ADHD is a common topic among parents, schools, and health providers. But ADHD in girls is an elusive concept.
Allison was always labeled a “Tom Boy.” When other girls were playing with dolls, reading, or coloring, she was outside playing with the neighbor boys. She preferred softball, kickball, riding her bike. She could never sit still. And she played tough, tougher than most of the boys. She never wore out.
But school was different. She struggled in math. It was hard to do her work carefully. She often lost her place reading. And her hand-writing was terrible. The simplest homework assignments reduced her to tears, and caused arguments with her parents.
“You can do this,” her parents told her. “How do you not know this stuff? We just did this two days ago.” Over and over she practiced her math homework. Her homework would sometimes get lost, and she could never remember instructions. Allison used to tell people it was her hearing, since she’d get things jumbled up so often. She also told herself that she wasn’t very smart, and that she wasn’t good at school.
Once, Allison, forgot a paper in her desk. Her teacher had asked everyone to turn in the assignment. But Alison didn’t. Later, her teacher helped her clean out her desk, and they found the assignment – incomplete. Allison had to stay in from recess all day to finish the assignment. She felt embarrassed and ashamed. A year later, Allison forgot a tuna fish sandwich in her desk for 3 weeks. She didn’t want the teacher to know because she didn’t want to get into trouble again. The sandwich began to stink. And again, her teacher found it, Allison got into trouble, and all the students laughed.
Years later, during college, Allison found that she was indeed bright, and that her “bad hearing” was actually something else: Attention Deficit Hyperactivity Disorder. Unfortunately, Allison’s story is a common one.
Why Girls with ADHD Are Missed
Early research on ADHD seemed to indicate that ADHD was diagnosed primarily in boys. In fact, in 1980, one girl for every 9 boys was diagnosed. Three decades later, researchers now know it occurs equally in genders. However, it is still not equally recognized and treated as such. Currently, one girl is diagnosed for every three boys.
Girls Present Differently
According to the CDC, boys are far more likely to receive a diagnosis of ADHD because girls with ADHD present differently. Even though the ICD-10 and DSM-V criteria have been updated, some argue that they still do not reflect girls accurately. The symptoms are often more subtle, and they don’t fit the stereotypes people hold for ADHD Children.
According to Dr. Patricia Quinn, director and co-founder of the National Resource Center for Girls and Women with ADHD, girls tend to be less disruptive. When they are overactive, they may be overly helpful, sit on their feet often, or talk too much. Many girls make up for their symptoms by staying compliant or trying to work harder.
The Cost of Being Diagnosed Later in Life
Like Allison, a late or missed diagnosis means that girls have missed academic opportunities, but also mental health challenges. According to Quinn, 70% of the time, girls present for services with depression, anxiety, or eating disorders. Later, as treatment progresses, girls are recognized as having ADHD symptoms.
Because ADHD in girls isn’t diagnosed until later, it can change the way girls learn to view themselves. Also, like Allison’s story above, girls are more likely than boys to internalize the negative feedback, the embarrassment, and the shame. Some women develop symptoms of trauma from all of the difficulties they went through prior to their diagnosis. It may take many years for girls and women to learn to trust themselves and their abilities.
Research has found that girls with combined-type ADHD have significantly higher rates of attempted suicide and self harm, even though 40 percent of them have outgrown their hyperactive and impulsive symptoms in adolescence (Hinshaw, 2012). They also have more difficulties with reading comprehension and math, and long-term struggle with their achievement and potential.
A Culture of High Expectations
As we’ve described many times on our blog, today’s children and adolescents have more pressure than ever before, predisposing them to more anxiety. Due to the high costs of college, and the need for scholarships, many students feel overwhelmed due to rigorous schedules and grade requirements in junior high and high school. A girl who was fine in grade school can suddenly find herself completely overwhelmed, stressed, and frustrated. They may find that they have good grades, but at the cost of their mental health, social life, and family life.
So What Can Parents of a Girl or Young Woman with ADHD Do?
Help with her self-esteem.
Make sure your daughter knows she is smart, and that YOU think she’s smart. Help her teachers know her strengths and areas of competence. Let her know you love her without condition, and that you are there to support her and advocate for her.
Learn about ADHD in girls.
Educating yourself about ADHD, particularly in girls, can help build a sense of control around a frustrating, complex disorder. It will also give you the information you’ll need to become a strong advocate for your daughter, and gradually teaching her to become an advocate for herself. You will need to know about academic accommodation, medication treatment, psychological treatment, and emotional support.
Help your daughter manage friendships.
Many people with impulsivity can say things they don’t mean, or act without thinking. Sometimes, people with inattention can miss social cues or struggle with leadership. Girls with ADHD often struggle with friendships, and the constant pressure of the female social world can be frequently overwhelming. Parents can help encourage appropriate activities, like drama club, sports, or leadership clubs. Keeping girls involved socially will be important for her self-esteem and mood.
Talk to your pediatrician or healthcare provider.
Your child’s physician is your partner in this journey. Most likely, they will provide medical options to help your daughter, or provide you referrals to providers who are skilled at working with ADHD in girls. Because of the frequency of overlapping medical conditions, at times, patients may require the services of a psychiatric prescriber.
Consider finding a mental health professional who specializes in the needs of ADHD in Girls.
It will be important to find someone who understands the particular needs of girls with ADHD. One possibility is to see if they are a Board Certified Child Psychologist, or a psychologist or psychotherapist who has published or given talks on girls with ADHD. It will be very helpful to have a well-rounded psychological evaluation that assesses your daughter’s intellectual potential, and rules out other conditions like learning disabilities, anxiety or depression. Most importantly, it is important to have FOLLOW-UP CARE in terms of therapy to help you and your child succeed throughout her life-span.
Work with your child’s school.
If your child’s school receives public funding, there are laws that may provide your child extra support or accommodations at school. These are often referred as a 504 Plan or an Individual Education Plan. Together with your child’s school, you and she can work together to create situations that bolster her abilities and offer support in the areas where she feels less competent. Often, these accommodations greatly help reduce the sense of pressure and anxiety, and better help students prepare for college.
Author: Cindy Anderson
Dr. Anderson is a Board Certified Clinical Child Psychologist. She also owns Hope Springs Behavioral Consultants. Dr. Anderson has achieved a high degree of specialization in working with children and families. She holds a Ph.D. in Clinical Psychology and completed APA Accredited internship and postdoctoral training in Clinical Child and Pediatric Psychology. She prides herself as a life-long student and tries to learn something new every day.
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