In this blog, I have written about the differences that are often seen between boys and girls (and men and women) with ADHD. To recap, girls and women tend to present with more inattentive and executive functioning symptoms that may not be immediately apparent to those around them, often leading to underdiagnosing. Boys and men, however, tend to have more outwardly obvious symptoms, including hyperactivity and impulsivity. There also tends to be a stereotype about ADHD that brings to mind a disruptive or overly active young boy in the classroom, and therefore, boys are more readily recommended for evaluation or diagnosed.
A new meta-analysis (analyzing multiple pieces of research to draw generalized conclusions) has confirmed these previously held findings. By using studies of children with ADHD (aged 3-17), several gender differences were found, particularly related to hyperactivity. Overall, as expected, boys with ADHD were found to have more hyperactivity than girls with ADHD and had a harder time controlling movements (i.e., staying in their seat, sitting still, not fidgeting). Boys also had greater difficulties with cognitive flexibility, meaning they tend to get stuck in one way of doing or seeing things and have difficulty coming up with or executing new problem-solving approaches. This also includes being able to think about multiple pieces of information simultaneously.
Girls and boys with ADHD both showed equal difficulties with inattention, though teachers were more likely to rate boys as having greater inattention. Girls with ADHD were found to have better motor response inhibition, meaning they were more able to contain their movements when required. This is not to say that girls with ADHD do not show any impulsive or hyperactive behaviors, but rather that they seem better able to rein in their impulses than boys with ADHD. Additionally, girls with ADHD may manifest different impulsive behaviors, such as blurting out in class or talking with their peers, that does not seem as disruptive to teachers as getting out of one’s seat or being very noisy. Indeed, teachers tended to most notice boys’ behaviors when they were disruptive or oppositional, which is significantly less common for girls.
Overall, girls continue to be diagnosed with ADHD at a lower rate than boys. In part, this is due to the findings presented above, particularly with regard to teacher observations that are often key in diagnosing. Additionally, the researchers of this current study noted that ADHD is most often studied in boys and that many of the criteria used in diagnosing is based on behaviors that are most often seen with boys. The subtlety of girls’ ADHD symptoms can make it less likely they are identified for evaluation, meaning increased awareness of and attention to possible symptoms is warranted.