What to Know About ADHD in Girls

When you hear the term “ADHD,” or attention deficit hyperactivity disorder, what do you picture? For most of us in education, we imagine an overly active little boy. That imaginary boy is who I pictured for most of my teaching career and later when I became a school administrator. Recently, however, as the father of a school-aged daughter with attention and focus issues, I have come to realize that ADHD is just as likely to affect girls as boys and that many girls who are labeled as messy, loud, and disorganized are in fact struggling with undiagnosed ADHD. 

ADHD: things to know

There are three types of ADHD: inattentive, hyperactive, and combined (a combination of the first two). ADHD affects boys and girls equally, yet girls are half as likely to be diagnosed as boys. This is because girls are more likely to have the inattentive type of ADHD and display “internalizing” symptoms, while boys typically have the hyperactive type of ADHD and display “externalizing” symptoms. Because of this, boys are more likely to receive treatment, medication, and other supports, while girls with ADHD may grow up struggling with their relationships, mental health, and self image. 

Inattentive: A child with inattentive ADHD will be a student who makes careless mistakes on a test, misses a whole section on an assignment, or just generally has difficulty with attention and memory. Following a set of instructions will be a challenge, as will starting assignments. At home, if we ask my daughter to “go upstairs, brush your hair, and get your jacket,” she will go upstairs, but the chances of her coming back down with brushed hair and a jacket are very low. Instead, we’ll find her singing, drawing, and happily playing by herself in her room. In the classroom, a girl with inattentive ADHD appears not to be listening, is likely to have a very messy desk or be the student who constantly loses personal items, misses instructions, or asks the same questions over and over again.

Hyperactive: A child with the hyperactive variety of ADHD is the student who can’t sit still in class, gets up constantly, and acts like their motor is running at top speed. They are likely to blurt out answers, interrupt others, and dominate conversations as a result. Many of us in education notice these behaviors when they occur in boys, but we are less likely to think of them as a function of ADHD when we observe them in girls. In my daughter’s case, she likes to socialize from sunup to sundown, but she tends to burn herself out participating in and often leading everything that she does. In the classroom, girls with ADHD may be seen as bossy by their peers. They may struggle to participate positively in a group because they talk over others or distract their classmates.

Implications of not recognizing ADHD

Over the course of a lifetime, not diagnosing girls who have ADHD can have long-term and significant consequences. For instance, girls with ADHD may be bullied or friendless as a result of their social challenges. As they get older, girls and young women with ADHD are more likely to have unplanned pregnancies or hurt themselves in accidents due to their impulsivity. Without a diagnosis, girls and teens with ADHD are more likely to suffer from low self-esteem, anxiety, depression, and substance-use disorders as they struggle to manage their hyperactivity and inattention issues in order to fit into a world that blames them for not being able to perform as well as their peers. 

Educators can help

It may not occur to parents to explore an ADHD diagnosis for their daughter. Teachers can help, however, by noticing the girls in your class who may be displaying some of the signs of ADHD and raising these issues in a sensitive way with parents.

Talking to parents: The starting point for a conversation with parents is going to be measuring and tracking the frequency and severity of the behaviors. Most parents will not appreciate teachers jumping to the conclusion that their child needs to see a psychiatrist, but if teachers share behavior logs and other data with parents, this may help parents come to the conclusion on their own that some outside help may be required.

Rather than starting from the position that the child needs to be medicated or sent to see a specialist, teachers can instead let parents know that they have noticed that the particular student seems to be struggling, and then share some of the examples gathered over a period of a few weeks, as well as the supports that they have provided in the classroom to try to help. Invite parents to comment on what you have noticed; they may well be experiencing some of the same things at home, although an ADHD diagnosis may not yet have occurred to them. This first conversation with the classroom teacher may lead families to seek outside help or may lead to the child being discussed at a special education meeting with parents and other professionals at the school.

Instructional strategies: Of course, even in the absence of a clear diagnosis, teachers can still use chunking, organizational coaching, and lots of visuals to support students who may be struggling. Provide extra time for assignments, for instance, in order to lower the pressure around academic performance. Allow simple environmental accommodations. My own daughter likes to use noise-canceling headphones when she needs to focus. Some students may be better able to stay on task if they sit up at the front.

Depending on their age and level of self-awareness, students may even be able to tell you themselves what sorts of things will make a difference. Most important, teachers should find a way to support and celebrate neurodiversity in the classroom. Helping the whole class to understand how we are each different and unique, and doing explicit lessons on growth mindset and neuroplasticity, can help to foster a classroom culture that is more understanding and inclusive of students who may need support for their focus and hyperactivity issues.

I’ll leave the final word on this topic to my daughter: “The best way to support a child with ADHD is for the adults to learn about ADHD. Adults sometimes focus on changing the child, but what really helps is being understanding and supportive and changing the ways in which teachers or parents interact with the child.”