Credit: Ben Michelman
Attention deficit hyperactivity disorder (ADHD) is harder to detect in girls than in boys. Julia Schechter, a clinical psychologist at the Duke Center for Girls & Women with ADHD in Durham, North Carolina, explains why girls with ADHD are harder to diagnose, and how undiagnosed girls face higher risks of bad outcomes than boys do, ranging from relationship issues to eating disorders and self-harm.
What are the current rates of ADHD diagnosis in women and girls?
In the past couple of years, there has been a rise in the number of women who have requested assessment and been diagnosed with ADHD. This means that the diagnosis rate in adult women is about the same as in men. However, there is a big discrepancy in diagnosis rates in children. The ratio differs depending on the study, but there are at least two to three times as many boys diagnosed with ADHD as girls1.
Nature Outlook: ADHD
Why are girls underdiagnosed?
In girls and women, ADHD tends to show up as inattentiveness — that is, difficulty remaining focused on a task, getting easily distracted or having trouble with organizing. Boys and men with ADHD, by contrast, characteristically display hyperactivity and impulsivity: they often fidget and have trouble staying seated. Girls can also have these symptoms, although they are less commonly reported. The latest research suggests that hyperactive behaviours in girls can show up as hyper-verbal tendencies, such as being excessively talkative2.
We also suspect that girls mask or downplay their symptoms. It might be that they have internal restlessness and a drive to be physically active, but that strong social pressures in the environment and in society more generally lead them to work extra hard to tamp them down. So, because their symptoms are less obvious or familiar to others, girls tend to not meet the diagnostic criteria.
Do we need better diagnostic criteria?
When we look at the studies that helped to inform the diagnostic criteria, most of the participants were male. This is problematic, because we cannot get a complete picture of the range of symptoms we might see across the sexes. We need more science to better understand how these symptoms present in everyone. The problem is circular. For example, researchers say that we need to study more girls. However, it can be difficult to enrol girls with ADHD in studies because they are diagnosed less often and are harder to find.
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