Parents, educators, and health professionals are used to looking at ADHD from the perspective of disruptive and disorganized school-age boys. The red flag goes up when they see kids who are hyperactive, inattentive and/or impulsive. But girls with the condition often don’t fit that stereotype. Instead, the core characteristic of ADHD among females is “emotional dysregulation,” the inability to manage hard-to-control emotions that shows up as tantrums, meltdowns, and generalized self-harm.
Because girls with ADHD don’t fit the male ADHD stereotype, they fly under the radar, explains Dr. Lotta Bork Skoglund, a renowned expert on girls with ADHD. As a result, they are frequently underdiagnosed or misdiagnosed leaving them without early treatment, which can put them in harm’s way for serious impacts in their adolescent and young adult years.
“Going through puberty,” says Skoglund, “teenage girls with ADHD can spiral down a rabbit hole of inner turmoil, sinking self-esteem, and self-doubt.” Too often they show up in healthcare settings with an array of academic, social, psychiatric, and mental health issues, injuries, traumas, victimization, suicidal ideation, and addictions (nicotine, alcohol, drugs, gambling, gaming, shopping, social media)—all manifestations of their emotional dysregulation, co-existing conditions, and risk factors associated with ADHD.
Research shows that without proper support, females with ADHD have an eight-to-ten-year reduced life expectancy.
Misdiagnoses Means Mistreatment
Skogland points out that when clinicians see a girl with social anxiety, social failure, feelings of sadness, or rejection sensitivity dysphoria (RSD), they look for causes such as bullying, peer rejection and isolation, trauma, poor sleep quality, stress, or a principal diagnosis of depression or anxiety. They may recommend school counseling or family therapy or prescribe antidepressants, anti-anxiety or sleep disorder meds, or mood stabilizers—none of which address her ADHD.
Clinicians frequently fail to recognize that those problems are due to ADHD. Girls with ADHD are bullied and rejected by peers more often than boys and suffer more undesirable emotions, anxiety, and depression because of their ADHD. In other words, a girl’s underlying ADHD is the root cause for those other problems. But when professionals overlook ADHD as a girl’s primary diagnosis, they neglect to prescribe first-line ADHD-specific medications and other necessary supports, leaving her without the treatment she needs most.
What You Can Do
In addition to raising your awareness of the unique challenges girls with ADHD face, Skogland recommends that you familiarize yourself with the differences between ADHD in girls and boys, as well as the pitfalls girls face in the diagnostic and treatment process. Below are recommendations to ensure that your daughter with ADHD gets a timely, accurate diagnosis and appropriate treatment.
- Know what to look for. Girls with ADHD are more likely than boys to experience inattentive ADHD, show fewer “externalizing” symptoms (e.g. disruptive behaviors), struggle with more serious depression and anxiety, be overwhelmed by hormonal variations, and develop lower self-esteem. They realize what’s expected of them in school and social settings earlier than boys, long to please others, and develop strategies to mask their ADHD symptoms to fit in better. For example, girls are frequently perfectionists who feel obligated to do well in school: They may work three times as hard as their peers; spend extra hours preparing for class; check their backpacks obsessively to make sure everything is in order; or beg family members for help completing a project overnight because they procrastinated, are too overwhelmed to complete it themselves, and need it to be perfect.
- Once there is an ADHD diagnosis, insist on further evaluations. Clinicians typically neglect to diagnose and treat a girl’s co-existing conditions in addition to her ADHD. But “co-morbidity is the rule rather than the exception,” says Skoglund. Girls with ADHD are at higher risk for mental health and psychiatric conditions that include emotional dysregulation such as anxiety, depression, mood disorders, sleep and eating disorders, bipolar disorder, autism, borderline personality disorder, substance abuse disorder, and self-harm, as well as learning disabilities. Furthermore, girls with ADHD are twice as likely as boys to suffer from depression, and they have more anxiety, depression, mood disorders, and impaired self-esteem than girls without ADHD. By overlooking girls’ specific co-occurring conditions, clinicians do them a serious disservice.
If you have a daughter who exhibits several of the symptoms below or you have concerns that she might have undiagnosed or misdiagnosed ADHD, seek a professional who has expertise in diagnosing and treating females with ADHD:
This article is based on the ADDitude webinar, The Emotional Lives of Girls with ADHD, by Lotta Borg Skoglund, M.D., Ph.D. Eve Kessler, Esq., a former criminal appellate attorney, is President of SPED*NET, www.spednet.org, and a Contributing Editor of Smart Kids.
