About the author:
Carolyn is a single mother of two and a Registered Nurse working in General and Cardiovascular Surgery. She also has a background in Behavioral Health. She’s just started a new blog at www.thedistractedmom.com, where she writes about parenting with ADHD while raising ADHD children.
Follow Carolyn on Twitter at @NurseMallon.
Thank you, Carolyn, for sharing your story!
Missing the warning signs
Do you know what it feels like to be a girl with ADHD?
I do, as do nearly 6% of all girls. But many of us struggle for years before we figure out why things seem so much harder for us.
We expect boys to be boisterous and loud. Even without a diagnosis of ADHD, it surprises no one when a boy acts like a clown, and they give him a pass when he talks back (after all, he’s got to grow up to be confident, right?).
We expect something else from girls.
We want them to follow directions and be tidy, and to be mindful of the feelings of others. There isn’t as much leeway for being messy and haphazard.
As an ADHD girl, you’re forever falling short of everyone’s expectations, never living up to your “potential.” You try to stay organized, but the lists and notebooks just get lost. You forget plans and goof on names. You struggle to fit in with the other girls, and you feel like everyone else has a cheat sheet of social rules.
As an undiagnosed ADHD girl, my childhood and teen years were awful.
I was depressed and crippled by anxiety attacks and a school phobia. At one point I had an ulcer made worse from the meds I was taking for my ‘emotional problems!’
I was only 12 years old. I just wanted to know what was wrong with me!
My older brother had ADHD, but he had the obvious kind — and he was a boy. He was hyperactive and oppositional. He engaged in risk-taking behavior that was hard not to notice. I worked very hard to behave and do well in school, even when it was obvious to me I wasn’t keeping up.
The tragedy was that in working so hard to hide my impairments, I only succeeded in postponing proper treatment.
I was intelligent enough to leave an impression on my teachers. In fact, I was in the gifted program, but I lacked the organizational skills to meet their academic expectations.
If I found a subject interesting, I could do well easily, but if a subject didn’t grab me, I could stare at a homework assignment for hours and still not make progress. I would try to follow the class lecture, but if I lost track of what they were discussing, I might as well have wandered alone in the woods. I just couldn’t catch up.
After a while, I started skipping classes to avoid the shame and embarrassment of having no assignment to turn in or knowing I was going to flunk a test. This contributed to my poor self-image: I felt like a loser and a delinquent.
By 11th grade, I wasn’t in honors classes at all anymore. I was failing remedial math and getting suspended for truancy. I was drinking, experimenting with drugs, and feeling more miserable than I’d been in my life.
This is often the lot of the undiagnosed ADHD girl.
ADHD’s far-reaching effects on women & girls
ADHD is the most common childhood psychiatric disorder, marked by impulsivity, hyperactivity, and inattention. While girls often present with those symptoms, they more commonly have difficulties sustaining attention, initiating and maintaining effort, and organizing information. Many struggle with learning impairments.
Left undiagnosed, girls tend to under-perform academically. Each year that goes by becomes a longer history of failure, social problems, and feelings of under-achievement.
More so than with ADHD boys, these impairments often lead to peer rejection. Relationships among girls are sophisticated and require more maintenance. Boys tend to be more forgiving of forgetfulness, hyperactivity, and inappropriate outbursts. Social awkwardness it not as easily forgiven among teen girls. There’s a perception that girls should know what to say and when; how to keep a secret; how to keep their lives in order and make it look effortless.
If they can’t do this, they feel like something is wrong with them.
What Happens When You Can’t Keep Up?
Depression and anxiety are common with ADHD, but even higher in girls, who tend to internalize problems. Whereas boys engage in oppositional behavior, girls more commonly internalize anger and engage in self-injury. Half of ADHD girls report self-harming behavior (Child Mind, 2012).
Perhaps not surprisingly, girls are also particularly prone to substance abuse disorders, possibly related to later diagnosis and high levels of stress as they try to self-medicate.
45% of women diagnosed with ADHD also meet criteria for another disorder.
But it’s not the end of the world, right?
Well, it can be the end for some. 18% of teen girls with ADHD report suicidal ideation (Rucklidge, J.J. 2008), and the incidence of successful suicide is five times higher in those with ADHD (Medscape, 2013).
There are other risks associated with “slipping through the cracks” and not being diagnosed. Left untreated, ADHD increases the risk for driving-related accidents, particularly for teen girls. Adolescent girls with ADHD also have a higher risk for teen pregnancy (30-40%) and a fourfold increased risk for STDs (Rucklidge, J.J. 2008).
As any grown-up girl can tell you, low self-esteem and poor impulse control do not add up to the best decision-making.
I had all the symptoms — how was it missed?
The therapists and doctors saw my anxiety and depression, my sense of never being focused or present, my inner feelings of restlessness, anger, and self-loathing. I also engaged in self-harm, but my impulsive behaviors looked like psychiatric symptoms, and didn’t point to ADHD. They threw around words like “dysthymia,” “generalized anxiety,” and “borderline.”
What they missed was ADHD combined-type — and just enough shame about my impairments that I managed to distract from the issue entirely. Rather than let anyone know how disorganized and forgetful I really was, and because I interpreted that as a personal failing, I focused instead on how miserable I felt. Understandably, they focused on that, too.
In doing so, we all failed to address the symptoms that were contributing to my unhappiness and poor self-image in the first place.
You couldn’t pay me a million dollars to relive my teenage years.
It’s not too late
Dropping out wasn’t the end of my story. I did get my life back on track eventually. But first I had to address the self-image issues holding me back and the ADHD symptoms keeping my life in disarray.
If you know a girl struggling with attention or anxiety issues, whether she’s been diagnosed or not, let her know she doesn’t need to struggle like that. And she’s not alone.
There’s no one-size-fits-all solution, but one intervention that does fit every situation is support. Not lectures, not tough love, not “ignore it; she’s just doing it for attention,” not hollow reassurances. Just support. Let her know that you notice her, and you want to help, and you’re there for her. Then ask how you can help.
ADHD Persists in Adulthood, Ups Mental Illness, Suicide Risk. Medscape Medical News, Psychiatry. Wed. 10 April 2015.
Cumyn, L., PhD., French, L., PhD., & Hechtman, Lily,M.D., F.R.C.P. (2009). Comorbidity in adults with attention-deficit hyperactivity disorder. Canadian Journal of Psychiatry, 54(10), 673-83. Retrieved from http://ezproxy.snhu.edu/login?url=http://search.proquest.com/docview/222845215?accountid=3783
Mikami, A. Y., Ransone, M. L., & Calhoun, C. D. (2011, 12). Influence of Anxiety on the Social Functioning of Children With and Without ADHD. Journal of Attention Disorders, 15(6), 473-484. doi: 10.1177/1087054710369066
Ramsay, J. R. (2005, 12). Girl, Repeatedly Interrupted: The Case of a Young Adult Woman With ADHD.Clinical Case Studies, 4(4), 329-346. doi: 10.1177/1534650103259741
Rucklidge, J. J. (2008, 12). Gender differences in ADHD: Implications for psychosocial treatments. Expert Review of Neurotherapeutics, 8(4), 643-655. doi: 10.1586/1473718.104.22.1683