By Rae Jacobson, Child Mind Institute


I have ADHD.

Around age 10, my grades tanked and homework became a nightly battle. I was perpetually losing things, forgetting appointments, and making us late for everything because my shoes no longer seemed to exist in the material universe.

Concerned, my parents took me to see a child psychologist.

“Nope,” he said, when they asked about ADHD. “I’ve seen ADHD and this isn’t it.

“She’s smart. She’ll be fine.”

I wasn’t accurately diagnosed for another 11 years.

Sugar, Spice and Space Cadets

Research suggests that ADHD affects girls and boys in nearly equal measure, yet for many—my erstwhile psychologist included—ADHD still conjures up the stereotype of little boys careening around like miniature bulls in a china shop.  But that’s just the stereotype, and there are actually different types of ADHD, and different ways that it might look, especially across genders.

“Girls with ADHD tend to cluster in the inattentive subtype,” says Dr. Patricia Quinn, director of the National Resource Center for Girls and Women with ADHD. “Even those who exhibit more of the hyperactive-impulsive symptoms don’t necessarily fit the so-called ‘classic’ profile of ADHD.”

Girls, she explains, present with more inconspicuous behaviors. Inattentive girls get written off as space cases, dreamy or even ditzy. Those who show more hyperactive-impulsive behaviors are seen as pushy, hypertalkative, aggressive and overemotional. Their behavior might be seen as a personality problem instead of signs of a disorder.

A boy with ADHD might be climbing the walls or wandering into the hall while a girl might be fidgeting and daydreaming. Both miss hearing the homework assignment but the boy will likely be called back and talked to and odds are the girl leaves unnoticed.

Misconceptions = Missed Opportunities

Even though girls and boys both suffer from the fallout of ADHD, for boys, looking the part means they’re more likely to be diagnosed and treated. Girls with ADHD often aren’t as lucky. The absence of more “typical” ADHD symptoms can mean girls go undiagnosed, leading to academic and social difficulties as well as mental health issues and poor self esteem down the line.

If you suspect that your niece might have ADHD, it’s important to know what ADHD does (and doesn’t) look like in girls so she can get the help she needs in the most timely and effective way.

- Inattention: For many girls with ADHD, maintaining concentration is a constant struggle. They may have trouble focusing long enough to complete tasks both at home and at school. Don’t be thrown off by hyperfocus. Some people with ADHD are capable of focusing endlessly on things that interest them but can’t sustain attention on less interesting but more important tasks: A girl might read a novel cover to cover but find herself unable to finish the one-page book report.

- Distractability: Girls with ADHD may also be easily distracted by outside stimuli, and prone to what Dr. Quinn calls “internal distractibility.” Unconsciously swept away by their own thoughts, they end up completely missing things going on right in front of them.

- Hyperactivity: Some girls show more “classic” signs of hyperactivity: being excessively active, struggling to stay still. Most, however, display the urge to be in motion more quietly, doodling, fidgeting, or constantly wiggling in their chairs.

- Impulsivity: This, too, looks somewhat different in girls than boys. Girls may be overemotional, unable to slow themselves down to process their feelings. “Girls are more likely to be chatty and verbally impulsive,” says Kathleen Nadeau, director of the Chesapeake Center for ADHD. “They interrupt and talk out of turn.” Impulsive girls may struggle to interpret what is and isn’t socially appropriate and have trouble making and keeping friends.

- Executive Malfunctions: Many of the issues associated with ADHD stem from poor executive functioning skills. Girls with ADHD can display poor time management and struggle with multi-step directions and task completion. Important items often go missing, sometimes remerging in surprising places: My phone was in the fridge? I have vivid memories of rushed, stupid mistakes that cost me dearly on tests, key buttons (ahem) left undone, vital papers lost only to be found, far past due and squashed beyond recognition, at the bottom of my backpack.

Coping Queens

Without context, the symptoms of ADHD can read as carelessness. You’re such a slob. Embarrassing situations abound. Could you repeat the question? Girls are frequently in trouble at home. Why do you never listen!?  And they’re often behind in school. Everyone else has their homework! Socializing can be confusing and other girls can be mean. You’re so weird. You always interrupt me.

Girls internalize these negative experiences and do their best to cope, compensate, and hide, which can make identifying their ADHD even more difficult.

Kathleen Nadeau notes that when girls furiously work to manage one area, others fall by the wayside and it can be helpful to find out what’s being left undone. “The work is in, her hair is done, but you’re wading through a knee-high pile of clothes just to find her bed!”

The awareness that they are working much harder than their non-ADHD peers just to stay afloat means that girls with ADHD often view themselves as stupid or broken. “Girls with undiagnosed ADHD often attribute their symptoms to uncontrollable character flaws, ” says Dr. Quinn.

All girls, she says, face a myriad of potentially self-esteem bashing pressures as they age but for girls with ADHD the obstacles are greater and the road more fraught. Girls with ADHD are at higher risk for depression, anxiety, and self-injury and a host of other internalizing disorders. When seeking a diagnosis it’s important to consider not only treatment for ADHD but ways to manage the emotional toll of having been undiagnosed as well.

Better Late Than Never!

We now know that ADHD isn’t just a childhood disorder, but rather a life-long neurobiological difference.

Early recognition is ideal but getting diagnosed at any age can open the door to much-needed services and understanding. Symptoms change as we age—just because a girl didn’t show conspicuous signs of ADHD during childhood doesn’t mean she doesn’t have it. Many girls are able to compensate for their ADHD during elementary and middle school, and only begin to show their struggles when the waters of high school are already almost over their heads.

If you think your niece might have ADHD, talk to her parents. You might mention that you’ve noticed your niece struggling and say that symptoms of ADHD are often overlooked in girls. If they want more information, point them in the direction of this article about how girls with ADHD are different.

Photo: iko
Published: February 6, 2017