How Do ADHD Symptoms Manifest Differently in Girls and Women vs. Boys and Men?

How Do ADHD Symptoms Manifest Differently in Girls and Women vs. Boys and Men?

What to look out for and why an early diagnosis is essential.

According to the Centers for Disease Control and Prevention, surveys have shown that boys are more likely than girls to ever be diagnosed with attention deficit hyperactivity disorder – 13.2 percent to 5.6 percent, respectively.

This isn’t surprising. Dr. Jeffrey Newcorn, associate professor of psychiatry and pediatrics and director of the Division of ADHD and Learning Disabilities at the Icahn School of Medicine at The Mount Sinai Hospital, explains that the diagnosis ratio between the genders at this age leans significantly more towards boys than girls.

The reason for this, he explains, boils down to differences in the way ADHD symptoms – inattention, hyperactivity or a combination of both – are typically exhibited between the genders. “Because boys are usually more hyperactive than girls, who tend to be more inattentive and quiet, they’re more likely to be diagnosed,” he says. “Boys tend to call attention to themselves.” The boy who is disruptive or frequently blurts out random comments without a filter, for example, is more noticeable, and therefore more likely to obtain an ADHD diagnosis, than a girl whose symptoms aren’t as blatant.

Not All Boys Are Hyperactive, Not All Girls Are Inattentive

However, this isn’t to say that boys are always strictly hyperactive, just as girls don’t always only have inattentive symptoms. “Boys can have inattention, it’s just that girls have it more so,” she says, adding that while it’s less common, girls may exhibit hyperactive behaviors. Gilbert explains that there’s a difference in physical disposition regarding hyperactivity, though; boys tend to demonstrate more disruptive behaviors while a girl’s impulsivity may manifest as chattiness.

Dr. Patricia Quinn, a developmental pediatrician in Washington, D.C. and the co-founder of the nonprofit Center for Girls and Women with ADHD, agrees. That center is no longer in existence, but Quinn says that is the resource site that continues to advocate for girls and women with ADHD.

Mistaken Symptoms and Diagnoses

But just because boys’ ADHD symptoms are more obvious does not mean that girls are never diagnosed, Newcorn notes. They are, though it’s often much later in life. “More females are diagnosed later as adults,” he explains.

“Symptoms of ADHD can be mistaken for emotional or disciplinary problems or missed entirely in quiet, well-behaved children, leading to a delay in diagnosis,” the National Institute of Mental Health notes.

A girl who comes home and goes to her room, Quinn explains, may be considered by parents to be reserved when in actuality, she may be struggling with her homework and consequently taking a long time to see it through to completion. However, many girls with ADHD also develop perfectionist tendencies; she’ll likely stay up late redoing her assignments until they are just right, while boys don’t care as much about sloppier handwriting or eraser smudges, she says. So while many parents feel their daughter is doing well in school, Quinn says she wonders “at what cost?”

Additionally, Quinn says that an inattentive girl may look as though she’s paying attention in school, but in actuality she may not be processing the information. Maintaining eye contact with a teacher, Quinn says, may be a people-pleasing quality that others confuse with attentiveness.

Quinn, who co-authored the book “Understanding Girls with ADHD,” also notes that anxiety and depression in girls often exists along with their ADHD, but they’re usually diagnosed as only having anxiety or only having depression. The truth of the matter, Quinn says, is that many times depression is the result of undiagnosed ADHD.

Maturity and Adulthood

Gilbert adds that for both boys and girls with ADHD, the transition to middle school can create new challenges. Changing classes every 40 minutes or so, she explains, can help with the need for movement that many people with ADHD experience, for example, but “at the same time, these new expectations may create challenges with organization and executive functioning.” Hyperactivity and inattention remain, she says, but the expectations on a child at this time become more significant, potentially compounding existing struggles.

But as a young child matures, that’s when symptoms and diagnoses may change. “As kids get older,” Newcorn says, “the gender ratio tends to even out.” He explains that in adulthood, more females are diagnosed whereas that may not have been the case as a child. Increased self-awareness or a self-discovery – including times when parents seeking treatment for their own son or daughter begins to recognize ADHD symptoms within themselves – is common, he says.

In adulthood, the person with ADHD may still have certain symptoms, but they’ll often manifest differently than during childhood. “On average, gross overactivity decreases with age,” Newcorn explains. “Overt hyperactivity doesn’t occur as much.”

He says that kids with ADHD can be overbearing while hyperactive adults are better able to sit through a class or a meeting. While adults may still feel stressed or bored in such environments, he says they’re more likely to experience an internal sense of restlessness, or a general sense of not feeling settled, than the hyperactive child who may dart away from a table or interrupt incessantly. “Kids are more in your face than adults when it comes to hyperactivity,” he says, which could be a reason hyperactivity in adults is sometimes missed altogether.

Early Diagnosis Is Essential

“College kids, mainly senior girls, have come to me saying they’re overwhelmed and filled with anxiety,” Gilbert says. “They’ll tell me they think there’s something wrong, but all along, it turns out their ADHD was overlooked. Early identification is important.”

Quinn is also an advocate for obtaining an early diagnosis and treatment, especially for girls. She says that there could be “a lot of fallout” from not doing so, including diminished self-esteem, shame and suicidal attempts or ideology later in a girl’s adolescent and adult life. “Women with ADHD stay in the closet longer,” she says, “but it’s a very messy closet.”


Original post can be found here.
By Jennifer Lea Reynolds, Contributor | June 7, 2017, at 10:24 a.m.

Does Immaturity Play a Role in ADHD?

Does Immaturity Play a Role in ADHD?

Experts suggest behaviors can depend on the environment as well as the child’s age.

