Five Reasons That ADHD Is Underdiagnosed in Girls

In the 1960s and 1970s, what we now call ADHD was referred to as “Hyperkinetic Impulse Disorder.” At that time, it was believed that the ratio of boys to girls who were diagnosed with this disorder was 6 to 1. The focus was on the hyperactive component. and it wasn’t until 1980 that “Attention Deficit Disorder” (A.D.D.) was added into the DSM-III. When this occurred, the criteria made it simpler to diagnose girls with ADHD, and by the time the DSM-III was released in 1987, it was believed that the ratio of boys to girls dropped to 3 to 1 rather than 6 to 1.

The newest information suggests that ADHD may be nearly as common in girls as in boys. While it’s still being diagnosed 3 to 4 times more frequently in boys than girls, girls continue to be underdiagnosed. There are many reasons for the underdiagnosis of ADHD in girls, including:  

  1. Anatomical brain differences. Girls’ brains develop earlier, which may account for some of the differences in diagnosis.
  2. Girls tend to be less active and disruptive than boys in elementary school. A common observation is that girls tend to be hyper-talkative rather than hyperactive. Often young girls with ADHD are simply identified as “social butterflies.”
  3. Fewer referrals for mental health issues at younger ages for girls. Possibly because ess aggressive and impulsive behavior is seen in younger girls, they tend to be less frequently referred for psychological evaluations and counseling. This changes as children move into their teenage years, when many girls are referred for issues of anxiety and depression.
  4. ADHD symptoms in girls may tend to be overlooked. Concerns such as forgetfulness, working memory issues, and daydreaming are often not a major issue unless the child is failing academically.
  5. Most of the research on ADHD has been conducted with boys. As a result, many of the symptoms are those seen primarily in boys.

Many of the symptoms of ADHD that are most prominent in girls are seen in difficulty with executive functions. The good news is that we can improve many executive functioning skills. One of the best strategies to help girls with ADHD is to approach it from the skill development perspective, where the goal is to improve a specific executive function. We have some great programs for girls with ADHD in our LearningWorks LIVE program. Check them out here.

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