Dec 12, 2023 | ADHD symptoms, Women with ADHD
ADHD symptoms are often different in girls. As medical knowledge evolves to understand more about these differences, so does our ability to identify and help our young girls at an earlier age.
For decades, ADHD diagnosis was limited by a myth that ADHD only affects young boys because they are more likely to exhibit the more outwardly apparent symptoms of hyperactivity and impulsivity. As recently as 2013, it was also classified as a disruptive disorder of childhood (before the age of 7) only, which caused problems for girls whose symptoms are often noticed at puberty.
Now we understand that ADHD can impact boys and girls of all ages, with varying presentations of symptoms. Save your daughter from the challenges of living with unsupported ADHD by being aware of the differences and seeking diagnosis and support if appropriate.
ADHD symptoms in girls and young women
Of the three ADHD presentations – hyperactive, inattentive, or both, boys will usually present as hyperactive, which is easy to notice. Girls often present as inattentive, which can be much easier to mask, hide, or go unnoticed. Instead, adults may label them spacey, lazy, or just overly talkative. This suggestion that their symptoms are instead personality flaws can lead to low self-esteem, depression, and a failure to seek proper diagnosis later in life.
Diagnosing ADHD as early as possible provides access to effective treatment, which can change her whole experience of the world. Symptoms to look out for in girls include:
- Daydreaming, zoning out, or appearing not to listen. She may look zoned out because the hyperactivity is in her head. This can lead to rumination and being lost in many threads of thought simultaneously. Watch for school reports advising that, ‘She would do better if she just focused.’
Disorganisation, mess, and difficulty managing time (executive malfunctions). She might make rushed and silly mistakes, forget daily activities, constantly lose things, or seem incapable of getting ready in time.- Difficulty concentrating. Difficulty staying focussed or becoming easily distracted may show up as a tendency to procrastinate long projects until the last minute or look bored when attempting to absorb new or complex information.
- Emotional sensitivity, anxiety or sadness. Girls with ADHD may cry or become irritated more easily than their peers. They may be seen as ‘over emotional’ and struggle to process their feelings.
- Challenges making friends. Impulsivity in girls can present as interrupting and talking out of turn. She may also have difficulty interpreting what is and is not socially acceptable. Combined with all of the above, these symptoms can make building and maintaining friendships difficult.
- Poor self-esteem. Years of worrying, trying to fit in, being accused of laziness or ditziness, and working twice as hard to concentrate or do as well as expected can take a toll on your daughter’s opinion of herself.
Masking ADHD symptoms to fit in
Girls’ ADHD symptoms are not only different but also commonly emerge later, with puberty, exacerbated by hormones only to get mistaken for ‘normal’ puberty-related issues. Many girls are also unintentionally socialised to achieve, please others, and avoid making trouble.
In an attempt to fit in and meet these social expectations, your daughter may mask her symptoms, hiding them through learned behaviours so that no one knows she is different. Common masking among girls includes:
- Mimicking and copying other people’s behaviour for acceptance.
- Developing perfectionist tendencies.
- Bottling up emotions until they feel sick without even knowing why.
- Excessive note-taking to help memory later.
- Reacting as expected rather than as felt.
- Obsessively checking belongings to avoid forgetting or misplacing something.
- Staying strangely quiet or being overly careful in every word.
- Constant (often ineffective) attempts to establish systems to keep life organised.
While these masking techniques can make life easier for her on one level, always wearing a mask is very tiring, and she is still struggling. You may notice an emotional crash when you collect her from school, tears over her own imperfection, or constant mimicking of whichever friend she spends the most time around.
Ways to help your daughter with ADHD
The first step to helping your daughter is to get her an ADHD assessment and be sure what you are dealing with. Your GP can refer you to a paediatrician, child psychologist or child psychiatrist who can assess and (if applicable) treat her for ADHD.
However, to fully support an older daughter, you should start by speaking with her about her symptoms. Ask open questions and give her space to share what she wants. Maybe it’s stress, something you said, or a genuine change in who she is and how she feels about the world. Mention ADHD gently at first. No girl, especially at puberty, wants to hear that there is something wrong with her, and many may still think of ADHD as a boy’s problem.
Unfortunately, wait lists for an ADHD assessment can be long. While a diagnosis allows your specialist to prescribe medication, which can be life-changing, there are other things you can start to do right now that can make a big difference too.
Be patient
Give her only one or two instructions at a time. Ask her to repeat them to be sure she heard and understood them.
Be consistent
Children (and many adults) with ADHD, may think they want lots of variety to stimulate their brain but actually thrive with clear, simple rules and routines they can rely on.
Break it down
As your daughter gets older and teachers ask her to complete more complex projects, the task may cause more stress than expected. Help her break it down into steps and make a plan.
Seek support
You do not need a referral to see an ADHD coach, and it doesn’t matter to us whether you have an ADHD diagnosis or not. We work to help manage symptoms regardless of what causes them. There are also some fantastic support books and podcasts available. Encourage her to find one she relates to and take whatever she can from it.
Look for the good in your daughter
People with ADHD are often fantastic at a particular special interest or discovering novel solutions to problems. They may be highly creative or oddly intuitive. Her empathy might make her the most caring and supportive person you will meet, or she may be wonderful in ways that have nothing to do with her ADHD. Let her know that you see her strengths as well as the areas where she needs support.
Social Living Solutions provides coaching for high school students and adults of all ages. Our coaches have lived experience with ADHD and can help you manage your symptoms with or without a diagnosis. Contact us today to find out more.
