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Column originally published Mar 30, 2021

It Is Much Harder To Recognize Girls With ADHD

Question: I am worried about our ten-year-old daughter. She is a smart and happy girl; that is, until a few months ago. School was always easy for her; she was at the top of her class, until this school year. Lately, she is coming home frustrated, crying, and saying that she is stupid. Her marks are still good, but they have clearly dropped. Her teacher said that she lacks focus, and she is slow to complete her work. I have always known that she gets distracted easily when I help her with homework. I wonder whether she has ADHD also. Our teenage son was hyperactive and disruptive in grade 1, and he was diagnosed right away. He has been followed by a paediatrician since. He is now a confident young man in high school, and takes his medicine daily. When I asked my family doctor to refer our daughter for ADHD assessment, she said that she cannot have ADHD. I was actually diagnosed with ADHD in my teen years, and I recall how hard school was for me; I had difficulty focusing and getting motivated to do homework and to study. I can see the same challenge in my daughter now. What can I do to help her?


I am glad that you can identify your daughter’s lack of concentration and easy distractibility as early signs of Attention Deficit Hyperactivity Disorder (ADHD). Although ADHD affects boys and girls equally, many more boys are diagnosed during childhood years than girls. It is because more boys are physically hyperactive and disruptive in classroom, making it difficult for teachers to teach, and for classmates to learn. Girls are still hyperactive inside their head, with lots of thoughts, or in their dreamworld; these can interfere with their ability to focus.

In spite of these challenges, many boys and girls are still able to do well enough to get through the school system without being recognized to have ADHD. Although they got through high school, they often don’t have good self esteem. I have seen many students who wished to be teachers, nurses, scientists, and other professionals, but deep down, they know that they cannot sit long enough to pay attention in post-secondary education. Some do attempt college and university, but drop out quickly. Statistics showed that students with unrecognized and untreated ADHD have less than 10 percent chance of graduating university.

Losing self-esteem poses the greatest harm to young people with ADHD; they believe that they are less smart as others. This is simply not true, but it is hard to convince them because they always get lower marks than their peers. For those few who did succeed, they have told me how hard it was; they have to work many times harder than others to get the same grade. It is not easy to sustain those efforts. Those who succeeded often paid a high cost; many developed anxiety and depression along the way.

Ever since I retired from paediatrics and seeing adults with ADHD, I have seen many successful women presenting with years of anxiety and depression. They never recognize that they have ADHD; they have a very busy brain that they struggle with every day. It takes them enormous efforts to think through the fog of those thoughts that get in the way. These are not welcomed thoughts; they are intrusive thoughts that they cannot control.

As a result, many women are incorrectly diagnosed with anxiety and depression, and treated with medications that may offer partial relief. Nobody has ever asked them how their brain works. As one young woman said, she has only one brain, that is the way her brain works, and she doesn’t know how it works in other people.

It is fortunate that your son has more obvious symptoms of ADHD, and was diagnosed and treated early. His challenge will be in the next few years, when he finishes high school and goes into post-secondary education or workforce. He may require more attention, and his medicine may not work as well. College and university students often need their medications adjusted to be successful.

You may need to see your family physician again, and insist on a referral to the paediatrician. There are ADHD questionnaires that you and her teacher can fill out to support the referral. If you have medical coverage, you can arrange for a private psycho-educational assessment which can identify ADHD and learning disabilities. She is already losing her self-esteem, further delay in diagnosis and treatment can make her more frustrated. Don’t give up until you get the right help for her.