ADHD: Differences and Types

ADHD can look different in those born female and those born male. While the medical and scientific community is becoming more aware of these differences, and the importance of understanding them, public knowledge and understanding of the issue has lagged behind. As Quinn and Madhoo discuss in their article "A review of attention-deficit/hyperactivity disorder in women and girls: uncovering this hidden diagnosis", while data shows that young girls are seemingly less likely to have ADHD than boys (due to rates of diagnosis), we also know that women are more likely to be diagnosed later in life than men, meaning that the symptoms which girls have are being missed by parents, teachers, or other adults in their lives who could refer them to a doctor (also known as knowledgable informants).

What do you think of when you think of ADHD? For many of us, we likely think of children, first of all, who are loud, restless, and disruptive. While it is true that some kids with ADHD do present these symptoms, they are not the only ones that exist.

According to Healthline ADHD symptoms in boys tend to show as: "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". Healthline describes the symptoms in girls as: "being withdrawn, low self-esteem, anxiety, intellectual impairment, difficulty with academic achievement, inattentiveness or a tendency to “daydream”, trouble focusing,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".

One thing that I believe to be central to the differences between the symptoms in boys and girls is the amount of disruption they have the potential to cause. A common way that children are diagnosed is through referral to a healthcare provider, the suggestion for this often coming from people like teachers, who see the behaviors and intervene. When looking at these symptoms those that more commonly appear in boys such as physical restlessness and aggression, talking too much, and impulsivity, we can imagine how this would get more attention in something like a classroom setting as opposed to a girl, who may be daydreaming, or too anxious to participate in class, or who has trouble engaging socially with her peers. The latter symptoms, while still harmful to the child struggling, seem to be less likely to cause a disturbance or raise the concern of a teacher, and this could possibly be a reason for the lack of diagnosis for girls.

This idea, and others, are discussed and confirmed by Quinn and Madhoo in their study as well. In addition to the differences in sexes when it comes to ADHD, there are also three prominent types of ADHD. The CDC defines these types as Inattentive Type (difficulty focusing and organizing, following conversations, and being easily distracted), Hyperactive-Impulsive Type (restlessness, excess physical activity/movement especially in children, and interrupting), and third, Combined Type (equal symptoms from the other types). Quinn and Madhoo also discuss how girls tend to have the Inattentive type more often, further adding to the argument that their symptoms are simply missed or overlooked in childhood.

In order to improve the quality of life for young girls struggling with ADHD, it is important that their symptoms are recognized and that they are treated appropriately. Many girls are overlooked, and diagnosis does not happen until much later in life in many cases, and with the internalized, emotional symptoms that come with the symptoms that females tend to have, this can lead to the development of other psychological disorders such as depression and anxiety. To do this, we need to recognize symptoms in girls at the same rate we do boys, education for teachers and other knowledgeable informants is key to doing this.

References:

https://www.cdc.gov/ncbddd/adhd/facts.html#Types

Quinn, Patricia O, and Manisha Madhoo. “A review of attention-deficit/hyperactivity disorder in women and girls: uncovering this hidden diagnosis.” The primary care companion for CNS disorders vol. 16,3 (2014): PCC.13r01596. doi:10.4088/PCC.13r01596

https://www.healthline.com/health/adhd/adhd-symptoms-in-girls-and-boys