By James J. Crist, Ph.D., author of What to Do When You’re Cranky and Blue

In the United States from 2011 to 2013, 9.5 percent of children ages 4–17 were diagnosed with attention deficit hyperactivity disorder (ADHD). More specifically, for kids ages 4–5, prevalence was 2.7 percent; for ages 6–11 it was 9.5 percent; and for ages 12–17 it was 11.8 percent.

However, the number of girls diagnosed and the number of boys diagnosed were significantly different. Among all age groups, the prevalence of being diagnosed with ADHD was more than twice as high in boys as it was in girls. While about 13.3 percent of boys were diagnosed with ADHD, only about 5.6 percent of girls received this diagnosis.

Not only is ADHD thought to be less prevalent in girls, but it is often harder to identify. Unfortunately, there are fewer studies on girls with ADHD so it is possible that ADHD in girls is more common than we realize. This post provides information about ADHD in girls as well as steps parents can take to identify it and successfully help their daughters with ADHD succeed in school and life.

Symptoms of ADHD
ADHD is a chronic mental health disorder that is characterized by persistent symptoms of impulsivity, hyperactivity, and/or inattention. It is most often diagnosed during childhood, but more adults are now being diagnosed and treated than before.

Behavior problems associated with hyperactivity are easier for parents and teachers to recognize. Inattentive symptoms are harder to pick up on. Adults may not realize that although students may look like they are focusing, they are actually daydreaming or zoning out. These students may be perceived as spacey or disorganized. Inattentive ADHD may not become apparent until students are unable to remember what they learned at school, forget to bring home the right materials, or get sidetracked while completing tasks at home.

Boys with ADHD more often have hyperactive symptoms while girls with ADHD more often have inattentive symptoms. As a result, ADHD in girls is often identified later than it is in boys.

In the book Understanding Girls with ADHD, Kathleen Nadeau, Ph.D., states that “there are many girls left undiagnosed because their symptoms look different” because “girls are less rebellious, less defiant, generally less ‘difficult’ than boys.” On the other hand, some girls with ADHD are more chatty, which can cause problems in the classroom. Others may be more hyperactive.

Other Problems Associated with ADHD
Being able to identify and treat girls with ADHD is particularly important. Girls with ADHD are at higher risk for other mental health disorders (such as anxiety disorders, learning disorders, or oppositional defiant disorder) that often lead to additional problems as they get older. These problems can include getting involved in abusive relationships, teenage pregnancies, poor grades, and drug abuse. Girls with ADHD are also more likely to be overweight, which may be a result of overeating as a way of coping with the stress of not being focused and the negative reactions of others. Also, girls are more likely to blame themselves for their problems or think that they’re not very smart because they struggle in school, which increases their risk for developing depression. As they go through puberty, hormonal changes can also worsen ADHD symptoms in girls.

Some girls with ADHD may have trouble maintaining friendships, something that most girls find fairly easy. If girls with ADHD are overly talkative, interrupt others too often, or have trouble paying attention to what others are saying, other girls may see them as bossy or socially inept and may exclude them from conversations and activities. Also, girls with ADHD may process conversations more slowly, so that by the time they think of a response, the topic has already changed. This can be very frustrating, leading girls with ADHD to avoid interacting with others.

Getting a Thorough Evaluation
Before concluding that ADHD is the problem, a thorough evaluation is recommended. Psychological testing can help determine if a girl has ADHD and if other problems, such as anxiety, depression, processing speed, or learning disorders, may be present that can either look like ADHD or make ADHD more challenging to treat. Seeing a pediatrician is also recommended to rule out medical conditions that may be causing problems. For example, some girls who have trouble focusing may actually have hearing or vision problems. Sleep problems can be a symptom of ADHD, but fatigue can also exacerbate ADHD symptoms.

Treating ADHD in Girls
Treatment strategies for ADHD are similar for boys and girls. Kids need help with organization, and many tools, including electronic devices, behavior charts, and checklists, can help. For example, setting alarms for getting up in the morning, getting ready for school, and doing homework can help kids keep track of time. Posting lists of tasks that need to be accomplished can reduce the chances of forgetting steps. Incentive systems can also provide motivation to complete tasks that are seen as boring, which is a common problem for kids with ADHD. Frequent praise for completing tasks, such as chores and homework, can help boost kids’ self-esteem.

Medication can make a big difference in allowing kids with ADHD to reach their full potential. However, medications can have side effects for some kids, so it is important to ask questions about any medications recommended for your daughter. Most medications wear off by the time a child comes home from school, which can make tasks such as completing homework and doing chores harder. Parents may need to adjust their expectations accordingly. Sometimes, extra medication after school can help.

How Parents Can Help
You can help your daughter by doing a number of things, including the following:

• Make sure she gets a thorough evaluation and an accurate diagnosis. Early intervention is key. Successful treatment can help prevent more serious problems as girls get older.
• Help your daughter with organizational strategies, such as keeping an agenda, cleaning out her backpack on a weekly basis, and making a plan for how to tackle homework and studying.
• Communicate with teachers more regularly to find out how your daughter is doing. Waiting until report card time may only set her up for failure. You need to know if your child is struggling sooner rather than later.
• Inform teachers of your daughter’s diagnosis. While some parents are hesitant about this, teachers who see a child’s inattention as due to ADHD rather than laziness or indifference are more likely to provide help and not to see your daughter’s problems as intentional.
• Provide frequent praise, especially for tasks that are difficult and require sustained attention, such as completing chores and homework.
• Break down larger tasks into more manageable chunks. You are more likely to get your daughter to successfully complete one smaller task at a time than by giving her a series of tasks all at once, which will feel overwhelming.
• Encourage your daughter to participate in activities that build her self-esteem, such as sports, chorus, theater, or anything else she may be interested in. Don’t make everything about schoolwork.
• Educate yourself about parenting strategies for kids with ADHD. Research shows that when parents are trained in these strategies, a reduction in symptoms of ADHD, and often in associated oppositional behavior, is seen.

Dr. James J. Crist is a psychologist specializing in children with ADHD, depression, and anxiety disorders. He is the clinical director and a staff psychologist at the Child and Family Counseling Center in Woodbridge, Virginia, where he provides psychological testing and individual, couples, and family psychotherapy for children, adolescents, and adults. Visit his website at jamesjcrist.com.

Free Spirit books by James Crist:

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Suggested Resources
4 ADHD, “Giving Girls the Attention They Need: What Parents Need to Know About Girls and ADD/ADHD”
Caralee Adams, “Girls and ADHD: Are You Missing the Signs?” Scholastic Teacher
Ellen Littman, Ph.D., “The Secret Lives of Girls with ADHD,” Attention
Kathleen G. Nadeau, Ph.D., “High School Girls with AD/HD,” ADDvance
Patricia N. Pastor, Ph.D.; Cynthia A. Reuben, M.A.; Catherine R. Duran, B.S.; and LaJeana D. Hawkins, M.P.H., C.H.E.S., “Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4–17 Years: United States, 2011–2013,” National Center for Health Statistics
David Rabiner, Ph.D., “ADHD/ADD in Girls” 

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