Supporting Girls with ADHD
This article is written for parents, guardians and other adults who provide care to girls with ADHD. The aim is to help you better understand
- their symptoms;
- their unique struggles;
- their vulnerability to risk factors; and
- how you can help.
ADHD as It Presents in Girls
Girls and boys develop differently because their bodies, brains and social experiences are different. Boys with ADHD tend to show their symptoms and get noticed for their behaviour problems (e.g., running around and shouting). They usually get diagnosed with ADHD, hyperactive-impulsive type. Girls with ADHD tend to hide their symptoms and get overlooked. They usually get diagnosed at a later age than boys and receive a diagnosis of ADHD, inattentive type. These girls can be misunderstood as ditzy, daydreamy, lazy, unmotivated or stupid. Girls diagnosed with hyperactive-impulsive type tend to present as overly emotional or overly chatty - as opposed to boys who tend to be overly rough and bump into things. These girls can be seen as sensitive, overemotional, bossy, selfish, stubborn or controlling. Their behaviours are sometimes explained away as part of their personality - being called social butterflies, drama queens or tomboys.
Review the list of symptoms below and see whether it helps expand your understanding of how ADHD tends to present in girls.
- Trouble paying attention and shifting attention (bored, loses interest)
- Daydreamy and misses out on information
- Easily distracted
- Forgetful and loses things
- Disorganized (messy room, backpack or desk)
- Difficulty starting a task/ work, following directions and finishing a task/ work
- Difficulty managing time and procrastinates (cannot keep track of time)
- Feels restless inside (doodle, fidget, squirm)
- Talks all the time and cuts other people off in conversation
- Verbally aggressive in relationships (e.g., controlling, teasing, taunting, name-calling)
- Very emotional and easily upset (extreme mood swings, easy to cry, quick to anger)
- Difficulty regaining control when excited (loud, flighty)
- Difficulty in social settings and forming friendships
- Fragile self-esteem and self-doubt
Social norms place pressure on boys and girls to act in ways that are considered masculine and feminine. When girls act in ways that are considered masculine or boys act in ways that are considered feminine, they tend to struggle to fit in. We know that boys are encouraged from a young age to speak their minds, be active and win at all costs. Meanwhile, girls are encouraged to sit still, be quiet and do as they’re told; keep tidy and organized; be polite and pleasant; be considerate and kind, and take care of others before thinking about themselves.
What does all this mean? Girls with ADHD often present as self-centred, energetic, erratic, easily upset, chatty, defiant and/ or pushy. These behaviours are more closely aligned with what we tend to think of as male behaviour. As a result, girls with ADHD don’t fit the social expectations of what it means to be a girl. Research shows that adults and children are more accepting of boys with ADHD than girls with ADHD. It is important that we recognize how social norms and expectations create additional challenges for girls with ADHD.
Internalization and Risk Factors
Girls with ADHD want to do well. They try their best but struggle to perform in everyday situations. Their lack of self-control is often just as frustrating for them as it is for those around them. And in the midst of their struggles, they tend to be misunderstood and receive a lot of negative feedback from adults and peers.
Girls often hold in feelings of frustration, shame, self-blame, anxiety and depression. They show that they are doing well, even when they aren’t. Many girls withdraw, develop low self-esteem and begin to feel hopeless that things can improve. Girls with ADHD become vulnerable to a variety of risk factors, including:
- mood disorders,
- eating disorders,
- substance dependence,
- risky sexual behaviour,
- reckless driving,
- self-harm and suicide.
Girls are often noticed for their low mood or negative self-esteem that results from their struggles with ADHD, rather than for symptoms of ADHD itself. It is not uncommon for girls to be misdiagnosed with depression or anxiety.
Girls with ADHD tend to live in the moment, get easily distracted and act on their raw emotions. They lack self-awareness and the ability to take other people’s perspectives into consideration. As a result, they often misinterpret or miss social cues, misperceive other people’s behaviours and struggle to fit in. They want to be accepted but often find themselves socially isolated (i.e., bullied, ostracized, rejected or neglected). Many girls develop low self-esteem and anxiety in social situations. This feeds into a vicious cycle of increased social-emotional challenges and decreased self-confidence.
