Steve:

Hi, everybody. So Harit and I had wanted to do a recording on ADHD in women. And I was going to do that. And then I thought, well, who better to ask than my co-director in my private practice? Dr. Claire Young, who also heads up a neurodevelopmental pathway in the NHS. So welcome, Claire.

Claire:

Hi.

Steve:

So I wonder if you could talk a little bit about the differences in ADHD in girls and women? And maybe some of the differences between that and how it might present in boys and men?

Claire:

Yes, of course. So I think when we're obviously looking at ADHD, we need to have in mind that there are these three sub-profiles. So you would have your ADHD inattentive type, you would have your ADHD hyperactive type, and then you would have the ADHD combined type so inattentive, and hyperactive. And I think when we look at some of the differences across the gender spectrum, we would typically see more of the hyperactive type amongst boys and men, and more of the inattentive type amongst girls and women. And I think it's for this reason that girls and women often get misdiagnosed. Because the inattentive type would be where you would typically see girls being a bit more distractible.

They may be described as in their own world, always in a daydream, staring out the window, teachers may say things like, certainly, in my experience working with children, young people in schools where these girls don't often cause a great deal of mayhem. They don't often get picked up. But teachers may say things like, “she never seems to be listening”. “She struggles to finish her work”. Or they may say, “oh, yeah, she's a really chatty Betty. But she talks about all sorts of different things. It's quite hard to get a word in edgewise.”.

But what you tend not to see more of those externalizing behaviours, which we may reasonably say, within the boys at schools, and maybe less so as people get older. But certainly, with the boys that I work with, they're much more of that sort of typical profile, where they are in and out of their seat, they're very fidgety, they're quite restless. Lots of these boys may end up being quite the entertainer in the classroom. So they're constantly telling jokes, they're often well-liked, quite popular. But maybe they're overly boisterous. They certainly draw attention to themselves. Whereas the girls are the ones, obviously, in a bit of a daydream, in a bit of a fantasy world. Sometimes they love doodling, I've got lots of girls who will draw and quite happily do that. So they don't really come onto the radar for teachers a great deal.

If they do, it's often because they're behind in their work, they're not achieving what the teacher might say is their full potential, "capable of so much more", "if only they'd work harder" tends to be some of the phrases that some of these girls attract. So I think, definitely when we're looking across genders, that we may see some of those notable differences. But that's not exclusive. Certainly, there are girls who have much more of that combined type where they are very, up and down. They can be quite defiant. They can be very outspoken. They can be quite dominant in their behaviours in their peer group.

So it's certainly not that all girls are inattentive, and all boys are hyperactive in any case, but I think you could definitely hypothesize that a number of the girls don't get a diagnosis where there is more of that inattentive type because that can often get missed and not picked up. And of course, that then can lead to some more of those sort of self-esteem and confidence issues that we might come on to later.