ADHD in Boys vs. Girls

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that begins in childhood. Symptoms of ADHD affect males and females differently. People with ADHD typically exhibit behaviors of impulsiveness and hyperactivity, inattentiveness, or a combination that may persist into adulthood.

According to the Centers for Disease Control and Prevention (CDC), as of 2019, about 6.1 million children (9.8%) in the United States had an ADHD diagnosis (13% in males, 6% in females). Researchers note that the difference is likely due to ADHD presenting differently in females, which may lead to their condition being underdiagnosed.

This article will explain how the symptoms of ADHD differ in females and males, and when to talk to your healthcare provider.

ADHD in Children

ADHD is typically classified into three categories:

• Impulsive and hyperactive type, such as fidgeting, talking a lot, interrupting, and not sitting still
• Inattentive type, such as difficulty paying attention, being easily distracted, and not finishing tasks
• Combination type

An ADHD diagnosis is based on these types and behaviors. The ADHD symptoms must be ongoing and affect the ability to function in day-to-day life.

Several studies have shown that up to 80% of children with ADHD will continue to have ADHD symptoms into adulthood, though this statistic varies widely from study to study.

Symptoms can also change over time. Outward hyperactivity in children may turn to inner restlessness in adults, for example.

ADHD in Boys vs. Girls

Males are diagnosed with ADHD in childhood far more often than females, but the difference is less in adults. Researchers believe this is likely due to an underdiagnosis of females rather than ADHD being more common in males.

There are a number of likely reasons for this discrepancy:

• Females tend to show inattentive symptoms, while males are more likely to show impulsive and hyperactive symptoms.
• Females often develop compensatory adaptive behaviors and coping strategies that mask their symptoms.
• Females often present more internally, while males tend to present more externally.
• Females with ADHD are often misdiagnosed with a different disorder such as anxiety or depression, or the ADHD is missed when they have a coexisting disorder.
• Inattentive symptoms are more likely to occur in a structured educational environment, such as in high school or college, making symptoms more noticeable when females are adolescents and young adults rather than children.

In general, males with ADHD are more likely to have symptoms and behaviors that are more disruptive and, therefore, more noticeable. Not only does this have a "squeaky wheel" effect, but it reinforces the stereotype of a child with ADHD being a male who "acts up" in class and is constantly on the go.

Because females with ADHD are usually less disruptive, it may not be as obvious that they are struggling. Daydreaming is not going to raise flags that are difficult to miss or ignore like frequent interrupting or the inability to stay seated.

Even when females do show similar symptoms as males, ADHD may be missed or minimized because they don't fit the mental picture of a typical child with ADHD.

Two studies were performed in which teachers were given brief ADHD-like descriptions, but the names and pronouns of the child attached to them were varied. The teachers in the studies were more likely to suggest the child be referred for additional support and be better suited for treatment when the description had male names and pronouns.

Symptoms of ADHD in Boys

While males can exhibit symptoms of inattention, they are more likely than females to show impulsive and hyperactive behaviors instead of or in addition to the inattentive ones.

Impulsive and hyperactive symptoms include:

• Fidgeting, tapping hands or feet, or squirming in their seat
• Difficulty staying seated when expected to, such as in a classroom
• Running around or climbing when or where it is inappropriate
• Inability to play or do activities quietly
• Constantly “on the go,” as if driven by a motor
• Talking excessively
• Blurting out responses before a question has been finished, finishing people’s sentences, difficulty waiting to speak in conversations
• Difficulty waiting their turn, such as while waiting in line
• Interrupting or intruding on others during conversations, games, and activities, taking over what others are doing, using other people's things without permission, etc.

Male children and adults are more likely to display externalizing (outward) behavior and have comorbid (co-occurring) conditions. These can include:

• Oppositional defiant disorder (ODD)
• Conduct disorder (CD)
• Rule-breaking behavior
• Fights in school or aggressive behavior
• Antisocial behaviors characteristic of antisocial personality disorder (in adults)
  

Symptoms of ADHD in Girls

Female children can have impulsive and hyperactive type ADHD, but more often they show symptoms of inattentive type.

Inattentive symptoms include:

• Lack of paying close attention to details
• Making "careless" mistakes in tasks such as schoolwork
• Difficulty staying focused on tasks or activities such as lectures, conversations, or reading for long periods
• Seeming not to listen, or "zoning out" when spoken to
• Not following through on instructions and not completing (or starting but losing focus on) tasks such as schoolwork, chores, or job duties
• Difficulty with organizing, such as poor time management, messy work, and living spaces, disorganized work (like homework), missed deadlines, etc.
• Avoiding or disliking tasks that require sustained mental effort
• Frequently losing needed belongings, such as school papers, books, cell phone, and glasses
• Easily distracted
• Forgetting common tasks like chores, or in teens and adults, running errands, returning phone calls, paying bills, and keeping appointments

Female children and adults tend to have internalized symptoms, such as:

• Emotional problems/sensitivity
• Somatic (physical) symptoms
• Problems with self-esteem and self-image

Late or Missed Diagnosis

When an ADHD diagnosis is late or is missed in females, and support is not given, they repeatedly have experiences of perceived failure, alienation, and inadequacy, which they frequently interpret as personal flaws rather than ADHD. This increases the risk of developing comorbid conditions such as:

• Depression
• Anxiety
• Sleep disorders
• Eating disorders
• Substance use disorder
• Low self-esteem

Many females are only diagnosed with ADHD as adults when they learn more about ADHD in general and how it presents in females. Some describe it as a light bulb moment, or as if they are checking off a list when looking at common tendencies of females with ADHD.

When looking back, most females who are diagnosed with ADHD as adults can identify experiences and behaviors in their childhoods that are examples of ADHD, though the condition wasn't recognized at the time.

When to See a Healthcare Provider

With support, ADHD can be managed. Getting an accurate diagnosis and appropriate treatment as early as possible can go a long way in terms of helping kids with ADHD function well both as children and into adulthood.

If you or your child's teachers notice signs of any type of ADHD, regardless of their gender, see their healthcare provider to discuss next steps.

Summary

ADHD is diagnosed more often in males, but research suggests that females may be under-diagnosed. That's because ADHD can manifest differently in males than in females. Males tend to have impulsive, hyperactive, and externalized traits. Females tend to have inattentive, internalized traits.

Because of these and other factors, females are generally diagnosed at older ages than males, often in adulthood. Females are also less likely than males to be sent for referrals for support or treatment. Research is needed on the effects of ADHD on people who are not cisgender.