Boys might seem disruptive, while girls might seem inattentive, but ADHD isn’t a gender-specific condition
Editor’s note: This article is about how ADHD affects people differently based on their sex assigned at birth. We know language matters when it comes to inclusivity and representation of all people. In consideration of readability, this piece refers to women and people assigned female at birth (AFAB) using the terms “girls” (for those under 18) and “women” (for those over 18) regardless of affirmed gender identity. This article also refers to men and people assigned male at birth (AMAB) as “boys” (for those under 18) and “men” (for those over 18) for the same reason.
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Parenting is like a high-stakes adventure. No matter how many twists and turns you and your children face, your level of love and concern for their well-being is never shaken. You care about whether or not their peers will love and appreciate them. You worry about them succeeding in school, work and other areas of life. And when your child starts experiencing difficulties completing their homework, focusing in class or just sitting still for any amount of time, alarm bells may start ringing in the back of your mind.
“Am I doing enough for my child?“ you might ask yourself. “Should I become one of those helicopter parents who look over their kids’ shoulders as they work on their homework?“
“Is my child just shy and introverted? Or is there something else going on that makes them clam up and seem to avoid their responsibilities?“
“Maybe they’re just naturally rambunctious or acting out of aggression? Or is there something that’s making them feel scatterbrained?“
When these questions arise and there are no obvious answers in sight, parents often turn to one possible identifier for what may be causing these different behaviors: attention-deficit/hyperactivity disorder, or ADHD.
Before you find yourself falling down a rabbit hole of worry, know that ADHD is quite common in children. In fact, It’s the most common childhood neurodevelopmental disorder, with an estimated 6 million American children between ages 2 and 17 having received a diagnosis of ADHD.
And, depending on many factors, the kind of ADHD they have and the kinds of symptoms they experience or present can be incredibly different. And that makes diagnosis and treatment perhaps a little difficult if you’re unsure of what exactly you should be looking for.
Research suggests boys are more likely than girls to receive an ADHD diagnosis — but that doesn’t mean the condition affects more males than females. In fact, women are more commonly diagnosed with ADHD later in life — and girls may present different symptoms of ADHD from boys.
“ADHD symptoms in girls tend to be more subtle and less disruptive than ADHD symptoms in boys,” says pediatric behavioral health specialist Michael Manos, PhD. “As a result, ADHD in girls goes undetected for longer — if it’s diagnosed at all.”
Why are symptoms so often different between boys and girls? Is it because of genetics? Are there other external or internal factors at play when it comes to neurodevelopmental disorders? Or can anyone experience any of the symptoms associated with ADHD regardless of sex and gender? The numbers and the reasons may surprise you.
Before we dig into ADHD differences, it could be helpful to understand ADHD on a more holistic level.
Healthcare providers refer to the most recent American Psychiatric Association’s Diagnostic and Statistics Manual (DSM-5 or fifth edition) to screen for ADHD. For a child to receive an ADHD diagnosis, they must show a persistent pattern of certain behaviors. And the behaviors must affect a child’s ability to function in two or more settings, such as at home, school or work, with friends or in public.
When diagnosing ADHD, there are three types to consider:
In order to receive a diagnosis of either inattentive or hyperactive/impulsive ADHD, a child must exhibit at least six of the symptoms associated with either condition. To receive a diagnosis of a combined type, a child must exhibit at least 12 of the total behaviors. And these different types of ADHD all have different symptoms.
Hyperactive and impulsive ADHD behaviors in children include:
Inattentive ADHD behaviors in children include:
Research shows that girls are 16 times less likely than boys to receive an ADHD diagnosis and treatment. When girls do get diagnosed, some studies indicate they’re more likely to have the inattentive type of ADHD, while hyperactivity and impulsivity are more common in boys. But other studies suggest this is actually a common misconception, and more in-depth research is needed to determine the exact cause-and-effect relationship of sex differences and ADHD.
Researchers suggest that these sex and gender differences may be partially attributed to social and cultural influences. We as a society, tend to uphold specific stereotypes and expectations for the way young girls and boys should act and behave. And these perceptions may have a direct impact on which symptoms we tend to look for in boys vs. girls and how we perceive the severity of those symptoms differently.
