My oldest son’s ADHD symptoms were well understood, and he was diagnosed with ADHD early.  By the time he was in kindergarten, he was already getting treatment for it.  Granted, he had been in a peer-integrated preschool for about two years beforehand, and things were just as chaotic for him in kindergarten as they were in pre-K.  Therefore, we could easily tell that his ADHD symptoms persisted in more than just one environment (home, school, social situations, etc.).

If there were classic ADHD Symptoms, he had them.  He couldn’t sit still for anything.  We called him “perpetual motion.”  He was late in talking (his first word at 18 months), but once he started talking, he never stopped.  Even before he could speak, he was always making noise, and taking turns while playing was impossible for him.  He just barreled right in there and did what he wanted to, much to the dismay of his peers.  When I would tell him he needed to wait his turn, he did not have it.  His emotions were huge, and he could not control them.

Therefore, his ADHD diagnosis was not a surprise at all.  My son put the “hyperactive” in Attention Deficit Hyperactive Disorder.  My daughter was a different story.

ADHD Symptoms in Girls are Different

My daughter was diagnosed with ADHD in second grade, which, to be honest, is still kind of early for a girl.  She struggled mightily in school.  It seemed like she had to work twice as hard for twice as long as other kids to get a good grade.  She was very tough on and demanded perfection from herself.  A big assignment would make her panic – she couldn’t figure out where to start and often left things for the last minute.  She had very low self-esteem and often told me she felt incapable.  Her teachers weren’t aware of these potential ADHD symptoms that were occurring at home, so her diagnosis came as a surprise to them.

Teachers are familiar with seeing ADHD symptoms in boys.  Obviously, I knew what that looked like.  However, my daughter’s ADHD symptoms seemed very different than my son’s.  This is because she had ADHD with an Inattentive Component.  Her brain may have been running a mile a minute, but she did not appear hyperactive on the outside.  In fact, one of my daughter’s teachers told me that my daughter couldn’t possibly have ADHD because she didn’t present like the other students this teacher had with ADHD – most of whom were boys.

I had to provide a letter from my daughter’s child psychiatrist stating she did have ADHD with an Inattentive Component to get her accommodations.  Why that shouldn’t have been the case is a whole different blog.  At the heart of this matter is why was it so easy to get accommodations for my son but so difficult to get accommodations for my daughter?  The difference is in how they presented with their ADHD.

ADHD Symptoms Presentation is Key

We’ve all heard the saying, “the squeaky wheel gets the oil.”  I believe that.  My daughter was a shy, anxious, disorganized perfectionist.  Many of her ADHD symptoms were kept inward and not displayed to the teacher or her classmates.  If you have a girl in inner turmoil but outwardly appears fine and a boy who is constantly running and screaming around the classroom – outwardly disrupting class – who will get referred for an evaluation?

It usually takes much longer for a girl to get a proper ADHD diagnosis.  Boys are more likely (although not exclusively) to display behavior problems.  While girls are more likely to suffer from mood or psychological disorders.  A girl daydreaming throughout class can easily go unnoticed for years.  Girls are also more likely to be misdiagnosed with anxiety and depression than ADHD.  While those things can and often do exist alongside ADHD, the treatment is not the same.

Can Delay in ADHD Diagnosis Cause Trouble Later in Life?

The short answer is yes.  This is bad news for girls who typically display the inattentive type of ADHD.  Females with ADHD are more likely to be able to mask their symptoms, which brings their struggles further inward. This can cause isolation, depression, and overcompensation, which often delays a diagnosis.  Some long-term effects of ADHD, especially undiagnosed or untreated ADHD, can cause similar adverse symptoms in both sexes, like insomnia, anxiety, low self-esteem, and engaging in high-risk behaviors like substance abuse or promiscuity.

However, monthly hormonal changes (which make ADHD symptoms worse) in females with ADHD make them at a higher risk for self-harm (like cutting and eating disorders).  Therefore, the earlier your child receives a diagnosis and treatment can begin, the better the long-term outcome will be for that girl.

The Bottom Line

Parents know their children better than anyone.  If you feel there might be a problem, you should act on that feeling.  Getting a diagnosis for a female with inattentive ADHD can be much more difficult than getting one for a male with a typical ADHD presentation.  Stay engaged with your children.  Seek an evaluation from a child psychologist or psychiatrist who is familiar with how ADHD symptoms present in females.  Male or female, make sure your children know that an ADHD brain is not faulty – it’s just wired differently.