People often associate attention-deficit hyperactivity disorder (ADHD) with a young boy who cannot sit still, has trouble paying attention and does not always do as he’s told. Rarely do they think of an effervescent young girl who enjoys social interaction and works hard in school.
Unfortunately, adults may overlook ADHD symptoms in young girls, leading to an underdiagnosis of girls who have ADHD.
When ADHD goes undiagnosed in girls, the likelihood of engaging in long-term, risky behaviors increases. Girls who struggle with ADHD for a long time without intervention can suffer from mental health problems. Early diagnosis is vital to ensure that girls with ADHD have the proper health treatment as they grow up.
Gender Differences in ADHD in Children
Individuals with ADHD exhibit three types of symptoms: hyperactivity, impulsivity and inattention. While three times as many boys are diagnosed with ADHD in childhood than girls, the diagnostic rates in adults are more equally divided between adult men and women.
Traditionally, ADHD is perceived to affect males more, leading to men being diagnosed more. In fact, research to assess ADHD is mostly based on samples consisting of just males. The ADHD spectrum was based mainly on behavior observed through male-dominated samples.
However, ADHD may present itself differently in girls. A boy exhibiting hyperactive behaviors may have trouble sitting still, and sit with a knee on his seat and a foot on the floor. Eventually, his constant shifting and unequal balance may cause the seat to fall over.
In contrast, a hyperactive girl may be out of her seat, but is wandering around the room helping her peers. In this instance, a teacher completing an ADHD rating scale may rate the boy higher on hyperactive questions than the girl, since he is seen as more disruptive.
This example showcases why girls may not score as high as boys on ADHD scales, and end up not meeting criteria for an ADHD diagnosis.
Not only do ADHD symptoms present themselves differently in boys, but boys also tend to be more hyperactive and impulsive than girls. Hyperactive and impulsive behaviors can be more disruptive in the classroom, and teachers may be more likely to notice them.
Without knowing it, adults often have different expectations of girls and boys. Girls may be expected to be tidy and organized, get good grades and lend a helping hand if needed. This set of expectations can cause girls to obey social norms and work hard not to cause trouble. Since girls often work hard to meet an adult’s expectations, their symptoms of ADHD may not be as obvious. When adults encounter girls who may exhibit behaviors outside of these expectations, they may excuse their behaviors as ditzy, dramatic or artsy.
Does Your Daughter Have ADHD?
Similar to the example above of a boy and girl showing hyperactive symptoms differently, ADHD symptoms can present themselves in a variety of ways, often leading to an underdiagnosis of ADHD in girls.
Girls with ADHD may have trouble with reading comprehension, making friends or are constantly running late. Learn how symptoms manifest in girls here.
Finding the Right Treatment for Your Child
When it comes to finding the right treatment for a child, parents often have to weigh the pros and cons about the different types of treatment options. During this process, it’s important for parents to remember that ADHD can be successfully managed. Working closely with healthcare providers, therapists, teachers, coaches and family members can help lead to a treatment plan decision.
The American Academy of Pediatrics (AAP) recommends behavior therapy and medication for children 6 years of age and older. For children under 6 years of age with ADHD, behavior therapy is recommended as the first treatment option.
A good treatment plan will include close surveillance of a child’s behavior to understand how the treatment is working and if changes need to be made.
Behavior Therapy for ADHD
Behavior therapy can be an important component of treatment for children with ADHD. Symptoms of ADHD may not only disrupt school, but they can also affect relationships with family members and other children.
Behavior therapy seeks to reduce disruptive ADHD behaviors and strengthen positive ones. Once a diagnosis is made, it is helpful to start behavior therapy shortly thereafter. Parents and teachers can benefit from using behavior therapy to help reduce problem behaviors in the classroom and at home.
AAP’s 2011 clinical practice guidelines recommend doctors first prescribe behavior therapy for preschool-aged children with ADHD.
Behavior therapy is an important first step in the treatment process, as it helps to give parents the skills necessary to help their child. The therapy has also been shown to be as effective as medication for young children. Evidence shows that parent training in behavior therapy is quite useful.
In 2010, the Agency for Health Care Research and Quality (AHRQ) conducted a review of all existing studies on treatment options for ADHD in children younger than 6 years of age. They identified four programs that parents of young children with ADHD could try to help reduce ADHD symptoms and problem behaviors:
- Triple P (Positive Parenting Program)
- Incredible Years Parenting Program
- Parent-Child Interaction Therapy
- New Forest Parenting Programme
Even for children over the age of 6, behavior therapy can be an important part of treatment. For this age group, the AAP recommends both behavior therapy and medication. Parent training in behavior therapy may also help children with disruptive ADHD behavior up to age 12.
Research shows that parent training in behavior therapy, classroom behavior management, peer interventions, organizational skills training and combinations of behavior treatments may be effective for older children.
Classroom Accommodation for Children With ADHD
Symptoms of ADHD can make it especially hard for children to succeed in school. It’s crucial that teachers have the necessary skills to help children manage their ADHD. However, since most children with ADHD are not enrolled in special education classes, their teachers will most likely be general education teachers without much knowledge about ADHD classroom management.
Teachers can look at the National Resource Center’s guide on how to help students with ADHD.
Learn more about ADHD treatment for children here.
ADHD Medication Options for Children
While behavior therapy is used to help children with ADHD, medication is another treatment option to manage ADHD symptoms. Medication may help control hyperactivity, impulsivity and inattention problems with family, friends and at school.
- Stimulants: are the best-known and most widely used ADHD medications
- Nonstimulants: do not work as quickly as stimulants, but can last up to 24 hours
Since children can react to medication differently, they may have to try a few different medications before finding one that works for them. Genetic testing can help patients avoid a lengthy trial and error process. Genomind’s Genecept Assay® may help guide clinicians as they develop a treatment plans for children with ADHD.