While commonly diagnosed in boys, ADHD symptoms look different in girls

Most kids are curious, fidgety, impulsive and have a brief attention span occasionally. Inattentiveness and hyperactivity for a longer period over time, however, may be signs of a neurological impairment known as Attention Deficit Hyperactivity Disorder, or ADHD.

“ADHD is a neurobiological syndrome that is seen in childhood where there is a developmentally inappropriate lack of being able to focus on tasks the child is asked to do,” says Dr. Bela Sood, an adolescent psychiatrist and expert on ADHD with the Children’s Hospital of Richmond at VCU. “It is characterized by inattentiveness, impulsivity, hyperactivity and restlessness.”

ADHD is one of the more common childhood behavioral disorders. According to the Center for Disease Control and Prevention (CDC), roughly 6 million children in the United States between the ages of 2 and 17 were diagnosed as having the disorder as of 2016. Boys are twice as likely to be diagnosed as girls with the average age of diagnosis being around 7 years old.

Sood recommends that children over the age of 5 who continually show signs of inattentiveness, impulsiveness and hyperactivity should be evaluated for ADHD.

“These symptoms of impulsivity, hyperactivity and inattentiveness can affect school performance, relationships with peers and parents, and can lead to significant behavioral difficulties,” Sood says. “ADHD affects children’s school performance as they have difficulty paying attention. Impulsivity shows up as aggression as they do things without considering the consequences. They also are more accident prone.”

Children and teens with ADHD may also have a harder time learning to follow and understand rules and social norms as well as self-regulating to stick to the rules.

While more boys than girls are diagnosed with ADHD, girls are often diagnosed later since symptoms may appear different in boys than in girls.

“Boys show more of the hyperactivity whereas girls tend to have more of the inattentiveness,” Sood says.

Boys with ADHD are usually more disruptive in a classroom by standing up or walking around at inappropriate moments, while a hyperactive girl may fidget, rock or squirm in her seat. Hyperactive girls are also more likely to be more talkative. Both males and females with ADHD may also exhibit stronger emotions; boys show signs of aggression such as getting angry, fighting or having physical outbursts while girls appear to have more intense emotions of being sad with crying and tantrums.

Children viewed as hyperactive are diagnosed with ADHD at an earlier age while those whose symptom is primarily inattentiveness, many of which as girls, aren’t diagnosed until they are further along in their academics, either at the middle or high school level, since inattentiveness isn’t easily seen.

Fredericksburg pediatrician Dr. Mary Callahan, who has more than a dozen years of experience diagnosing and treating ADHD patients, particularly females, points out that every child is different as well as every diagnosis.

“ADHD is a complex diagnosis requiring an intricate approach to best understand each child’s presentation and design the best approach to treatment,” Callahan says. “A large part of this involves good communication between members of their care team, which should include but is not limited to parents, physicians, teachers, school psychologists, babysitters and extended family members.”

Callhan adds: “There are so many subtle nuances between stages of childhood development and that of disordered development that one must have a broad understanding of all the factors at play to make a correct diagnosis.”

So, what should parents do if they suspect their child may have ADHD?

“The first step is to talk to your pediatrician and see what they suggest,” says Sood.

“These days pediatricians are quite proficient at managing ADHD. They will make referrals for additional services as needed. These services may include seeing a child psychiatrist. If learning disabilities are suspected, getting a psychological evaluation is a good idea.”

What’s next once they diagnose a child with ADHD? Treatment can include therapy and medication, such as stimulants, to help children learn to self-regulate. Assessing what might trigger difficulties in their daily environments is also key.

“A well-trained therapist can evaluate multiple factors in that setting and identify ways to change or improve their relationship to the child’s needs,” Callahan says. “They can also gain a better understanding of how the child is being affected by these difficulties and set a plan in place to help foster self- esteem. Children need to understand that they, too, play a role in the management of their difficulties. It is vital for the care team to empower the child to help identify their struggles and play a role in creating strategies to overcome them.”

Sood also recommends that parents find resources or assistance in social skills training so they can set boundaries for their kids and teach them expected and appropriate behaviors. Altering diet and introducing calmer physical activities such as yoga may also help.

There is no cure for ADHD, though some hyperactive symptoms may diminish with age. As parents navigate their child’s behavior in order to determine what is normal and what may be ADHD, it’s important for them to offer their child their patience, love, and support.

“Try not to focus on the symptoms of the ADHD as your child is not defined by that,” Sood says. “They have other gifts and strengths that need to be showcased. Building self-esteem while paying attention to the illness with appropriate management is paramount.”