*Children who have been socialized as girls, regardless of actual gender identity.
Current research on ADHD in girls
Girls with ADHD face (at least) two stacked stigmas: sexism and dis/ability, plus any other intersecting identities, for instance race and class, which can prevent access to comprehensive and timely diagnosis and treatment. Girls are systematically under-diagnosed for ADHD compared to their male counterparts, and are mostly classified as the inattentive subtype because of social expectations for female behavior (e.g., being demure, calm, attentive) (Grskovic & Zentall 2010, Kok et. al. 2016). Further, even though girls exhibit similar symptoms to boys -- for instance lack of focus, hyperactivity, and stimming -- girls with ADHD are more likely to mask these symptoms than boys, pushing themselves (often in unhealthy ways) to conform socially and overachieve academically (Faulkner 2020).
In examining the social experiences of girls with ADHD, educators not only can identify specific areas of social-emotional need but also explore the mutually reinforcing relationship between biology and culture and how this dynamic influences friendships and socialization in neurodivergent girls. Grskovic & Zentall, quoting research from Mikami and Hinshaw (2006), note that elementary-aged girls with ADHD are more likely to develop substance use and eating disorders as adolescents (i.e., self-medicating behaviors), likely due to both their symptoms and indirectly from the trauma and low self-esteem caused by ableism, social "delays," and unstable friendships (pg. 171-2). In their study of 262 girls with ADHD and their parents, Grskovic & Zentall found that, in addition to the attributes described above, neurodivergent girls were likely to be labeled as "dreamers, fantasizers, or readers" who were "always in love" (pg. 173); this can be seen as both a description of how symptoms may manifest and a reflection of how society frames young girls' behavior as frivolous and flighty.
Girls with ADHD tend to struggle with high levels of stress and anxiety because of their chronic failure to conform socially and are prone to internalizing these negative feelings about themselves (Jacobson/Child Mind Institute); according to Kok et. al., girls with ADHD also "display a different pattern of comorbidity than boys; comorbid internalizing disorders (i.e. anxiety and depression) and emotional dysregulation are more prominent in girls, whereas boys are more likely to present with externalizing, disruptive disorders" (pg. 2). (The key phrase here is "more likely," as predominantly hyperactive-impulsive girls who are likely to exhibit "externalizing" symptoms exist even though they have not been the focus of recent research. [In other words, because of sexist societal norms, there may be an unconscious bias in research that frames the externalizing symptoms of girls with ADHD as less notable or noticeable.])
Sexism and social struggles
In previous posts, I've outlined how ADHD symptoms are often externalized as socially unacceptable behaviors that make a child a target of ridicule in classrooms and social situations. When considered alongside one another, sexism and ADHD's social impacts are mutually reinforcing; neurodivergent girls face harassment and maltreatment as a result of both their gender and ADHD behaviors. Kok et. al. writes that as girls in general usually have tighter and more intimate social networks, and as the peer relationships of girls involve higher peer attachment, disruption to such relationships may impact more negatively on girls than on boys. Second, low self-esteem is more prominent in girls with ADHD relative to typically developing (TD) girls as well as to boys with and without ADHD. Third, children typically tolerate higher levels of ADHD symptoms in boys than in girls, and many typical ADHD symptoms are considered more deviant for girls relative to boys. This may be explained by gender expectations of how girls are supposed to behave. Girls with ADHD therefore may stand out from their peers to a higher extent than do boys. (pg. 3)
Because neurodivergent girls have less practice with stable friendships and friendships are not reciprocated as often, they might be less attuned to and less skilled in picking up on social cues, which is further intensified by their inattention and impulsivity (HowtoADHD, Grskovic & Zentall 2010). At the same time, girls with ADHD tend to be aware of their "social failure and rejection" and experience high levels of guilt (Grskovic & Zentall 2010) because society puts girls' achievements and social images at the center of the school experience.
When designing social-emotional interventions for students with ADHD, it is crucial to consider how female children are often left behind, how their struggles may be minimized or misunderstood, and how their voices might not be heard in conversations about the academic and social-emotional accommodations that affect them directly.
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