According to the American Psychiatric Association, attention deficit hyperactivity disorder affects approximately 5 percent of children. Typically, it’s initially observed at a young age. The APA says ADHD “is often first identified in school-aged children when it leads to disruption in the classroom or problems with schoolwork.”

In this case, the young age of a child may raise an important question: What role does immaturity play when it comes to ADHD? The disorder involves behaviors such as an inability to focus, frequent movement and fidgeting and acting on impulse without thinking through an action’s consequences – or elements from each.

While some parents may be concerned about the negative or potentially dismissive implication behind the term “immaturity,” which may suggest a mere childishness rather than a legitimate disorder, experts maintain it’s an important term to explore.

Immaturity Matters

“I always consider chronological age and maturity when thinking of and diagnosing ADHD,” says Dr. Sharone Gilbert, a pediatric neuropsychologist with offices in Manhattan and Long Island, New York. “What requires consideration is the impact of social maturity as well as the maturation of the brain itself when considering these behaviors pathological.”

A study published online in February in the journal The Lancet Psychiatry revealed differences in an ADHD child’s brain – specifically, certain regions were smaller compared to children who did not have the neurologic disorder.

Various sections of the brain exist which control a child’s ability to concentrate and “hit the brakes,” says Amanda Morin, parent advocate, former teacher and expert at, a nonprofit organization dedicated to helping parents whose children struggle with learning and attention issues.

These areas may be less active and develop more slowly in kids with ADHD, something that appears to occur in the frontal lobe, or the front section of the brain, she explains. “This can upset the balance of certain brain chemicals. It can also explain why your child may have more trouble socially than his peers.”

Objectivity About Environment, Age

It’s also important to remain objective when assessing ADHD in young children. Gilbert, who has a child with ADHD, uses the example of a child’s home and school environment, explaining how behavioral observations in certain settings can vary and perhaps spur hastily drawn conclusions about a child having the disorder in the first place. There are often differences between home environments and school settings regarding what’s expected of a child at a certain age, all of which can often be subjective, Gilbert says. “The question to ask is, ‘How significantly are these behaviors impacting a child’s growth in terms of learning, development and social emotional adjustment across settings?’”

A teacher, she explains, may express concerns over a child’s ADHD-related behavior to parents, noting that it differs from other students in the classroom. However, upon hearing about these behaviors, a parent may deem the actions completely normal since they’re commonly observed at home.

Another professional, Dr. Marilyn Wedge, a family therapist in Westlake Village, California, further illustrates this point. “Many parents have told me that while their child qualified for an ADHD diagnosis at school, the mother home-schooled the child and the ADHD behaviors disappeared. The point here is that kids behave differently in different contexts.”

In fact, the Mayo Clinic says a child should never be given an ADHD diagnosis “just because they’re different from their friends or siblings,” adding that “most healthy children are inattentive, hyperactive or impulsive at one time or another.”

Gilbert encourages parents to assess their young child’s environment – to include the age of the others in their group – with a critical eye. Using the example of school settings, she explains the importance of assessing whether certain behaviors simply stem from being the oldest among a group of children in the same grade, or whether this older child truly demonstrates behaviors indicative of ADHD.

“I often counsel parents to consider the comparison group to which their children are being compared,”

Gilbert says, adding that she also likes to find out from parents where the child is developmentally.

Asking this, she says, can help both parents and teachers avoid coming to an immaturity conclusion when, in fact, there may be a “budding ADHD process” taking place.

The Difference a Year Makes

Paying close attention to varying ages in school settings matters to Wedge as well. She says the age that a child enters school can impact ADHD diagnoses, noting that “being born just before the kindergarten eligibility date increases a child’s chances of being diagnosed with ADHD.”

“Children who are among the oldest in their classrooms have a significant academic and social edge over their younger classmates.” Wedge says younger children have shorter attention spans and therefore may tend to “goof around” more than an older classmate who is able to focus more and sit still longer.

She stresses that six months or a year “means a lot of difference in maturity” for a 5-year-old, explaining that while a child may be intellectually prepared for kindergarten, he or she may not necessarily be prepared socially.

“My own grandson has an August birthday,” Wedge says. “He entered kindergarten just after turning 5. His parents thought he was too bored at home. He got through kindergarten, but struggled to keep up with his first grade class. He was simply too immature to focus for long hours in the classroom. He repeated kindergarten at a new school and now is doing well in second grade.”


Wedge and Gilbert encourage parents to embrace and understand their child’s immaturity, and offer recommendations. Of course, it’s up to each family to proceed in a manner they feel is best for their own child, working in tandem with professionals.

For starters, Wedge suggests not rushing a child into school. If a child starts school at age 5 1/2 or 6, she says, they’ll be more likely to gain an academic and social edge.

However, parents should discuss this option with educators. A National Education Association policy brief states that while the organization recommends “5 be the uniform entrance age for kindergarten,” flexibility in age requirements may be considered. “In joint consultation with parents and teachers, a school district should be allowed to make case-by-case exceptions to age requirements,” the brief says.

When it comes to school settings, Gilbert stresses the environment can be a factor in a child’s behavior. In one setting, she explains, a teacher may suggest a child is out of control, but in a different learning environment that’s perhaps smaller and more nurturing, the child may respond differently. According to the APA, “Children with ADHD can benefit from study skills instruction, changes to the classroom setup, alternative teaching techniques and a modified curriculum.”

Finally, Wedge urges parents not to confuse behaviors that may be typical for a fun-loving, young child with having ADHD. “Don’t mistake mischievous or clownish behavior for ADHD. It may simply be immaturity.”

Original post can be found here.

ByJennifer Lea Reynolds, Contributor | April 14, 2017, at 9:00 a.m.