Why is ADHD Under-diagnosed in Girls?

People throw around the term ADHD pretty casually, perhaps when describing themselves as being forgetful, distractible, or excitable. Widespread assumptions about what this disorder looks like have led to misunderstandings about the criteria for diagnosis as well as what symptoms those diagnosed must deal with. So beyond the stereotypes, what even is ADHD? And why are boys around twice as likely to be diagnosed with this disorder than girls? 

Brief History of ADHD

In the early 1900s, what is now understood as ADHD was labeled hyperkinetic reaction to childhood, and noted as “an abnormal defect of moral control in children.” Children diagnosed struggled with hyperactive behavior while maintaining intelligence. In 1980, the disorder was renamed attention deficit disorder (ADD). Hyperactivity was not considered a common symptom at the time, and children could be diagnosed with it as a subtype. In 2000, officially titled ADHD, the three subtypes still in use today were established: predominantly inattentive type ADHD, predominantly hyperactive-impulsive type ADHD, and combined type ADHD. 


The rate of ADHD diagnoses has been steadily increasing. There are many theories as to why this might be the case. Some believe that as awareness of ADHD grows, more people are getting treated. Others believe that ADHD is truly becoming more common in the population. Another potential reason has to do with the changing diagnostic criteria.


Research and Diagnostic Disparities 

Recent studies support ADHD as an “equal-opportunity disorder,” affecting people at similar rates regardless of sex. Even so, the number of boys being diagnosed with ADHD is still disproportionately higher than girls. Although this rate has been approaching more of a balance over time, there is still a clear disparity. Perceptions of gendered roles and expectations seem to have a factor. Additional studies have shown that parents overrated boys’ hyperactivity and impulsivity levels while underrating girls’ hyperactivity and impulsivity levels as compared to objective interview with a clinician. These studies suggest that girls typically exhibit more emotional and behavioral problems associated with ADHD, and that the diagnostic criteria could be more expansive to meet their needs. 


Behaviors associated with the disorder seem to be more visible in boys than in girls. Where boys commonly present with symptoms more along the lines of stereotypes, including hyperactivity and lack of focus, girls present differently. Instead, ADHD often expresses itself in girls through excessive talking, poor self-esteem, worrying, perfectionism, risk-taking, and nosiness. 


Perhaps the biggest reason why ADHD is underdiagnosed in girls is that the vast majority of research on ADHD has been with boys. In a culture where boys and girls are raised very differently, it is important to get high-quality research that takes into account all of the potential factors that lead to an individual’s struggles, including sex and gender differences. 

It seems that the stereotypes around what ADHD is are based on what ADHD looks like most frequently for boys. Feeling self-conscious, perfectionistic, or lazy are all potential symptoms of ADHD, particularly for girls. Building awareness about the wide-ranging possibilities of this disorder can help more girls get the treatment they need. 


Does your child struggle with ADHD or executive functioning deficits? Want to help your child build up their executive functioning skills? Check out the EF classes we offer here!

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