Why attention deficit disorder is diagnosed less often in girls

Attention deficit disorder with or without hyperactivity (ADHD) is a disorder that makes it unusually difficult for children to concentrate, pay attention, sit still, follow instructions and control impulsive behaviour. While all young children are sometimes distracted, restless and unresponsive to instructions from parents and teachers, children with ADHD behave in this way much more often than other children their age.

Their inability to calm down, concentrate and complete tasks in an age-appropriate way makes it very difficult for them to do what is expected of them at school. It can also lead to conflicts at home and difficulties getting along with their peers.

Unfortunately, the fact that girls are diagnosed less often than boys is not because they suffer less. Boys with ADHD generally display more outward and disruptive behaviours, such as hyperactivity and impulsivity, which may be more visible and lead to earlier diagnosis. Girls, on the other hand, may show less obvious and more internalised symptoms. They may be more prone to daydreaming, inattention and internal struggles, which can be easily overlooked or attributed to other factors, such as shyness or anxiety.

Late or missed diagnosis doesn't just mean that girls miss out on the academic services and accommodations that could help them succeed. Research shows that undiagnosed ADHD can compromise girls' and young women's self-esteem and, in some cases, their mental health. While boys with ADHD tend to take out their frustration and blame the 'stupid test', girls are more likely to blame themselves, turning their anger and pain inward. Girls with ADHD are much more likely to suffer from major depression, anxiety and eating disorders than girls without ADHD.

So why are girls still under-diagnosed?

• Prejudice: Societal expectations and gender bias can influence the perception and identification of ADHD symptoms. Girls are often expected to be more attentive, more organised and more compliant, which leads to their ADHD symptoms being underestimated or ignored. Gender stereotypes can create a prejudice that ADHD is a predominantly male condition, leading to girls being overlooked or misdiagnosed.

• Coping: Girls with ADHD may develop coping mechanisms to mask their symptoms or adapt to societal expectations. They may work harder to compensate for their difficulties, maintain good grades or appear more comfortable in society. These coping strategies can make it difficult to identify the underlying symptoms of ADHD, leading to a delay or absence of diagnosis.

• Medical knowledge: Historically, research and clinical guidelines have focused more on male samples and symptomatology, potentially contributing to the under-diagnosis of ADHD in girls. Assessment tools and diagnostic criteria may not take into account the unique manifestations of ADHD in girls, leading to an incomplete understanding of their experiences.

What should I look out for in girls?

• Inattention: Girls with ADHD may have difficulty maintaining attention, getting organised and completing tasks. They may frequently lose or misplace objects, have difficulty following instructions or concentrating on schoolwork.

• Hyperactivity and impulsivity: Although hyperactivity and impulsivity are often more pronounced in boys with ADHD, girls may still show restless behaviour or have difficulty sitting still for long periods. They may also interrupt conversations or have impulsive outbursts.

• Daydreaming and internal struggles: Girls with ADHD may frequently daydream or seem to be "in their own world". They may have difficulty regulating their thoughts and emotions, leading to internal struggles and anxiety.

• Social difficulties: Girls with ADHD may have difficulty making and maintaining friendships. They may have difficulty understanding social cues, interrupting others or being too talkative. They may also tend to be overly sensitive or react emotionally in social situations.

• Poor school results: Girls with ADHD may perform below their potential at school, despite having average or above-average intelligence. They may have difficulty organising themselves , managing their time and completing homework on time.

If you notice one or more of these factors, or if you have any doubts, consult your GP. You will also need to consult a doctor specialising in ADHD: paediatrician, neurologist, child psychiatrist, neuropsychologist (a specialist in disorders of cerebral functioning) in order to establish a precise diagnosis and prescribe appropriate therapies.