Girls with ADHD are often misdiagnosed with depression or anxiety or are seen as lazy or spacey. They are not diagnosed with ADHD as often as boys and when they are diagnosed, it often occurs at a later age, i.e., adolescence and beyond. For both boys and girls, undiagnosed ADHD can often cause problems later in life and can result in low self-esteem and depression.
In A Review of ADHD in Women and Girls: Uncovering This Hidden Diagnosis (2014), developmental pediatrician, Dr. Patricia Quinn indicates that, "in part, the underrecognition of ADHD in women and girls may be due to a symptom profile (i.e., more inattentive and less hyperactive/impulsive than males) that is less likely to be disruptive in the class or in the workplace.”
To better understand why girls are still underdiagnosed and undertreated, I spoke with Michael Wetter, Pys.D., who has a private practice in California and is a Diplomate and Fellow of the American Psychotherapy Association.
HealthCentral (HC): During the past decade, there has been great progress in understanding and treating ADHD. Why do you think, despite this progress, girls and women are still underdiagnosed?
Michael Wetter: ADHD in girls can sometimes be referred to as laziness or fatigue, but more specifically, it may be incorrectly diagnosed as something else, such as depression or bipolar disorder, both in adolescence and adulthood.
HC: Do you believe many in the medical community still dismiss the idea of girls/women with ADHD because the symptoms manifest differently than in boys/men?
MW: While the presentation in girls tends to be a bit more subtle (e.g., not quite as wild), I do not believe the symptoms manifest that much differently. I do believe that people attribute different meanings behind the symptoms attributed to either boys or girls. Boys are wild and out of control; girls, who tend to be less hyper, are therefore less likely to be considered "symptomatic." Careful attention needs to be paid to performance, not just the "out of control" factor.
HC: What are some of the main differences in symptoms in girls?
MW: For girls, I believe the perception is that they are apt to "day dream," "fantasize," "or drift" versus boys who "space out" and "don't attend." Therefore, people are more likely to "forgive" inattentive behavior with younger girls, and thereby, ignore the diagnosis. Again, girls tend to be less "hyperactive" than boys.
HC: When should parents and medical professionals consider assessment for ADHD?
MW: The tendency to appear to daydream or "tune out" can be a symptom, but it must also be linked to performance; a child who is doing well in school and in work performance who has a tendency to daydream is likely not ADHD; but one whose performance is negatively impacted routinely should be assessed.
HC: Are girls/women often misdiagnosed with anxiety or depression?
MW: Depression or anxiety may be present, but this might also be a product of an undiagnosed ADD. They can be directly related.
HC: What are some consequences of not being diagnosed or treated?
MW: Girls are more likely than boys to internalize their troubles; boys will blame a test or work, whereas girls will blame themselves. As a consequence, impaired self-esteem is more likely within undiagnosed girls than boys, as is a greater potential for depression. There was a study done in 2012 that showed girls with combined ADHD/mood disorder are at increased risk of attempting suicide or engaging in self-harming behaviors.
HC: What can parents do if they see these types of behaviors in their daughters?
MW: Don't fear a diagnosis of ADHD; diagnosis means that there is an intervention and plan for improvement -- the sooner the better. Parents (and educators) should be more vigilant to the subtle signs of ADD, and not just looking for kids who bounce off the wall. Teachers and parents should also communicate more with one another if either is observing performance difficulties.