Many girls and women with ADHD are often overlooked by medical and psychiatric providers. This is because research and clinical practices are built around the presentation of ADHD in males. In fact, ADHD is often misattributed as anxiety, depression, and hormonal fluctuations. Diagnostic criteria have historically played up overtly behavioral indicators like hyperactivity and the externalizing symptoms that are more common in males.
Why girls and women with ADHD are often overlooked:
- Symptom types: Hyperactive/impulsive-type symptoms, which are more common in boys and men, are usually easier to notice. That makes it more likely that boys and men will draw attention that leads to a diagnosis.
- Bias: Because ADHD is more common in men and boys, healthcare providers and educators may not look for the symptoms in girls. That can make it harder for girls to receive a correct diagnosis and treatment.
- Less available ADHD research in females: Early ADHD research mainly focused on the condition’s effects in boys and men/people AMAB. That’s why ADHD research specific to girls is years behind.
- Criteria flaws: Some experts argue that the writing of the current criteria is less helpful or accurate for diagnosing girls and women.
- Stereotypes about sex, gender and behavior: ADHD-linked behaviors — especially hyperactive/impulsive symptoms — are often considered more socially acceptable for boys and men. As a result, girls may suppress or hide ADHD behaviors to fit in better.
Symptoms of ADHD in Girls
Research and lived experience indicate that girls and women most often appear to have the inattentive presentation. Symptoms include:
- Fails to give close attention to details or makes careless mistakes
- Has difficulty sustaining attention, does not appear to listen
- Struggles to follow through with instructions, has difficulty with organization
- Avoids or dislikes tasks requiring sustained mental effort, loses things easily
- Is easily distracted, is forgetful in daily activities
Other symptoms common in girls:
- Talks excessively
- Fidgets and often needs to get up and walk around
- Acts impulsively or speaks before thinking
- Appears to daydream but will explains that her thoughts feel like they are “going a million miles a minute” and she has trouble keeping her mind on one topic
- Easily makes friends but has difficulty sustaining friendships
- Self-harming activities, or activities that require extreme and unhealthy self-discipline
- Adopts compensatory strategies, leading to working two to three times as hard as her peers in order to be equally successful
- Fears rejection by peers or friends and clings to other people or remains in unhealthy relationships
Assessment of ADHD in Girls and Women
One of the most important tools for diagnosing ADHD is psychological testing, which involves a comprehensive evaluation of a person’s cognitive, behavioral, and emotional functioning. Psychological testing for ADHD typically includes multiple methods, such as clinical interviews, rating scales, behavioral observations, and neuropsychological tests.
Psychological testing place a critical role in the diagnosing and treating ADHD. Different components of psychological testing, including clinical interviews, rating scales, behavioral observations, neuropsychological tests, intelligence tests, and mood and personality tests, provide a comprehensive assessment of a person’s cognitive, behavioral, and emotional functioning.
This comprehensive assessment allows clinicians to make an accurate diagnosis of ADHD, rule out other conditions that may mimic ADHD symptoms, and develop an individualized treatment plan that addresses the person’s unique strengths and challenges.
Psychological testing can provide valuable information for developing accommodations and interventions for individuals with ADHD. For example, neuropsychological tests can help identify specific cognitive deficits that may affect academic or occupational performance and inform the development of targeted interventions to address those deficits. Behavioral observations can also help identify specific triggers or contexts that exacerbate ADHD symptoms, which can inform the development of environmental modifications or behavioral interventions to reduce those triggers.
Types of psychological tests used to assess for ADHD
Objective Tests
Psychometric tests assess various cognitive functions, such as attention, memory, executive function, and processing speed. Neuropsychological tests are useful in psychological testing for ADHD because they can provide information about the underlying neurocognitive processes that may contribute to ADHD symptoms.
Some commonly used neuropsychological tests for ADHD include the the Wisconsin Card Sorting Test and the IVA-2, a continuous performance test (CPT). Each test assesses a different aspect of cognitive functioning and can provide valuable insights into the person’s strengths and weaknesses in various cognitive domains.
Cognitive Tests
Intelligence testing can provide valuable information for understanding the impact of ADHD on a person’s cognitive functioning and inform the development of appropriate interventions and accommodations.
Intelligence testing typically involves the administration of standardized tests that assess various cognitive abilities, such as verbal comprehension, perceptual reasoning, working memory, and processing speed. These tests can provide a comprehensive picture of a person’s cognitive strengths and weaknesses and help identify any specific cognitive deficits that may contribute to ADHD symptoms or impair daily functioning.
At Therapy Dynamics, we use the Reynolds Intellectual Scales-Second Edition (RIAS-2). Working memory scores are evaluated and are added to the information collected through other psychological tests. Individuals with ADHD tend to have lower working memory scores and greater discrepancies between verbal and nonverbal working memory scores.
Mood and Personality Tests
Mood and Personality testing can be useful in diagnosing ADHD in certain cases. Several mood and personality patterns can impact a person in similar ways as ADHD, and it is important for the clinician to rule out of problems that may be affecting a person’s functioning or identify co-morbidities.
There are several types of mood and personality tests that can help identify ADHD symptoms, including self-report questionnaires, structured interviews, and rating scales. At Therapy Dynamics, we use the BASC-3 in girls and the Personality Assessment Inventory (PAI) in women.
I thought ADHD was a clinical diagnosis
There are many proponents of diagnosing ADHD clinically solely by doing an interview, answering a questionnaire, and checking off the criteria met for the diagnosis. This process lends itself to subjectivity because it primarily relies on self-reported symptoms. When testing children, difference between rating scales filled out by parents and teachers can be significantly different.
A robust evaluation uses both objective and subject measures. Testing is a critical component in the diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD) due to the complexity and variability of the disorder’s symptoms. There is no one test thoughthat definitively diagnoses ADHD.
Cognitive Performance Tests (CPT) are objective measures that provide objective data that is less subject to personal bias. CPT tests measure:
- Sustained attention: Ability to maintain focus over a prolonged period
- Response inhibition: Ability to withhold a response when inappropriate
- Reaction time variability: Consistency in response speed
At Therapy Dynamics, we use the IVA-2 in part because it is normed separately for females and males. In addition, we also use the Wisconsin Card Sorting Test, and Brief Test of Attention along with clinical interview and questionnaires like the BRIEF-2.
Testing involves a series of standardized assessments that measure various cognitive abilities, including memory, attention, problem-solving, and executive functioning. The findings can inform treatment recommendations and educational strategies tailored to the individual.