A recent study examined self-awareness of ADHD symptoms in older teens and found that girls have particularly high levels of self-awareness in this area.
Studies that examine behavioral symptoms rely on self-reporting, or a combination of symptom reporting from the individual and those around them. When the individual is a minor, the studies may rely heavily on reporting by parents and teachers.
However, this raises a question: how different are reports by the individual from those by the adults in their life?
Why Does This Matter?
The primary reason that self-awareness matters in research and treatment is for accurate reporting. Suppose an individual reports that their symptoms are reduced, but their teachers and parents find that the symptoms are still significantly disrupting daily life. How should a doctor handle this situation? How should a researcher, testing the effects of a new medication regime, consider this reporting?
The doctor or researcher is left to compile the information and make the best possible assessment, and then determine the best course of action forward. Knowing how reporting from an individual may differ from that of those around them can provide some insight into this.
Outside of the doctor’s office, simply understanding the difference in how the child sees the symptoms compared to how others see them may help a parent gain a better understanding of their child’s feelings and experience as well.
The Gendered Difference In Reporting
There is some gendered difference in ADHD symptom presentation overall, and there’s still debate over how much of this is socialized, how much is perception, and how much is a genuine difference in how ADHD affects boys and girls.
What we do know is that boys are diagnosed at a rate of about two to three times that of girls, and that when diagnosed, girls are more likely to be recognized as having inattentive symptoms. In contrast, boys are more likely to be acknowledged as having hyperactive symptoms. We also know that girls’ symptoms are more likely to be overlooked, and parents are more likely to report greater difficulty with symptoms in boys (which may explain some of the diagnostic disparity).
The authors of this new study specifically acknowledge that the traits associated with ADHD are based heavily on clinical diagnosis of male patients, and that there are traits more associated with boy behavior, regardless of diagnosis. That is to say, boys are stereotyped as being hyperactive, with or without ADHD, so it’s little surprise that the disorder is heavily associated with boys.
Self-Awareness Turns Out To Be Gendered Too
When researchers asked teens aged 15-18 about their symptoms and compared these to the symptoms reported by the adults in the teens’ lives, they found a disparity.
Girls typically reported their symptoms on the same level as their parents reported, while parents reported symptoms that were more severe than the teen would report himself. According to the report in Science Direct:
“Males rated fewer symptoms compared to their parents and clinicians, whereas females’ self-ratings did not differ from parent and clinician ratings. Relatedly, females were in higher agreement with parents and clinicians compared to males.”
Researchers concluded that teen girls were more insightful and more aware of their symptoms, while teen boys were likely to “underestimate their symptoms.”
Parental Perception Of Symptoms
One factor could also be that girls’ symptoms tend to be overlooked more frequently anyway. It’s also relevant that the symptom most heavily associated with ADHD in boys (hyperactivity) is more disruptive than the symptom most frequently associated with girls (inattention).
While kids of any gender can have ADHD presenting with any of the symptoms, these presentations are currently considered more common. A parent, teacher, or doctor is undoubtedly more likely to notice a boy with stereotypical behavior, such as running around the room, falling out of his desk, and throwing erasers, compared to a girl with stereotypical behavior, who may be daydreaming instead of doing her work.
Girls’ symptoms are so much more likely to be overlooked that they’ve been labeled the ‘lost girls’ — children who grew up without the support they needed, because nobody realized they were suffering. The Children’s Health Council noted that girls with ADHD or autism are likely to become perfectionists who mask their symptoms heavily, and that there is still significant underdiagnosis.
Social Pressure On Girls Is Different
Again, I must emphasize that gendered norms can vary widely, so this will not reflect everyone’s experience, but rather the most common or ‘normalized’ socialization.
Boys and girls are both pressured to fit in, but this can manifest differently. A 2018 study available through the National Institute for Health found that girls “worry more about abandonment and losing friendships with their peers,” which may result in more adaptation of their behavior to fit in.
For girls with ADHD or other neurodivergences, this can mean heavier masking of symptoms and a more constant vigilance about any differences between oneself and one’s peers.
The same study posited that boys may “feel more inclined to act out and participate in deviant behavior” because of common portrayals of ‘boy behavior’ in popular media.
What Does All Of This Mean For Parents?
As parents, we can take a few important lessons from this.
First, if our boys are exhibiting strong symptoms, this data suggests that they may genuinely be unaware of the severity of the symptoms. If you are noticing that your son’s ADHD symptoms are severe and interfering with his endeavors, he may be entirely unaware of the level. This might mean that we need to give a little grace, or that we need to do more gentle correcting and calling our boys’ attention to concerns.
In the doctor’s office, it may mean that we need to communicate more clearly with a pediatrician, because he may hear from our boys that their symptoms are less severe than what we’re witnessing.
For our girls, this heightened self-awareness can be uncomfortable, and they may need more support and understanding. They may need us to just let them know that we see their struggle and that we’re with them.
For all of our kids, regardless of gender, we need to pay attention to how ADHD symptoms affect their lives, not just how they affect us and others in our kids’ orbit. When we’re making decisions about medication or other treatments, accommodations and support in schools, and other aspects of their care, we need to recognize that their perception of their experience matters, even when it differs from our own.