Nov 30, 2022 | Social Living Solutions, Women with ADHD
Women, like myself, my clients, and more famously Em Rusciano and Hannah Gadsby, are reaching middle age, and finally discovering nothing is ‘wrong’; they are not a failure. There is a reason for the overwhelm they feel, that their friends do not. A reason that life can seem so hard. That reason is ADHD. Unfortunately, the path to diagnosis is rarely easy due to stereotypes of who has ADHD and how it presents itself.
Mention ADHD in most circles, and you will hear about young boys who can’t sit still, don’t focus, and struggle at school. We would now describe this as ‘hyperactive’ or ‘combination’ ADHD. However, women often present with slightly different ‘inattentive’ ADHD symptoms which can be much harder to see from the outside. As to how we define ADHD, I like the definition Solden and Frank use, describing ADHD as a genetic, chronic, brain-based condition that impacts the management functions of the brain, including:
- Ability to activate yourself enough to begin a task,
- Sustaining focus once you start a task, and
- Sticking with it when your energy or interest wanes.[1]
Many of my clients can relate to this. However, many have learnt to show the outside world a different face in order to fit in. This ‘masking’ contributes to the difficulty in obtaining a diagnosis. Luckily, even while you await a diagnosis, or are unable to attain one, there are a few steps you can take to support yourself in managing your symptoms.
Why is it so hard for women with ADHD to get a diagnosis?
Women’s ADHD symptoms are different
Teachers and parents of a hyperactive young boy may remember a child who was constantly bouncing around, couldn’t sit still or would have been a high achiever if they only focussed. They may recall a loud child who was impulsive. Such traits often refuse to be ignored. This helps young boys get the correct diagnosis at an early age.
On the other hand, women and girls are often less hyperactive in their ADHD. Instead, they may experience challenges sustaining attention, following through on larger tasks, and organising themselves on tasks and activities. They might be easily distracted and avoid or dislike tasks that require sustained mental effort. Unless clearly ‘off with the fairies’, these traits can be much more complex for the outside world to see, especially if a girl or woman has learnt to mask them.
Masking
Masking is a coping skill that many of my clients have learned, either consciously or inadvertently, through life experiences, to ensure they appear normal. They may only be able to keep it on for limited periods, like work or school, or they may have adopted it so strongly that not even their immediate family know the difference anymore. Some of these learned behaviours can be helpful, but they can also come with an energy cost that takes a toll at the end of the day. Masking can include:
- Mimicking or copying others
- Consciously suppressing more obvious movements, but the desire will remain
- Learning to react the way society expects rather than as you feel
- Withdrawing inward and being overly careful about everything you say
- Perfectionism or obsessively checking and organisation
- Overcompensating to appear in control, even if struggling
These strategies may have kept us from being socially cast out, but they can often leave women with depression or anxiety because it is so difficult to hide or because it delays a diagnosis that may provide healthy support for moving forward.
The impacts of a delayed diagnosis
“We diagnose ADHD based on the DSM-5 diagnostic criteria, which requires evidence of ADHD prior to the age of 12 as it is a neurodevelopmental disorder. Without this evidence we are unable to provide a diagnosis of ADHD.”
– an all too common response from medical professionals and diagnostic clinics.
The DSM-5 (the rule book for mental health diagnosis) classifies ADHD as a ‘Child Mental Disorder’ and requires evidence of the ‘disorder’ prior to 12 years of age.
Often it is not until women have children of their own that the scaffolds that supported them, school routines, work routines, masking and checklists, cease to be enough. These women can end up diagnosed with depression or anxiety, when really, they are overwhelmed with executive functioning challenges. Sometimes, the diagnosis of a child prompts a woman to investigate her own symptoms. (Not that having children is the only reason midlife can prompt diagnosis.)
By this time parents and those who ‘knew us when we were younger’ may have passed on, left our lives, or simply not be able to recall the details necessary to see through younger masks and assist with diagnosis. For some of us, we won’t even remember ourselves.
What can you do if you think you have symptoms of ADHD?
Know your support network
Being diagnosed with ADHD as a woman can be challenging, long and expensive. I wish it were otherwise. It really helps if you have one or two people in your corner that you can talk to about what is happening so that you know you are not alone. Try and find that person in your network who has been there themselves, or the close friend or family member who always has your back no matter what, and don’t be afraid to be honest with them about your journey. Having support will make it so much easier for you.
Talk to your GP
In Australia, your GP will usually run through a few questions to determine whether you have enough symptoms to warrant a referral to a psychologist or a psychiatrist for a potential diagnosis.
Whilst GPs are getting better at understanding the nuances of women with ADHD and how we may present, some are still hesitant to make the referral. If you feel strongly that you may have ADHD seek a second opinion. Remember, at this point, all you are doing is asking for a referral to a specialist who can assist with your symptoms whether it’s ADHD or something else. Once you have a referral, your specialist will advise their diagnosis process as these may differ.
Help yourself
While you wait to see the specialist or find the GP who understands you, while you save the money or even if you receive a negative result after testing, you can take some matters into your own hands.
Many ADHD resources are available to support women with symptoms, including podcasts, books, YouTube videos and websites. You may also find a counsellor or coach (like myself), who cannot medically diagnose you, but has more immediate availability to work with you to put in place systems and plans to help manage your symptoms (regardless of their cause).
After all, the diagnosis is only part of the process. What we are all really after is an easier life, and a little understanding. Understanding yourself and supporting yourself just as you are can be done without diagnosis so don’t be afraid to start now.
[1] Solden, Sari & Frank, Michelle, A radical guide for women with ADHD, 2019, New Harbinger Publications.
