ADHD and Girls

Attention-deficit/hyperactivity disorder (ADHD) is one of the most diagnosed psychiatric disorders in children and is typically associated with a marked level of inattention, impulsivity and hyperactivity. These seemingly straightforward symptoms can impact virtually all areas of the child’s life. Fortunately, however, ADHD is typically viewed as a brain difference, not a defect (Rapport, 1995), and can be managed and even leveraged to one’s advantage in certain tasks and settings.
Since ADHD afflicts three times more boys than girls (Ohan, 2007), the majority of research on ADHD has focused on males. Because of this focus on ADHD in boys, girls as a population have tended to be under-diagnosed. Additionally, girls tend to experience broader and deeper symptomology related to their ADHD than do boys, so the symptoms associated with male ADHD are not always adequate to describe female ADHD.
The Additional Risks Among Girls
Research indicates that ADHD among girls may develop into a broader range of problems than ADHD among boys.
1. Increased Risk for Eating Disorders
Girls with ADHD are at a higher risk for developing an eating disorder than the general population (Mikami, 2008). Mikami’s research indicates that this increased vulnerability to eating disorders may be due to the increased level of impulsivity among girls with ADHD. Girls with ADHD are also more likely to be overweight and have increased peer difficulties, two factors that can contribute to eating disorders.

Some stimulant medications used to treat ADHD decrease appetite, creating a risk of abuse among girls with ADHD who are also struggling with body-image issues and/or an eating disorder.

While boys with ADHD tend to externalize their acting-out behaviors through aggression and substance abuse, girls, by contrast, tend to internalize their symptoms through mood symptoms and eating disorders.

2. Social Problems Among Girls with ADHD (Ohan & Johnston, 2007)
Even more so than their male counterparts, girls with ADHD tend to have a high incidence of peer difficulties. These difficulties include:

• Basic social-skill deficits
• Alienation of their peers (Gaub & Carlson, 1997)
• Aggression (Silverthron, 1996)
• Gossip and social exclusion (relational aggression)
• Deficits in pro-social behavior
• Fewer friends (Blachman & Hinshaw, 2002)
• Less awareness of social cues
• Decreased ability to regulate anger in social situations
• Lack of specific positive behaviors necessary for acquiring and maintaining friendships
• Social awkwardness
Not only are the symptoms of ADHD exaggerated in girls, but the consequences of these symptoms are exacerbated by basic differences in how girls and boys socialize. The social deficits caused by ADHD may be more destructive in the context of a girl’s tighter, more intimate social milieu than they are in a boy’s looser, more active social network (Crick, 1996; Maccoby, 1998).
3. Increased Risk of Anxiety and Depression (Bauermeister, 2007)
Girls with ADHD also struggle with higher rates of separation anxiety, generalized anxiety disorder and depression than boys with ADHD.

4. Difficulties with Executive Functioning (Hinshaw & Carte, 2007)
Again, girls even more than boys, experience a high rate of difficulty with executive functioning. These cognitive functions include some basic abilities critical to day-to-day social, academic and work activities. Girls experience a high rate of difficulty with:
• Planning
• Mental shifting (i.e. from one mental task to another)
• Interference control
• Working memory

5. Difficulties with Detection
Girls with ADHD are more likely to go undetected than their male counterparts because their symptoms are less obvious. They tend to exhibit, for instance, inattention rather than outward hyperactivity. Girls are also less likely to be identified and treated for ADHD because their “acting-in” behaviors are less frustrating to parents and teachers than a boy’s acting-out behaviors. Girls are more likely to be diagnosed for ADHD when comorbidity is present; in other words, when one or more secondary issues capture the attention of parents, educators, and/or professionals. It is, therefore, when a girl is being diagnosed and treated for a secondary condition that the primary condition of ADHD is typically detected.
• Ohan & Johntson (2006) What is the Social Impact of AHDH in Girls? A multi-Method Assessment Journal of Abnormal Child Psychology, 35:239-250
• Ascribe Newswire: Health (2008) Adolscent Girls With ADHD at Increased Risk for Eating Disorders
• Woosely, L (2006) ADHD Ignores Gender: Neurological disorder also proves debilitating to girls Tulsa World
• Mikami & Patterson (2008) Eating Pathology Among Adolescent Girl With Attention-Deficit/Hyperactivity Disorder Journal of Abnormal Psychology, Vol. 117, No.1. 225-235
• Bauermeister, J (2007) ADHD and Gender: are risks and sequela of ADHD the same for boys and girls? Journal of Child Psychology and Psychiatry 48:8

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