologist Kathleen G. Nadeau, Ph.D., author of Understanding Girls with AD/HD, explains what parents need to know about girls with this affliction.

Q: Why is ADHD sometimes missed in girls?
A: Their struggles are silent. They are not bothering parents and teachers as much as boys with ADHD. Girls are less likely to have behavioral problems in the classroom. They’re more likely to be hypertalkative rather than hyperactive. And some girls with ADHD and very quiet and shy. Often, they don’t fit the diagnostic criteria, which say you can’t have ADHD unless you are diagnosed by age 7.

Q: What special challenges do girls with ADHD face?
A: Girls with ADHD can do pretty well in elementary school. But their ADHD becomes more problematic at puberty, when hormone levels begin to fluctuate. Also, in middle school demands for time management and organization increase, and girls with ADHD can feel overwhelmed; their grades might start falling. And because social relationships are so important for females, it’s painful when girls don’t fit in. Sometimes their too aggressive or opinionated, or are socially awkward. They’re at high risk for teen pregnancy or sexually transmitted diseases, and may be more likely to smoke. Many may self-medicate with food and are terrified they are going to get fat, so we’re also looking at eating disorders in girls with ADHD.

Q: What should parents of a girl watch for?
A: Parents should pay attention to whether their school-age daughter is messy, disorganized, forgetful or easily distracted. Girls with ADHD may have difficulty leaving on time or being on time. They may procrastinate or have feelings of overwhelming anxiety as they have more and more difficulty keeping up with the demands of daily life. Many become extremely emotional and argumentative.

Q: How can girls get diagnosed?
A: Many more girls—and women—are coming in for treatment. You still see a higher percentage of females in treatment than in studies, however, since research studies must strictly adhere to diagnostic criteria that aren’t appropriate for females. But those criteria are being revisited. Two huge issues need to be addressed—how to better identify adults with ADHD, and how to better identify females. I think—and hope—we are going to see a different set of diagnostic criteria for both groups.

About Out Expert
Kathleen G. Nadeau, Ph.D. is director of the Chesapeake ADHD Center of Maryland in Silver Spring.

—Medzine’s Healthy Living, Thrid Quarter 2007

Thank you so much for posting this. I am one of those girls that lived life with the stigma of being "just a little odd and totally disorganized" but nothing was ever mentioned. I am now 39 and was just diagnosed a few months ago. My daughter is 6, has received the same diagnosis and there is so much that we can do to make her life easier than mine was.

I am currently reading "Women With Attention Deficit Disorder" by Sari Solden. It has been extremely helpful and I recommend it to any woman who has ADHD or who has a daughter with it.

my daughter was dx-ed as ADHD~hyperactive impulsive type in the Fall of 2006....still not so sure i agree with the dx of ADHD (vs. Aspergers).

Now this has got me wondering if I might have co-morbid ADHD as I was and am very disorganised in a lot of areas including being on time, having my belongings organised, and started panicking and feeling overwhelmed by the demands of life in adolescence.

Personally, I don't consider this article to be the final athority on this issue, just a starting point. Pursue your own investigations and come to your own conclusions.

Hi Pandora, I recommend you get a diagnosis but research different centres to try and gauge their knowledge of Adult ADHD and ASD. The reason being is Adult ADHD is actually poorly recognised, I warn you now.

I am co-morbid ASD and ADHD with bad executive dysfunction, I’m currently seeking referrals for other dysfunctions outside. I’m completely inattentive type and not hyperactive. When ASD and ADHD mix it can be messy. Executive problem occur in both, it is quite a broad area. I am ADHD because I meet the current diagnostic requirements of it, but that is not the whole picture.

I'm not a girl but I think this article in part implies to me. It is similar reasons why it took till 25 years old to figure out by myself. I also curse my verbal skills, which made seem normal on the surface. Still I sort of hate all articles like his because I’m sort of on the far end bordering on a category of its own so the typical things don't really apply. I guess it is ok because three is not enough of us, not that I know anyone at all.

Last edited by 0_equals_true on 31 Jul 2007, 10:04 am, edited 1 time in total.

Think I might get that book, I don't have a daughter but I have AS and ADHD and really bad executive functioning issues and it's really not making life easy for sure. Thanks for the book recommendation. So tired of not being able to get things done and the stress it puts on the family.

Thanks for that. I think if I were ADHD, it would be the inattentive type. I'm certainly not very active, except very occasionally.

The executive dysfunction could be exacerbated by the co-morbid depression.

It could be that way. I know the anxiety can be depression driven or anxiety can cause the depression, it can hard to say sometimes. That wasn't relevant to executive dysfunction except my cognitive dysfunction and ASD caused me to be overwhelmed and caused mental heath problems, which I spent a long time working on and is much more under control but could easily come back.

They have to be able to distinguish from Major depression, Bi-Polar, OCD as they can have an ADHD appearance. That is not to say you don’t have both. Simply speaking ADD is not eposodic, it a neurological imbalance that is a problem all the time.

Chances are if you are like the average ADD, you will have a little executive dysfunction and mostly inattentiveness, which is seperate. I'm not belittling the executive dysfunction of the average ADDer, I'm just putting it in perspective the way it was explained to me. See the drugs for ADD working on the attention problem not the executive dysfunction. But by virtue of being more focused it should improve things. Then you can have things like ADHD coaches to try and help you plan your life.

In my case he said these drugs I'm on won't be able to help me with me executive dysfunction as they wouldn't anyway. My ED is likely much bigger than my attention problem. So chances are these drugs won't be enough or any ADHD specific drugs. There isn't much they can do. He said that he may have to try Aricept, which is a drug used on Alzheimer's patients. It is quite a new application. There aren’t really that many cases of people with ADD/Executive dysfunction being on it.

Just to make clear executive function is a broad area, the area to do with emotions such as ‘empathy’ can respond to some antidepressants apparently.

People who primarily have inattentive ADD (without hyperactivity) will go unnoticed by the system and their selves. Especially students who are fairly advanced academically. A person with inattentive ADD will daydream or draw pictures when they are supposed to be doing work. But again if they are fairly advanced they might be able to get there work done super fast(even if its average) and never get noticed by the teachers.

I can remember finishing a test insanely fast in 4th grade and then turned it in and started reading a comic book. The teaching became mad. But the only thing she really could challenged me on was my bad handwriting as I had all the right answers. I got a note and whipped at home for it.

Wonderful! It's my daughter in a nutshell!

TheMachine1, I was like that at school - fairly good academically but used to doodle and daydream in class. When I struggled with a subject, I tended to spend the lesson looking busy but not really doing anything; but because I was quiet, the teacher didn't notice the problems.

The issues with executive dysfunction only became really obvious when I left home for the first time and couldn't use a phone, arrange travel for myself and wasn't eating properly. During all that time, I was still doing reasonably well academically, but had intermittent bouts of severe depression.