Doctors uncover why ADHD wildly underdiagnosed in girls

After research began showing difference in red flags, diagnoses spiked

SAN ANTONIO – Signs of ADHD in girls are often different than in boys, which has created a considerable gap in misdiagnoses for years.

“It’s very well known in my field now, in my training, that girls tend to be underdiagnosed with conditions such as ADHD,” said UT Health San Antonio psychiatrist Dr. Barbara Robles-Ramamurthy.

ADHD stands for attention deficit hyperactivity disorder. The word “hyperactivity” is a key component of what’s created the gender gap in diagnosis.

“Oftentimes, these diagnoses require or expect that there may be behavioral difficulties that are often displayed more by boys than by girls,” Robles-Ramamurthy said.

Girls with ADHD often have a type called ADHD-Inattentive or (ADHD-I).

That means they have difficulty paying attention, staying organized, and managing their time. However, they are not hyper, like the stereotypical boy bouncing off the walls.

“If you have a girl at home who is intellectually capable of doing work but for some reason cannot get through it, or they’re taking much longer than you would expect, but they’re really trying, then that might be a good sign to speak with their teacher, with their pediatrician and get them assessed,” Robles-Ramamurthy said.

Many women are also being diagnosed later in life and opening up about it on social media. They’re documenting their experiences using hashtags like #ADHDwomen.

“I think it’s really important that people share their stories and are understanding of their own narratives so that others can be educated and empowered to seek care and assessments,” Robles-Ramamurthy said.

She explained that undiagnosed disorders, like ADHD, can lead to other issues that complicate the situation.

“Untreated ADHD can place people at risk for substance use, for example. So they might end up finding substances that make them feel better and get their work done, so they might have ADHD but be misusing the medication. When we see those behaviors happening, we need to connect them to a clinician that will help assess the situation and help them through the treatment,” Robles-Ramamurthy said.

Robles-Ramamurthy explained that, though ADHD medications can carry a stigma, using the correct ones in the proper doses can help patients tremendously.

“These medications are highly effective, and hopefully, with the help of a really good clinician, whether it’s your pediatrician or a psychiatrist, you can navigate finding the right medication that works for you,” she said.

Her message to doctors is to ensure they are up to date on training on this subject.

“I would say most pediatricians are now feeling comfortable doing the assessment and starting medications. If they struggle along the way to find the right agent, then they might refer you to a psychiatrist,” she said.

For more information on the gender gap and ADHD diagnoses in girls and women, visit the website for Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), the nation’s leading nonprofit organization serving people affected by ADHD.

There are also articles available from the Child Mind Institute.

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About the Authors:

Courtney Friedman is a KSAT anchor and reporter. She has an ongoing series called Loving in Fear, confronting Bexar County’s domestic violence epidemic. She's also covered Hurricane Harvey, the shootings in Sutherland Springs and Santa Fe, and tornadoes throughout Texas. She’s a California native and proud Longhorn who loves calling SA home.

Valerie Gomez is lead video editor and graphic artist for KSAT Explains. She began her career in 2014 and has been with KSAT since 2017. She helped create KSAT’s first digital-only newscast in 2018, and her work on KSAT Explains and various specials have earned her a Gracie Award from the Alliance for Women in Media and multiple Emmy nominations.