When you picture a child with ADHD, a few images may come to mind: A kid who doesn’t ever seem to sit still. A child who can’t stop interrupting the teacher or goofing off in class. A C- and D-student who never manages to finish a single homework assignment.
Symptoms like these are easy to spot, but they’re also much less common for girls with the disorder. And that’s why their parents, teachers, and others have a harder time knowing when they have it, says Michael Manos, PhD, head of the ADHD Center for Evaluation and Treatment at Cleveland Clinic.
“Kids who have problems with attention rather than hyperactivity, on the other hand, are barely noticed, and yet those ADHD symptoms are much more prevalent in girls than in boys.”
What ADHD Looks Like in Girls
Boys with ADHD tend to have a lot of behavior problems, and the key issue is often how their disorder affects others, says Patricia Quinn, MD, co-author of Understanding Girls with ADHD. With girls, it’s more about how their disorder affects themselves.
Rather than troublemakers, girls with ADHD tend to be daydreamers. “Your daughter may do what she’s told, but she might have difficulty focusing, paying attention, or finishing her work,” Manos says.
Still, bad grades aren’t always a telltale sign. “Girls sometimes continue to do well in school, particularly if they’re very bright or hard working,” Quinn says. “They compensate. Parents might not realize there’s a problem, but the girls recognize that they need a lot more help than anyone else, and they realize that they’re different.”
If schoolwork or other tasks just seem harder for your daughter than they do for other kids -- if she’s staying up late doing homework, if she’s only able to study when conditions are “just so,” if she’s dreading going to school -- those are signals that there may be something going on, Quinn says.
Beyond Behavior and Attention
Although girls’ ADHD symptoms are more likely to be overlooked than boys’, it doesn’t mean the disorder affects them less. Studies have shown that girls with ADHD have a harder time than boys in some ways. They’re more likely to have anxiety and depression, as well as low self-esteem.
“A girl without ADHD might not be able to play volleyball as well as other girls, but she doesn’t necessarily infer that there’s something wrong with her,” Manos says. “Girls with ADHD, on the other hand, tend to be more self-critical.”
As a result, Quinn says, self-injury, eating disorders, and even suicide attempts are more common among girls with ADHD than among girls without. “So getting a diagnosis is very important, even if your child is able to compensate,” she says.
Getting a Diagnosis
There’s no single test to diagnose ADHD, and symptoms can be hard to untangle from “normal” childhood behavior. If you think your daughter might have ADHD, it’s important to find a doctor or health care professional who has experience diagnosing it, especially in children. You can talk first to your child’s pediatrician, who may also refer you to a mental health specialist, like a child psychiatrist or psychologist.
The specialist will ask you about your daughter’s behavior and watch how she acts during different activities. He may also check with other adults who know your daughter well, like her teachers, tutors, or coaches.
It’s important to take a broad look at how the disorder might affect her.
“We need to ask about every type of symptom, not just the ones that we’re most likely to see, or the ones we expect to see,” says Dave Anderson, PhD, senior director of the ADHD and behavior disorder center at the Child Mind Institute. “Sometimes we don’t ask the right questions, just because we don’t think that young girls are as prone to those issues as they actually are.”
Also, keep in mind that there will be times when your child may seem perfectly attentive. “Parents often see their child is able to focus during certain activities, like playing video games or chatting with a friend, and assume they can’t have ADHD,” Anderson says. “We’re looking at a child’s ability to pay attention during tasks they find boring or that require a lot of effort, and then how that affects their day-to-day functioning.”