For example, cultural stereotypes and gender-related behavioral expectations suggest that boys tend to be more aggressive, hyperactive and harder to manage than girls. In comparison, girls are shouldered with expectations to be more reserved, quiet and contemplative. When someone believes those stereotypes to be true — whether it’s the child themselves, a concerned parent or even a clinician who’s tasked with making a diagnosis — it could directly impact the nature of the diagnosis itself. And this often results in ADHD being underdiagnosed until later in life or overlooked completely — especially for girls and women living with any type of ADHD.
“ADHD isn’t a gender-specific condition,” notes Dr. Manos. So, a boy with ADHD may have trouble paying attention. And a girl with ADHD may struggle to stay in her seat.
So, why do some diagnoses slip through the cracks? Well, there are several factors to consider when deciding which behaviors are being manifested and what’s actually causing a disruption to a child’s well-being.
ADHD symptoms in boys are often considered disruptive and, therefore, more visibly noticeable — and it’s those symptoms specifically that people look for more often when diagnosing boys with ADHD.
“Parents and teachers are more likely to notice a child who squirms in their chair, constantly interrupts or can’t wait their turn,” says Dr. Manos. “The behaviors call attention to a child, often leading to an ADHD diagnosis early in elementary school.”
Because inattentive symptoms are harder to spot in general (given their internalized nature), boys who are naturally shy, quiet or follow the rules may have inattentive ADHD and still fly under the radar because they aren’t presenting what’s considered typical ADHD behavior for boys.
In comparison, the most common ADHD type in girls is thought to be inattentiveness. It’s more subtle and internal, unlike an external display of hyperactivity. Girls with ADHD may also be more likely to be verbally aggressive (making hurtful comments or teasing others) rather than physically aggressive like their male counterparts, notes Dr. Manos.
Because of these perceived differences, parents and teachers may dismiss a young girl’s inability to focus or pay attention as characteristic daydreaming or spacey-ness.
“Inattentiveness isn’t disruptive to a class or home life, which makes it easier to overlook,” adds Dr. Manos.
In addition, hyperactive or impulsive behaviors in a girl may sometimes be perceived as part of an overemotional or pushy personality — rather than a sign of ADHD — no matter how wrong that perception may be.
The important thing when it comes to these sex differences is to acknowledge that many of these observations lend themselves to gendered stereotypes and what we’ve come to expect in terms of how young girls should act in today’s society. And these stereotypes may play a large part in girls being underdiagnosed for inattentive ADHD until later in life.
ADHD in girls tends to become more noticeable during middle or high school. That’s when inattentive tendencies affect a child’s ability to stay organized and on task and complete assignments on time. A young woman with undiagnosed and untreated ADHD may really start to have difficulties when they begin college or get their first full-time job.
Girls with ADHD may also be more likely to:
Children who have the inattentive type of ADHD are less likely to receive a diagnosis at an early age, regardless of their sex or gender. This is especially true when a child is very bright.
“ADHD is more difficult to detect when a child is smart because they’re usually successful at finishing tasks — and they do the task well — even if they wait until the last minute,” explains Dr. Manos. “But they have to work twice as hard as their peers to pull it off.”
ADHD affects everyone a little differently. Regardless of sex or gender or ADHD symptoms or type, ADHD medications, combined with cognitive behavioral therapy (a type of psychotherapy), can help. Your child’s healthcare provider will recommend a treatment plan based on their age and symptoms.
A growing awareness among healthcare professionals, parents and teachers about the many ways ADHD can present in children — and how the condition can look different in boys and girls — should lead to earlier detection and care. And the more research we do into the field of sex and gender differences as it relates to ADHD, the more aware we can all be about embracing gendered stereotypes.
“Despite concerns that too many kids are diagnosed and treated for ADHD, our research shows otherwise,” says Dr. Manos. “Unfortunately, many girls and boys with ADHD don’t get any treatment, or the treatment doesn’t meet their needs.”
If you’re concerned about your child’s behaviors or symptoms, talk to your pediatrician who can guide you to the right care.
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