Is it harder for girls with ADHD to be diagnosed?
By Claire Spreadbury
After plucking up the courage to confide in my daughter’s school that I was concerned she may have ADHD, I felt let down by the response. They seemed adamant there wasn’t the slightest of chance my 8-year-old could possibly have it, leaving me in a quandary as to whether I should make a bigger deal of it via the doctor, or park it and hope I’m wrong.
It might well be that she doesn’t have the condition, but it did get me wondering. My daughter has around half of the symptoms listed on the NHS website, but because she’s not struggling at school and doesn’t have the more disruptive symptoms – which can be more prominent in boys – her fidgety feet, forgetful brain and lack of listening have pretty much been dismissed.
So, can it be harder for girls with ADHD to get a diagnosis?
“Girls often show symptoms that are generally less ‘hyperactive’,” says Gabrielle Laycock, who was diagnosed with ADHD as an adult and now works with neurodiverse charities and brands like Equazen, to raise awareness of managing symptoms. “I think it comes down to the false assumption we have in our society that one size – the male size – often fits all.
“What is asked in diagnosis sessions in my experience seemed to be centred around more typically male experiences of ADHD. I remember being asked if I’d ever fallen asleep whilst working or being in a lesson at school, and answering no, knowing full well I have come very close, but social judgement stopped me from actually nodding off every time. Whereas males are generally judged less for this type of behaviour, especially in school.
“I initially received a ‘mild’ diagnosis of ADHD, even though specialists I’ve seen since have said there’s no chance I only have a mild form. Would I have received that same diagnosis if I’d lived a male perspective of ADHD? How many women have completely slipped through the net?”
Laycock went undiagnosed until 2018, going through school, university and her early career years with no support whatsoever. She only suspected she might have the condition after reading a magazine article on ADHD in girls, and noticing similarities to things she had always struggled with.
What exactly is ADHD?
ADHD stands for Attention Deficit Hyperactivity Disorder, and the core symptoms are hyperactivity, impulsivity, and difficulties with attention, notes Dr Maite Ferrin, consultant child and adolescent psychiatrist at Re:Cognition Health. “It’s the most common neuropsychiatric condition, affecting approximately 5% of children and adolescents, and 4% of the adult population worldwide.”
“There are three subtypes of ADHD – hyperactive-impulsive, inattentive, and combined, each of which has slightly different symptoms,” says Dr Louise Karwowski, head of science at Cognassist (cognassist.com). “Those with the hyperactive-impulsive subtype are most likely to fit the stereotype of ADHD (they might move around a lot, fidget or struggle with self-control). Those with the inattentive subtype often make careless mistakes, and struggle with concentration and organisation. And people with combined-type ADHD have characteristics of both.”
Getting a diagnosis
“ADHD is diagnosed three times more often in boys than girls, and boys are usually more frequently referred to child and adolescent mental health services,” Ferrin says. “This is because symptoms of hyperactivity and impulsivity are more pronounced, and because boys usually present with more externalising symptoms, such as aggression, defiance and conduct problems.
“Girls with ADHD usually present with less aggression and more internalising symptoms, such as anxiety, depression, and increased rates of self-injury and suicidal attempts.”
It seems unfathomable that medical diagnosis could be suffering from gender issues but Karwowski also says: “As girls tend to present in particular with the inattentive type, there can be a delay in diagnosis, as they are thought to be shy, withdrawn or passive, rather than having ADHD.”
She continues: “The problem is made worse by the fact that the bulk of ADHD research has been conducted on boys and men. Generally speaking, boys will show symptoms very early in life, and see a decrease in symptoms at puberty. The opposite is true for girls, whose symptoms may be exacerbated by increasing levels of oestrogen. This means they are less likely to meet the classic diagnostic criteria (which used to specify that symptoms were present by age seven).”
What is inattentive ADHD?
The signs of inattentive ADHD in girls (and boys) can be subtle, especially if they’re high-functioning, says Dr Hayley Van Zwanenberg, consultant child and adolescent psychiatrist at Priory’s Oxford Wellbeing Centre. “Young people with inattentive ADHD might make more careless mistakes at school than others, as they’re not reading the questions properly. They might seem like they’re daydreaming and not listening. They might take longer to complete a piece of work, or forget to hand it in. They can be disorganised and not follow a task through, and they can be thought of as quite messy.”
What should parents who are worried about ADHD do?
All experts strongly advise talking to your child’s school and teachers over any concerns you might have, and if that doesn’t get you anywhere, then go through your GP.
“When it comes to your child’s education and how they will cope in the school environment, it’s crucial that you speak to the school about the worries you have, and the support your child is going to need. The chances are, your child’s teacher may have already picked up on an issue, however, things can slip through the net, so don’t be afraid to approach the school and discuss your worries with them,” Karwowski continues.
“The best thing you can do is make the school aware of the situation and work with them on a plan to support your child. Ensure that you accept your child has a learning difficulty, be supportive and understanding. Be open and encourage conversation around differences in learning and thinking.
“A parent can be a huge support and motivator if they use a positive approach to build the child’s confidence and resilience. It may take a while, but the results can be life-changing.”