By: Donae Cannon, OTR/L
I often hear from women who suspect they have ADHD but weren't diagnosed as children. Is it possible that these women developed ADHD as adults? According to the DSM 5, ADHD is a neurodevelopmental disorder that "begins in childhood". In other words- if you have ADHD, you've always had it. There's a problem though; ADHD symptoms are often missed in young girls. They're more likely to present with inattentive symptoms (which are not as disruptive so less likely to be noticed) both in classrooms and at home. Symptoms such as impulsivity and hyperactivity are readily associated with ADHD, whereas traits like emotional dysregulation and executive functioning deficits may be misinterpreted (or missed altogether). So, what does ADHD look like in girls?
You're about to meet eight girls- all of these girls have ADHD. Although they share the same diagnosis, ADHD impacts their lives in different ways. As you read their profiles, you'll have the benefit of knowing that their behaviors are linked to a neurodevelopmental disorder, but I encourage you to try to look at these girls with a blank slate. Imagine that you didn't know they had ADHD- how would you interpret their behaviors? How do you imagine others would interpret them? What stories will these girls tell themselves to explain their ADHD characteristics in the absence of this knowledge?
Ellie is highly emotional and the adults in her life often tell her that she's just too sensitive. Ellie cries- a lot. She becomes easily frustrated when things don't go her way and when she's frustrated, she can't hold back her tears. This embarrasses her (especially when it happens at school), but she's just not able to stop herself from crying and "overreacting". Ellie's friends complain that she's a "cry baby" and always wants her way. Her mom has noticed that she's not getting invitations to play at her friends' homes lately (and fewer friends are accepting Ellie's invitations).
At home, Ellie gets so angry that she yells, stomps, and even throws things. She can go from 0-60 with her reactions with little warning. Ellie's older sister is sick of living with her tantrums and complains to her parents that Ellie acts like a "baby" and a "spoiled brat". Ellie doesn't want to act like a brat, but her feelings are so strong that it often feels like they're "bubbling over". This makes it hard for her to slow down and choose her actions.
What's up with Ellie? Ellie has difficulties with emotional regulation which means that she's often overwhelmed by the intensity of her emotions. Combined with her impulsivity, it becomes particularly difficult for her to pause before she reacts and make the choices she would like to make. Some may consider decreasing Ellie's outbursts, tantrums, and crying (the outward signs of her emotional dysregulation) the most important goal for Ellie, but it's important to remember that even if she is able to suppress some of her reactions, it doesn't necessarily mean that she's regulating emotionally. Ellie may attempt to cope with her overwhelming emotions by using any tools that are available to her. That means that as she grows, Ellie has an increased ADHD increases risk for substance abuse and as a girl with ADHD, she's four times more likely to develop an eating disorder than her peers.
Natalia is outgoing and has always made friends easily. Making friends may be easy for her, but keeping friends is becoming more difficult. It's often hard for her to listen when others are talking. She interrupts her friends, finishing their sentences for them or even changing the subject completely. If someone shares a story, Natalia often remembers a story that's similar and interjects without acknowledging or responding to what her friends have said.
Although she knows that she should allow her friends to finish their stories, she also recognizes that she'll forget what she wants to say if she does. These behaviors didn't seem to bother her friends when they were younger, but lately her friends have made it clear that they're annoyed with how she "makes everything about her". Natalia is devastated when she overhears a few of her friends saying that she is "annoying" and "selfish" in the hallway.
What's up with Natalia? Natalia's challenges with impulsivity and working memory make it hard for her to navigate the social expectations that others have of a young pre-teen (like listening and responding to a friend's story before sharing her own). She's also inattentive to social cues such as rolled eyes or uncomfortable pauses in the conversation, so her friend's harsh criticisms seems to come out of nowhere and Natalia is completely blindsided by them.
Meg worries- a lot. The strange thing is, she's noticed that her worrying actually helps her remember. Meg has forgotten about important things in the past, so now she's constantly worried that she'll miss an assignment or instructions and get into trouble. In class, she sits next to her friend Anna who's almost always able to pay attention. Anna is usually willing to explain the instructions to Meg if she misses something or doesn't understand, but there are times Anna gets frustrated because Meg's questions cause her to miss what the teacher is saying.
Meg's worries aren't just about her teacher. She also worries about saying the wrong thing in front of her classmates and friends and is constantly second guessing herself. In fact, she worries so much about what she's going to say (and what others will think of her) that she often stays quiet and is hesitant to join in conversations with others or participate in class.
