Does ADHD Look Different in Boys and Girls?
By Dr. Mary Rooney, Ph.D.
For decades, ADHD was thought to be a condition that primarily affected boys and was characterized by impulsive and disruptive behavior and difficulty staying focused at school. It was also believed that, in most cases, kids with ADHD would outgrow their symptoms once they became teenagers or adults.
Fortunately, over time, our understanding of ADHD has evolved. We now recognize that ADHD affects girls as well as boys, continues into adulthood for most individuals, and, in some cases, can present predominantly as symptoms of inattention and disorganization with little to no hyperactivity or impulsivity.
In recent years, there has been an increased focus among researchers and clinicians on the differences in the way ADHD shows up and is diagnosed in boys and girls. Being aware of these differences is important for parents and teachers who can help make sure that kids with ADHD can get the treatment they need as early as possible.
Differences in Rates and Age of Diagnosis
It is now widely acknowledged that ADHD is a disorder that affects girls as well as boys. Yet boys continue to be diagnosed with ADHD and referred for treatment at a much higher rate than girls, with estimates of the ratio of boys to girls with ADHD ranging from 2:1 to 13:1, depending on which study you consult. While these ratios suggest that ADHD shows up more often in boys, it may actually be the case that it shows up just as often in girls, but is less severe or less likely to be diagnosed in girls than in boys.
Differences in Symptom Presentation
Girls with ADHD are more likely to experience the symptoms of inattention and disorganization associated with ADHD, and are less likely to experience severe hyperactivity and impulsivity symptoms. In contrast, boys are more likely to have high levels of hyperactivity and impulsivity, as well as symptoms of inattention and disorganization. Since boys with ADHD tend to cause more disruption in the classroom because of their hyperactive and impulsive symptoms, they are referred for evaluations earlier and more often than girls with ADHD.
Differences in Rates of Co-occurring Mental Health Conditions
Disruptive behavior disorders, like Oppositional Defiant Disorder, are the most common mental health conditions diagnosed in kids with ADHD. However, these conditions are found at much higher rates in boys with ADHD than in than in girls with ADHD. In contrast, girls with ADHD are more likely to internalize their thoughts and feelings and develop anxiety and mood disorders. These internalizing disorders often go unnoticed by teachers and parents because they aren’t always accompanied by challenging or disruptive behavior.
Differences in Social Difficulties
Most kids with ADHD experience some challenges with making and maintaining healthy friendships, but the challenges often look different between boys and girls. Boys with ADHD may struggle because other kids find their hyperactivity and impulsivity too intense. Classmates and friends may actively avoid and exclude boys with ADHD from group activities. In contrast, girls with ADHD who have few hyperactive or impulsive symptoms may have difficulty initiating conversations with other kids. They may hang back and behave passively in group settings, have a hard time picking up on subtle social cues, and struggle to understand complex social interactions. As a result, they may be overlooked or ignored by their peers, and feel left out or different without understanding why.
Differences in Efforts to Hide or Mask ADHD Symptoms
Boys with ADHD struggle in academic and social situations, but they often don’t go to great lengths to hide their symptoms. This is probably due largely to the fact that as a society, we tend to take a ‘boys will be boys’ attitude toward their behavior and academic performance. As a result, their symptoms are obvious to their teachers and parents.
In contrast, girls with ADHD also struggle in academic and social situations, but often go to great lengths to mask their symptoms. As teenagers, they may become perfectionistic to compensate for their organizational difficulties, or they may spend hours taking notes and preparing for a test just so they can perform as well as their peers who only studied for a fraction of the time. They may also work hard to fit in with their classmates by closely observing and copying their behavior. While these strategies may make it harder for others to notice a girl’s ADHD symptoms, they can contribute to the development of anxiety and depression.
While there are many differences between boys and girls with ADHD, there are similarities as well. Both struggle to pay attention, stay organized, and keep up academically and socially with their peers. Early diagnosis and treatment are extremely valuable for both boys and girls with ADHD, and effective interventions can improve their symptoms at school and at home. If you think your child is showing signs of ADHD, reach out to their pediatrician to learn about ADHD evaluation and treatment options in your area.
ABOUT DR. MARY ROONEY
Mary Rooney, Ph.D., is a licensed clinical psychologist in the Department of Psychiatry at the University of California San Francisco. Dr Rooney is a researcher and clinician specializing in the evaluation and treatment of ADHD and co-occurring behavioral, anxiety, and mood disorders. A strong advocate for those with attention and behavior problems, Dr. Rooney is committed to developing and providing comprehensive, cutting edge treatments tailored to meet the unique needs of each child and adolescent. Dr. Rooney's clinical interventions and research avenues emphasize working closely with parents and teachers to create supportive, structured home and school environments that enable children and adolescents to reach their full potential. In addition, Dr. Rooney serves as a consultant and ADHD expert to Huntington Learning Centers.
ABOUT HUNTINGTON
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