Girls with ADHD have difficulty with attention, memory, organization and planning. They struggle with school but tend to do extra work behind the scenes to keep up with their peers. This means that many young girls with ADHD fly under the radar and are unnoticed for their struggles. These girls fail to know and understand that they have a brain-based disorder. As their workload increases, they begin to fall more and more behind with significant harm done to their developing sense of self. Because of their previous successes, adults may tell them that they are just not trying hard enough. Many girls feel invalidated and misunderstood. They develop low-self-esteem and anxiety around their academic performance. This feeds into a vicious cycle of increased academic challenges and decreased self-confidence.
When girls are not recognized for symptoms of ADHD and are not diagnosed, they remain misunderstood. They tend to encounter more and more daily challenges that further increase their negative outcomes and decrease their self-esteem. Early diagnosis and intervention support is key to helping girls with ADHD.
How You Can Help
There are a variety of treatment and intervention strategies available to support children with ADHD. These include:
- school accommodations,
- behavioural parent training,
- nutrition and
- sleep hygiene.
So, Where Do You Start?
We know that girls with ADHD tend to (1) feel bad about themselves; (2) feel misunderstood by those around them; and (3) hide their struggles and suffer in silence. Given these facts, it becomes clear that girls need adults in their lives to offer them consistent support and positive attention to help put their struggles into perspective. Reflect on the following points to identify what you are already doing - and what more you could be doing - to promote your daughter’s best interests.
Recognize that ADHD is a brain-based disorder. She is not her behaviour. Remember that she is not choosing to be uncooperative and fail to meet expectations. Try and separate your understanding of who she is from what she is doing.
- Help her understand ADHD. Help her develop a realistic and constructive understanding of herself. Help her recognize her strengths, weaknesses and accomplishments.
- Promote a safe and trusting relationship. Make time to connect with her in fun ways. Show her that you unconditionally accept her, appreciate her and believe in her.
- Validate her feelings. Show her that you hear her and understand her, without judgment.
- Maintain realistic expectations. Keep in mind that a 10 year-old girl with ADHD has a brain that can resemble a 7 year-old’s without ADHD. Find appropriate strategies to help her meet your realistic expectations (e.g., visual cues, charts and reminders).
- Be a positive role model. Show her what emotion regulation, respectful communication, problem-solving, self-advocacy and resilience look like. Maintain a positive attitude and optimism for her growth.
- Respond to her in a calm and flexible manner. Keep your own frustrations and anxiety in check so you don’t exacerbate hers.
- Create a predictable environment with consistent routines. If she knows what to expect, she can develop healthy habits and decrease the need for executive functioning.
- Give her choices. Show her that her voice matters. Support her to make decisions for herself.
- Promote her self-confidence. Encourage her to keep trying and taking risks. Show her that you have faith in her ability to handle things. Give her room to make mistakes as she learns and grows.
- Help her experience fulfillment, competence and success. Find activities that she enjoys and does well in. Find opportunities for her to develop social skills whenever possible.
- Praise, recognize and reward her efforts and persistence. Give immediate, specific and positive feedback so she knows which behaviours to repeat. Focus more on effort than on outcome because she cannot control the outcome of her effort.
Reflect on this article and remember that ADHD is a brain-based disorder. Girls with ADHD are doing the best they can, but struggling to do well. What can you do? Show her that you understand her, unconditionally accept her and truly believe in her. This will help her understand herself, accept herself and believe in herself. Know that with your active support, she can become more confident, resilient and successful in life. Last, but not least, don’t forget to invest in your own self-care on a daily basis. When your needs are met, you will find that you are in a much better place to coach her, support her and cheer her on in this difficult journey.
Key Takeaway Points
Girls with ADHD:
- are often misunderstood by those around them - as daydreamy, lazy, sensitive, chatty, bossy or stubborn;
- smile on the outside, while holding in feelings of guilt, shame, self-doubt and frustration;
- often feel alone in their struggle and develop negative self-esteem;
- are more likely to be diagnosed at a later age than boys and receive a diagnosis of inattentive-presentation;
- are vulnerable to developing further problems that include depression, anxiety, eating disorders, self-harm and suicide; and
- need your understanding, acceptance, validation and support in order to believe in themselves and maximize their full potential.
- Childmind.org - resource for mental health and learning disorders
- Understood.org - resource for learning and attention issues
- Understanding Girls with ADHD - by Kathleen G. Nadeau, Ellen B. Littman & Patricia O. Quinn
- Raising Girls with ADHD - by James W. Forgan & Mary Anne Richey
- Smart but Scattered: The Revolutionary “Executive Skills” Approach to Helping Kids Reach Their Potential - by Peg Dawson & Richard Guare