How Girls With ADHD Are Different

I’ve always been a space cadet. Prone to lateness and losing things, brought crashing back from daydreams by people clapping their hands in front of my face. “Earth to Rae,” they’d say, exasperated. As a kid I read for hours but the simplest homework assignments reduced me to a tearful mess.

“You can do this,” my bewildered parents insisted. “You know this stuff!”

“No, I can’t,” I’d bawl. “I’m not normal enough to be a normal person. Something is wrong with me.”

Years later, a few months after my 21st birthday, that “something wrong” finally got a name: attention-deficit hyperactivity disorder.

Why did it take so long?

“We were initially taught that ADHD is boys’ phenomenon,” says Stephen Hinshaw, PhD, chair of the psychology department at UC Berkley. “Three decades later we know this is an equal opportunity condition.”

Equal opportunity, maybe, but equally recognized and treated it is not.

According to the CDC boys are far more likely to receive a diagnosis of ADHD—not necessarily because girls are less prone to the disorder but because in girls ADHD presents differently. The symptoms are often more subtle, and they don’t fit the stereotype.

“Girls are not as hyperactive,” says Patricia Quinn, MD, an expert on girls and women with ADHD who has written several books on the subject. “People imagine little boys bouncing off the walls and think: That’s what ADHD looks like and if this girl doesn’t look like that then she doesn’t have ADHD.”

Politely daydreaming underachievers just don’t attract attention the way hyperactive and impulsive boys do. Staring out the window is nothing when the kid next to you is dancing on the sill.

A late or missed diagnosis doesn’t just mean girls don’t get the academic services and accommodations that could help them succeed. Research indicates undiagnosed ADHD can jeopardize girls’ and young women’s self esteem and, in some cases, their mental health. Whereas boys with ADHD tend to externalize their frustration, blaming the “stupid test,” acting up and acting out, girls are more likely to blame themselves, turning their anger and pain inward. Girls with ADHD are significantly more likely to experience major depression, anxiety and eating disorders than girls without.

In 2012, Dr. Hinshaw and his team published a study showing 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. “The lack of social and academic skills—the cumulative effect of what they missed when they were younger—take a toll,” says Dr. Hinshaw.

Without proper diagnosis and understanding, failures become evidence, confirmation of self-convicting charges: I’m not smart. I’m a failure. I don’t belong.

Quinn says she asks parents if at a young age their daughters have ever said “I’m stupid.”

“One hundred percent say yes,” she notes. “Even as a kid, as early as 8, you know you can’t do things that other people can do. And that takes a toll.”

A 12-year-old girl with ADHD I know put it best: “If everyone else can do these things and I can’t, it must be me.”

Today’s kids have more obligations and opportunities than ever before. The word overscheduling is on everyone’s lips and college admission hopes loom large. The pressure to multi-task and succeed has increased tenfold.

One of the consequences of this is that girls who were able to manage their ADHD symptoms before are no longer able to do so. A girl who was fine in grade school can suddenly find herself drowning in the academic, social and extracurricular intricacies of middle school.

Kathleen Nadeau, director of the Chesapeake Center for ADHD, elaborates. Girls with ADHD often struggle to decode the myriad of social subtleties of girl-world: what to wear, what to say, how to talk, when to be comforting, when to be mean. “Girls are under a lot more pressure to be socially tuned in and self-controlled,” says Dr. Nadeau, who is a clinical psychologist. Being unable to fit in, or perform up to girl-code can make them a target for mean girls and leave them isolated and confused.

Dr. Hinshaw refers to these vice-like pressures as the “Triple Bind.” All girls, he says are subject to a trio of unreasonable expectations:

• Be good at “girl things,” be pretty, empathetic, demure and polite.
• Be good at “guy things,” be competitive, driven, funny and athletic.
• All this and more! Conform to these impossible standards, make it look effortless, and look hot while you’re doing it.

Overwhelming for anyone, says Dr. Hinshaw, but “for girls with ADHD, this is a quadruple bind.” There is no opt out.

And though some girls manage to stay afloat, success comes at a very high price. Sometimes we are our own worst enemies, dissembling and compensating, feverishly working on one thing while other equally, if not more important things languish.

“Girls with ADHD do a lot of hiding because they try very hard to put up this facade of competence,” says Dr. Nadeau. “But what’s behind that facade is ‘Yes, I got a good grade on this paper but I’ve been up for two days and I’m so stressed out I’m about to lose my mind.’ ”

The time between declaring my inability to be a normal person and getting diagnosed was turbulent and frustrating. Every failure chipped away at my self-esteem. I began to think of myself as broken, stupid, the one of these things that was not like the others.

But suddenly, as I recognized myself in the symptoms, the baffling discrepancy between what I should be able to do and what I actually seemed capable of was no longer an unseen, unnamed thing. It was something outside of myself, something I could understand, something I could plan for and manage.

“Some girls need glasses, some need ADHD treatment,” says Dr. Hinshaw. “It’s a vulnerability that needs addressing, it doesn’t define you.”

I know firsthand the benefits of having a diagnosis, and I’m hopeful that with advances in research and advocacy, the next generation won’t have to wait so long.