Written by: Lynn Tian
Edited by: Christine Huang
Attention Deficit Hyperactivity Disorder, or ADHD, is a neurodevelopmental disorder affecting millions of individuals. Characterized by symptoms of inattention, hyperactivity, impulsivity, ADHD impacts individuals in daily life, relationships, and overall health and well being. It has two general subtypes of expression: Hyperactivity/Impulsivity and Inattentive (or a combination of both). An individual who predominantly expresses as hyperactive and impulsive tend to be physically restless and exhibit disruptive behaviors while an individual who predominantly expresses as inattentive tends to have trouble prioritizing and is easily distracted. While ADHD tends to be associated more with children (restlessness and inattention), many experience symptoms throughout adulthood. In many research studies, it has been seen that boys are diagnosed more frequently than girls, primarily due to the gender differences in expression of ADHD.
Historically, it was believed that boys were more likely to express the hyperactivity and impulsivity symptoms of ADHD while girls were more inattentive, which caused them to be less likely to be diagnosed. However, recent research investigates these assumptions, revealing that girls and women with ADHD often present with different combinations of or pattern of symptoms compared to their male counterparts. According to Etkins et al. 2011, girls would express less externalizing symptoms of hyperactivity and impulsivity, but rather more of internalizing symptoms e.g. inattention, disorganization, forgetfulness, and daydreaming. As a result, girls are diagnosed less often and are described as “quiet or well behaved” and “underachieving”. These symptoms are far less disruptive compared to their counterparts, which contributes to the large difference between the rates of diagnoses between boys and girls. According to data from the Center for Disease Control and Prevention (CDC), in 2016-2019, boys were diagnosed around 13% compared to girls’ 6%. The stark contrast between the gender difference and rates of diagnoses brings up a possibility that the disparity is caused by the inherently externalizing symptoms of the diagnosis process itself.
There are several other additional factors that may play a role in the underdiagnosis of females in early childhood, including the influence of gender stereotypes and gender expectations. Girls are often seen as more mature and less rowdy compared to boys of the same age, and if they are acting out or being disruptive, they meet more discipline rather than a boy who is seen acting as a “typical boy.” Another factor may be the fact girls tend to internalize their symptoms, often manifesting as different traits such as perfectionism and overachievement (Stibbe et al. 2020). These more often than not lead to comorbidity of symptoms such as anxiety and depression (Skogli et al. 2013). Additionally, since girls do not tend to exhibit such obvious signs of ADHD, parents and teachers will often underreport compared to those who are hyperactive.
Attention Deficit Hyperactivity Disorder is a neurodevelopmental disorder commonly affecting young children and even persisting through adulthood. While it was historically associated with boys due to differences in symptom presentation, recent research highlights the diverse ways ADHD can manifest across the gender divide. Challenging stereotypes and breaking down biases by becoming more informed are essential to ensure all individuals, regardless of gender, receive accurate diagnosis and treatment they need. Early intervention and a comprehensive understanding of gender variations and individual expressions of ADHD are necessary steps towards helping individuals.
References:
1. CDC. (2023, September 27). Data and statistics about ADHD. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/adhd/data.html
2. Elkins, I. J., Malone, S., Keyes, M., Iacono, W. G., & McGue, M. (2011). The impact of attention-deficit/hyperactivity disorder on preadolescent adjustment may be greater for girls than for boys. Journal of Clinical Child and Adolescent Psychology: The Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 40(4), 532–545. https://doi.org/10.1080/15374416.2011.581621
3. Skogli, E. W., Teicher, M. H., Andersen, P. N., Hovik, K. T., & Øie, M. (2013). ADHD in girls and boys – gender differences in co-existing symptoms and executive function measures. BMC Psychiatry, 13(1). https://doi.org/10.1186/1471-244x-13-298
4. Stibbe, T., Huang, J., Paucke, M., Ulke, C., & Strauss, M. (2020). Gender differences in adult ADHD: Cognitive function assessed by the test of attentional performance. PloS One, 15(10), e0240810. https://doi.org/10.1371/journal.pone.0240810
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