ADHD in males versus females: What you must know about the differences in symptoms and treatments

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Attention-deficit/hyperactivity disorder (ADHD) may be common, but it’s also sometimes hard to spot.

ADHD is usually first diagnosed in childhood and is one of the most common neurodevelopmental disorders in children, according to the Centers for Disease Control and Prevention (CDC).

Symptoms of ADHD in kids can include trouble paying attention, difficulty controlling impulsive behaviors and displaying periods of hyperactivity.

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But how these symptoms show up in boys versus girls, and eventually in men versus women, can make a big difference in diagnosis.

Sabrina Nasta, a licensed mental health counselor with Grow Therapy in Orange Park, Florida, told Fox News Digital that ADHD can show up in three different ways: through inattention, hyperactivity and a combination of the two.

ADHD in males compared to females can mean significantly different symptoms, experts say. (iStock)

In women, ADHD most commonly manifests as inattention, which includes an inability to pay attention, distractibility and lack of compliance, according to Nasta.

In men, ADHD occurs in a hyperactive way, causing issues with sitting still or wanting to be constantly "doing something," said the expert.

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McCall Letterle, head of U.S. commercial operations for ADHD assessment company Qbtech, also commented on these differences in a conversation with Fox News Digital.

Athough many of the symptoms, including hyperactivity, inattention and impulsivity, are the same, it’s how the symptoms "manifest themselves" that causes a variation between males and females, the Atlanta-based expert noted.

Young girls with ADHD may sit still in the classroom, but they're "not paying attention," an expert said. (iStock)

A struggle with discipline seems to be a commonality of ADHD in men and women based on their lifestyle and age, Nasta added.

In young boys, for example, ADHD shows up as "unnecessary" hyperactive energy; they "don’t have the capacity to not do anything," the expert said.

In girls, the same inattentiveness may arise, but it's most likely internalized.

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"They may be sitting in the classroom, they may be sitting still, but they're not paying attention," Nasta said.

"It's tough because for a girl, it looks like they're rebelling or being disobedient, [but] for a boy, [it seems that] they're just being ridiculous and hyper."

Underdiagnosis in women

The differences in ADHD presentation have led to a "massive amount of underdiagnosed women," according to Letterle.

"This [disorder] was first researched in males, and the criteria developed around symptoms most commonly seen in boys," she told Fox News Digital. 

Initial research on ADHD in boys and men could have led to the misdiagnosis in women, one mental health expert suggested. (iStock)

"These are also the most overtly obvious symptoms — like hyperactivity, inability to sit still, disruption and difficulty focusing, often in the classroom — that lead to associated behavioral issues," Letterle added.

While some women do experience these hyperactive symptoms, they are not the most prevalent symptoms and they look different when they do occur, according to Letterle.

"Women tend to exhibit symptoms that are more internalized," she said. 

"For instance, their inattention is much harder to recognize than boys, as it can be displayed as daydreaming or inward distraction."

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Letterle pointed out the "external fallout" of these ADHD symptoms in girls — which results in "high rates of anxiety" due to missed information at school.

In many cases, girls have to work twice as hard to retain information and meet academic standards as their peers, and they experience low levels of confidence stemming from these difficulties, she added.

Girls with ADHD can experience "high levels of anxiety," said a mental health expert. (iStock)

"That is subjectively a lot harder to identify than distracted boys, who are poking the individual next to them as they struggle to maintain focus."

These variants lead to a "massive difference in diagnostic rates" between young girls and boys, Letterle said.

Boys are often diagnosed and treated faster than girls because their symptoms are easier to identify, she added.

Personalized coping 

One of the best ways to cope with ADHD is to educate yourself, or your child, on the best way to function in different environments, said Nasta.

Some of the strategies she recommended include practicing mindfulness and self-awareness, and coming up with the best game plan in any given situation.

Stress management is another great coping tool, especially for boys, added Nasta.

Allowing kids with ADHD the time to release stress is an important coping technique, experts say. (iStock)

For kids, stress management can mean participating in leisure activities or hobbies like playing video games or hanging out with friends.

"It's about allowing them to let that energy go in a more supportive way," Nasta said.

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ADHD in boys and girls can be difficult for caretakers — parents, guardians and even teachers — to identify when they lack the "appropriate tools" to make "more accurate referrals," Letterle noted.

To overcome that challenge, Nasta encouraged caretakers to "listen more."

"If you’re really paying attention and your kid’s trying, this could be a neurological or neurodevelopmental concern versus them just struggling with emotions," she said.

In young boys, ADHD shows up as "unnecessary" hyperactive energy; they "don’t have the capacity to not do anything," according to experts. (iStock)

It might be helpful for parents to "be more curious" and ask their children questions about their feelings when they are overwhelmed, Nasta suggested.

"What do you experience when you're overwhelmed? Are you able to focus or pay attention to your teacher? Do you notice what your thoughts are doing?" she listed as example questions.

"If it sounds really concerning and intrusive, I would say that's the point of … seeing a professional."

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Early ADHD intervention is "critical for reducing suicide rates, job instability and substance abuse in those left untreated," Letterle said.

"The diagnostic process has been left largely to subjective rating scales, creating a desperate need for clinicians to start adopting a more data-driven approach to symptom measurement," she added.

Impairments in managing basic hygiene, finances, academic or communication skills could signal the need for ADHD evaluation, according to experts. (iStock)

"Objective data compares performance in the three core symptom areas against age- and sex-matched controls without ADHD — meaning women are compared to other women to improve the ability to accurately identify their diagnosis," the expert said.

When to seek help

While the term "ADHD" is often tossed around to describe when someone is feeling unfocused, Nasta listed a few warning signs that could point to an actual diagnosis.

The expert said to monitor daily responsibilities such as hygiene, finances, academics and even basic social skills such as listening and communication.

"If you notice impairments and deficits in any of those, I would say that would be the time to talk to somebody," she advised.

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For people who are unsure of their symptoms, Letterle recommended seeking out a provider who uses objective data in a comprehensive evaluation.

"[This] would help to better ensure not only a more accurate diagnosis, but also one that helps eliminate the bias that often leads to high rates of underdiagnosis or misdiagnosis in women," she said.

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