What's up with Meg? Meg's a tricky one. Her anxiety (super common in those with ADHD who are trying to avoid mistakes/ failures) and hypervigilance end up masking her ADHD symptoms. She's also found a compensatory strategy (relying on her friend Anna), but this can be exhausting for Meg (and for her friend). Meg's inattention makes it difficult for her to listen to instructions and she has working memory and executive functioning deficits that make multiple step directions hard to remember and sequence. Meg's anxiety also prevents her from making connections with friends and limits what she's willing to do socially.
Jessie's mom says she has "ants in her pants". Even if she's doing something "sedentary" like watching TV, she's always moving. Jessie is able to watch her favorite show hanging upside down on the sofa with occasional flips off of the couch. At dinner, she rushes through eating and wants to leave the table almost as soon as her family sits down. She's so quick in the shower that she misses washing out some of the shampoo, and when she's telling a story she talks so fast that her parents can't keep up. They constantly ask her to slow down. Jessie has difficulty controlling her volume (especially when she's excited).
Her siblings get annoyed with her because she kicks the table legs when they eat dinner and flops around in her seat during car rides. In school, Jessie's teachers send home behavior reports frequently. They notice that she has a hard time staying in her seat and will often get up (and even leave the room) without permission. She distracts classmates by making noises, drumming on her desk, and talking to others and needs constant reminders to not touch her friends when walking in line.
What's up with Jessie? Jessie's behaviors would be classified as impulsive and hyperactive and in line with what most people picture when they think of ADHD. On the positive side, that means Jessie is more likely to be diagnosed with ADHD (and hopefully access support to manage her ADHD), but it also means she's likely to receive consistent negative feedback about her behaviors.
Her hyperactivity can be quite disruptive, and her impulsive behaviors can appear like intentional defiance or unwillingness to follow rules (such as getting out of her seat during class or pestering others). Jessie's brain is also "in the moment", so feedback (whether it is a reward or consequence) that's not immediate is generally not effective for her.
Shreya doesn't move as much as Jessie, but she needs to move to pay attention. Sometimes that means doodling on her paper when her teacher is talking or chewing on her pencil or fingernails, but her teacher has asked her to stop doodling and the girl who sits next to her told her that it's gross to chew on her pencil. At times she hums, fiddles with the zipper on her jacket, or plays with her hair. Last week she was fidgeting with her pencil box lid and dropped the whole thing during quiet work time, which embarrassed her.
At home, Shreya's mother gets annoyed when she shreds her napkin into tiny strips, rolls her bread into balls or makes designs with her mashed potatoes. Shreya hums or sings while she's doing her homework. This frustrates her siblings who complain that they aren't able to concentrate when she's being so noisy. Shreya doesn't mean to distract them, but it's hard for her to stop since she often doesn't realize she's making these noises.
What's up with Shreya? Shreya is displaying some less recognized behaviors related to attention regulation and hyperactivity. Her fiddling, doodling, and humming are actually helping her pay attention since they allow her to move and get the sensory input her body needs to focus. Although her behaviors are not as disruptive as Jessie's, they may be misinterpreted and can annoy those around her.
Whether or not her fidgeting bothers others, it is clear that Shreya is having to compensate in order to regulate her attention levels. She may not stand out as someone who needs help, but she works so hard to stay regulated in the classroom that she often lacks the energy for activities after class.
Faith appears to have low energy- especially in school. She often lays her head on her desk and struggles to stay awake. When we think of the "constant motion" stereotype of ADHD, Faith appears to be the opposite! She used to rock back in her chair because this helped her stay alert (the vestibular input this offered her nervous system increased her energy and focus) but she got in trouble because leaning back on two chair legs isn't safe. Now she makes sure to sit still.
During class, her thoughts often drift to her favorite games or what she's planning to do with her friends. When her teacher calls on her, she's not prepared to answer. This made Faith feel self-conscious, so now she tries to avoid eye contact and not draw attention to herself in hopes to not be noticed in the classroom. And in general, she's not noticed.
Faith often knows the answers to questions, but she's not able to answer as quickly as her classmates. Lately, she's not even sure if she does know the right answer because other students always respond before she has time to think. Faith spends more time than her classmates on her assignments. Even though she gets the answers right, she's anxious when she's the last one working and has to ask for extra time. Faith finds the fast pace of the classroom exhausting and is usually grumpy and worn out when she gets home.
What's up with Faith? Faith has a hard time regulating her attention and alertness levels. Unlike her hyperactive friends who need to lower their nervous system's arousal level in order to pay attention, Faith needs to raise this level to pay attention. She may rock in her chair or bounce her leg, but these behaviors are not actually a result of hyperactivity. Faith is trying to get sensory input to "wake her up" because nervous system level is running low.
