‘The Picture Between Home and School is Miles Apart’: Reflections of Parents/Carers and Professionals in the UK on the Manifestation of Attention Deficit Hyperactivity Disorder in Girls

Abstract

Background: Attention deficit hyperactivity disorder (ADHD) is more commonly missed in females than males, partly because the diagnostic criteria may not fully capture the female presentation. This study aimed to qualitatively identify difficulties experienced by females with ADHD, especially those beyond the current diagnostic criteria, from the perspective of parents/carers and professionals. Method: Seven focus groups were conducted in the UK in 2023: three with parents/carers, two with healthcare professionals, and two with educational professionals, involving a total of 35 individuals. Participants were asked to describe their experiences of supporting girls with ADHD. Data were analysed using the framework method. Results: Four themes were identified: (1) attention regulation difficulties and their social impact, (2) hyperactivity and impulsivity manifest more verbally and subtly, (3) prominent difficulties with emotional impulsivity and regulation and (4) difficulties are more obvious at home than at school. Conclusion: Female ADHD might be missed as difficulties are less externally disruptive and more emotional than the current ADHD diagnostic criteria. Additionally, females may engage in masking behaviours. Improving current ADHD diagnostic assessments and criteria to reflect this presentation would benefit diagnostic inequalities and access to care for females with ADHD.