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Column originally published Nov 26, 2019

Girls With ADHD Often Present Differently From Boys

Question: Our daughter is in grade 9. She is a very anxious child since she was small; she worries about going to new places, or meeting new people. She worries about anything and everything. At home, she is happy, busy, and excitable. She had no problem in elementary school, although she did put up a fight when she had to do homework. Since junior high, her marks started dropping; she missed a lot of assignments. This year, she started skipping school, hanging out with other kids roaming the mall. We caught her using weed once. Last week, we had a meeting with the school. Her guidance counsellor asked us whether we have considered ADHD. Her older brother was diagnosed with ADHD in elementary school; he was hyperactive and disruptive. He is on medicine which helps him in school, but not so much at home. As a result, we have been busy dealing with him, and paying less attention to our daughter. We never thought she can have this condition. Is it possible that we could have missed it completely?


Yes, it is entirely possible that you, as well as her teachers, could have missed the signs of Attention Deficit Hyperactive Disorder (ADHD). Girls often present differently from boys.

Many parents and teachers are familiar with boys who are hyperactive and disruptive. They are recognized earlier because of their behaviour. Long-acting ADHD medications are helpful for them to pay attention and to learn in school, and do their homework. Some girls who are hyperactive and disruptive are similarly recognized and received help early.

However, many girls present differently. Some can be hyperactive in less obvious ways, like talking in class, playing with things, or drawing in their scribblers. They will stop talking when being told; they are less likely to break the rules or get into fights. Many will daydream, or get distracted by noises or things around them. As a result, they fly under the radar and not being recognized. They may still get good marks, although they are not performing at their best. Some teachers may comment that she can do much better if she puts in more effort, or pays better attention.

As they get into higher grades, the demand for attention increases. It is harder to pay attention especially in boring classes. Many procrastinates with homework and assignments, or not doing them altogether. Their marks can drop in junior or senior high school; their self esteem suffers.

At the same time, they want to fit in with their peers. Some start skipping school to hang out with friends. This is also the age when they start smoking cigarettes, using marijuana, and drinking alcohol. It can be due to curiosity, or to their impulsive behaviour. These drugs can calm their brain a little, but also give them high and lead to addiction.

As you may already know, ADHD is a genetic condition; children inherit the genes from one or both parents. Since your son has ADHD, she may have inherited some of these ADHD genes also, although her symptoms are less obvious. You may not recognize her problem because she was doing well in school until recently.

In addition to ADHD, your daughter may also have anxiety. Children with ADHD can become anxious because they haven’t done their homework, or didn’t study for tests and exams. Adults with ADHD often worry about forgetting tasks that they have to do, and try to set reminders for themselves. Sometimes, it is difficult to tell whether these worries are part of ADHD, or whether someone has anxiety in addition to ADHD.

You can ask your family doctor to make a referral to see a paediatrician. With proper assessment, the doctor can determine whether she has ADHD alone, or ADHD with anxiety. Sometimes, it may be necessary to give her treatment for ADHD first, and see whether it reduces her anxiety.

She is at a critical stage in her life that she needs treatment soon. Otherwise, she can get into more serious trouble, dropping out of school, and getting involved with drugs and alcohol. Teenage pregnancy is much more common in girls with ADHD than their non-ADHD peers.