Attention deficit hyperactivity disorder (ADHD) is being missed in women and girls because they aren’t exhibiting the disruptive behaviour often associated with the disorder, according to a NHS treatment adviser. The National Institute for Health and Care Excellence (Nice) says this means that females with ADHD are frequently diagnosed late, or not at all.
Part of the reason that young girls with ADHD are overlooked is because the disorder manifests differently in girls than it does in boys. Gillian Baird, who led the development of the Nice guidance, said that there was a particular problem with girls not getting the right diagnosis. “There may be more presentation with the more disruptive disorders [in boys],” she said. “Girls are trying to be more conforming.”
While the condition tends to make boys hyperactive, research shows that in girls it can show up as inattentive and disorganised behaviour. Sadly, young girls often mask these symptoms to try and conform to society’s expectations of them, which can cause them to develop anxiety and depression. As a result of this, some studies have shown that the risk for self harm and suicide attempts for girls with ADHD is four to five times higher than girls without the diagnosis. Girls with ADHD “tend to have few friendships,” explains Dr. Ellen Littman, clinical psychologist and co-author of Understanding Girls with AD/HD. “As a result of their low self-esteem, they often choose unhealthy relationships in which they may accept punitive criticism and or abuse.”
Young girls often mask symptoms to try and conform to society’s expectations of them, which can cause them to develop anxiety and depression
The lack of understanding around ADHD in girls is thought to be because ADHD was first diagnosed in young, white boys and the key indicators that parents, teachers and doctors looked for was hyperactivity and an inability to concentrate. Because of this, most of the guidelines and research around the disorder has been exclusively focused on how the disorder affects boys. According to Littman, only one per cent of the research into the disorder has focused on girls.
Professor Mark Baker, director of the centre for guidelines at Nice, said: "Our draft guideline raises awareness of people who more likely to be wrongly diagnosed with ADHD, those with ADHD who are wrongly diagnosed with another condition and those whose ADHD is missed altogether.” He is hopeful that the new guidelines will help more girls receive a correct diagnosis.