The longer Faith has to sit in the same place, the lower her energy and attention levels drop, so it's not uncommon for her to have her head on her desk and even look like she is about to fall asleep by the end of class. She's also slower to process auditory information due to inattention and an inability to filter out distractions in her environment. This makes it hard for her to answer as quickly as the other children in her class and contributes to her need for extra time on her assignments. Faith is out of sync with the pace of the classroom, and this makes it hard for her to learn and connect with others.
Jada has a hard time managing much of the everyday sensory information in her environment. Sensory inputs such as sounds, sights, and textures can cause her to feel overstimulated, annoyed, and even angry. Noisy places like the lunchroom tax her sensory system and make it hard for her to filter out noises and listen to her friends. When her class goes to the bathroom after recess, the sound of the toilets flushing causes her to jump and cover her ears. This makes some of her classmates laugh.
The tags on her clothes often make her feel so itchy that she needs her mother to cut them out and the seams on her socks bother her unless she wears them inside out. Jada doesn't like many different foods- she can't tolerate the feeling of certain textures in her mouth and will even gag if she tries to eat something she doesn't like. Because Jada finds everyday life so overwhelming, she often appears grumpy and controlling when she tries to avoid some of her sensory triggers.
What's up with Jada? Jada has sensory regulation difficulties. Although these alone do not indicate ADHD, they are present in many individuals diagnosed with ADHD and can have a significant functional impact for those who have to manage them. Sensory regulation challenges can also be misdiagnosed as ADHD since they can impact attention and emotional regulation. Jada becomes overstimulated by much of the sensory input her body takes in, so everyday tasks can leave her feeling irritable and on edge. She may try to avoid this sensory overload by refusing to do things/go places and this can make her appear rigid or controlling to others.
Lily's dad calls her the "master of disaster". She has a hard time keeping her room clean without a grown up's help. Her dad has to tell her what to do step by step (put her dirty clothes in the hamper, put her trash in the trash can, books on the bookshelf, etc.) in order for her to complete the task. If he leaves her to clean the room on her own, it doesn't get done. Last week he spent hours helping her organize her room, but the next day the piles were back!
Lily's backpack is also a mess- her papers are crammed into folders and falling out of the bag when she opens it. This week she lost her field trip permission form even though she knows she put it in her folder. When Lily went through all of the trash and crinkled papers in her backpack, she tried to organize her papers. That was hard because she wasn't sure what she could throw away and what she should keep. In the end, Lily thought it was better to keep all of it and crammed everything back into her backpack. Her school locker is even worse- sometimes things fall out when she opens it. When she can't find her gym clothes amongst the items in the locker, she's late to PE which causes her problems with her coach.
What's up with Lily? Lily has a hard time with her executive functioning skills. Large, multi-step tasks are particularly difficult for her as she has difficulties with initiating, sequencing, and planning. Even if she starts with a clean room, keeping it clean is a challenge. Why? There are actually mutiple reasons.
When she enters her room, Lily's brain is often thinking of the next thing she wants to do, so she doesn't pay attention to where she drops her jacket, clothing, backpack and toys. Lack of attention and poor working memory make her more likely to misplace things. In addition, once so many of her discarded items pile up on her bedroom floor, she becomes overwhelmed visually and doesn't know where/how to start. Lily's deficits in working memory can also make it difficult for her to remember where each item's "home" is (even though her Dad helped her organize them earlier, the simply can't recall the places they went).
Planning and prioritizing are challenging for Lily, so when she has to decide if she needs to keep her old math tests, permission forms, and class notes, she's honestly not sure what's important. Unsure of what's safe to throw away, she keeps everything and thus adds to her pile of items without a home.
These girls aren't selfish, bratty, lazy, or defiant. Their behavior is confusing to their parents, teachers, friends, and even to themselves! They are all navigating their worlds with ADHD even though that looks quite different for each of them.
Some of our girls will be fortunate enough to have an early diagnosis and receive some guidance to help them understand their brains and work with them. Others will not. Without that support, many of our girls lose trust in themselves, especially if their hard work is unable to close the gap between expectations and their performance.
I work with many women who are diagnosed with ADHD as adults. When they reflect on their childhoods, it may have never occurred to them that their tantrums, difficulty making friends, low energy, or inability to follow directions were actually related to ADHD symptoms, not their character flaws. If you're a woman with ADHD (or suspect that you are), I hope that this article has offered you a bit of understanding and compassion as you look back at your history. Most of us could use more of both.
If you're involved in the lives of children (as a parent, professional, or family member/friend), I hope that meeting these girls has deepened your understanding of ADHD. When the adults in their lives are able to educate, empower, and advocate for them, the impact can be profound.
If you are interested in learning more about how to work with your unique brain to create powerful change in your life, please contact me for a free coaching discovery call below. You can also contact me for general information @ TheADHDclaritycoach@gmail.com.