Attention deficit hyperactivity disorder (ADHD) is one of the most common conditions diagnosed in children. It’s a chronic mental disorder that causes various hyperactive and disruptive behaviors. Symptoms of ADHD often include difficulty focusing, sitting still, and staying organized. Many children show signs of this disorder before age 7, but some remain undiagnosed until adulthood. There are significant differences in how the condition manifests in boys and girls. This can affect how ADHD is recognized and diagnosed.

As a parent, it’s important to watch for all signs of ADHD and to not base treatment decisions on gender alone. Never assume that the symptoms of ADHD will be the same for each child. Two siblings can have ADHD yet display different symptoms and respond better to different treatments.

ADHD and Gender

According to the Centers for Disease Control and Prevention, boys are three times more likely to receive an ADHD diagnosis than girls. This disparity isn’t necessarily because girls are less susceptible to the disorder. Rather, it’s likely because ADHD symptoms present differently in girls. The symptoms are often more subtle and, as a result, harder to identify.

Research has shown that boys with ADHD usually show externalized symptoms, such as running and impulsivity. Girls with ADHD, on the other hand, typically show internalized symptoms. These symptoms include inattentiveness and low self-esteem. Boys also tend to be more physically aggressive, while girls tend to be more verbally aggressive.

Since girls with ADHD often display fewer behavioral problems and less noticeable symptoms, their difficulties are often overlooked. As a result, they aren’t referred for evaluation or treatment. This can lead to additional problems in the future.

Research also suggests that undiagnosed ADHD can have a negative impact on girls’ self-esteem. It can even affect their mental health. Boys with ADHD typically externalize their frustrations. But girls with ADHD usually turn their pain and anger inward. This puts girls at an increased risk for depression, anxiety, and eating disorders. Girls with undiagnosed ADHD are also more likely to have problems in school, social settings, and personal relationships than other girls.

Recognizing ADHD in Girls

Girls with ADHD often display the inattentive aspects of the disorder, whereas boys usually show the hyperactive characteristics. The hyperactive behaviors are easy to identify at home and in the classroom because the child can’t sit still and behaves in an impulsive or dangerous manner. The inattentive behaviors are often more subtle. The child is unlikely to be disruptive in class, but will miss assignments, be forgetful, or just seem “spacey.” This can be mistaken for laziness or a learning disability.

Since girls with ADHD usually don’t display “typical” ADHD behavior, the symptoms may not be as obvious as they are in boys. The symptoms include:

  • being withdrawn
  • low self-esteem
  • anxiety
  • intellectual impairment
  • difficulty with academic achievement
  • inattentiveness or a tendency to “daydream”
  • trouble focusing
  • appearing not to listen
  • verbal aggression, such as teasing, taunting, or name-calling

Recognizing ADHD in Boys

Though ADHD is often under-diagnosed in girls, it can be missed in boys as well. Traditionally, boys are seen as energetic. So if they run around and act out, it may be dismissed as simply “boys being boys.” Studies show that boys with ADHD report more hyperactivity and impulsivity than girls. But it’s a mistake to assume that all boys with ADHD are hyperactive or impulsive. Some boys display the inattentive aspects of the disorder. They may not be diagnosed because they aren’t physically disruptive.

Boys with ADHD tend to display the symptoms that most people think of when they imagine ADHD behavior. They include:

  • impulsivity or “acting out”
  • hyperactivity, such as running and hitting
  • lack of focus, including inattentiveness
  • inability to sit still
  • physical aggression
  • talking excessively
  • frequently interrupting other peoples’ conversations and activities

While the symptoms of ADHD may present differently in boys and girls, it’s critical for them to be treated. The symptoms of ADHD do tend to lessen with age, but they can still affect many areas of life. People with ADHD often struggle with school, work, and relationships. They’re also more likely to develop other conditions, including anxiety, depression, and learning disabilities. If you suspect your child has ADHD, take them to a doctor for evaluation as soon as possible. Getting a prompt diagnosis and treatment can improve symptoms. It can also help prevent other disorders from developing in the future.

You Asked, We Answered

  • Are there different treatment options for boys and girls with ADHD?
  • The treatment options for ADHD in boys and girls are similar. Instead of considering gender differences, doctors consider individual differences since everybody responds to medication in a different way. Overall a combination of medicine and therapy works best. This is because not every symptom of ADHD can be controlled with medication alone.

    - Timothy J. Legg, PhD, PMHNP-BC