ADHD in Girls

When most people think of ADHD, they often think of the hyperactive boy being disruptive, naughty, and rude. What they do not picture is the girl who is sitting quietly doing her work at her desk.

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Approximately 4.2% of the population in Australia, under the age of 14 have ADHD. Boys are (on average) three times more likely to be diagnosed than girls. Girls are also diagnosed (on average) 5 years later than boys (average age of diagnosis for boys is seven and for girls it’s twelve). When you think of that in terms of years of intervention that are lost for girls, that is significant.

Quinn and Madhoo (2014) concluded that girls are often misdiagnosed with anxiety and depression instead of ADHD due to the way that ADHD looks in girls compared to boys. Often the same core symptoms look different in girls than boys. e.g., a boy might be physically hyperactive, where a girl might be verbally hyperactive. A boy might show aggression because of emotional difficulties related to ADHD, where a girl may withdraw or cry. Often girls with ADHD are labelled as “emotional.” Girls are also often better at masking their symptoms and demonstrate internalising disorders (e.g., depression, anxiety, withdrawal) more often than boys with ADHD, often making it difficult to “see” her symptoms.

Early identification and treatment for girls (and boys) with ADHD are vital. There are many great articles and websites if you are interested in the differences between boys and girls with ADHD (ADDitudemag.com here and hereChild Mind® Institute and a great YouTube episode from How to ADHD.)

Research into girls with ADHD is sobering, and their underdiagnosis is concerning. Dr Pat Quinn (Developmental Paediatrician) reports that, even when girls are displaying the same symptoms as a boy with ADHD, they are less likely to be referred or treated for ADHD, often ending up with a mental health diagnosis instead (e.g., anxiety, depression, Bipolar disorder). ADHD significantly increases the risk for many comorbid disorders and significantly worse long-term outcomes than girls who do not have ADHD. 

Research shows that in comparison to girls without ADHD: girls with ADHD,

  • Have lower self-esteem.
  • Is more likely to blame herself for her difficulties (e.g., “I failed the test, which means I’m so stupid!”) and live with more shame
  • Have more trouble making and keeping friends. They are known to have significantly more difficulty in friendships, peer interactions, social skills, and functioning, as well as a higher chance of being bullied.
  • Show unique issues during puberty, related to hormonal effects on ADHD and how they respond to treatment. Often girls with ADHD may not realise the impact on their functioning until they are older. Sometimes not until high school, university, or even, until they have children of their own.

Particularly during the tween, teenage and adult years, they are far more likely to struggle with mental health issues than girls without ADHD. Girls with ADHD are:

  • 5.6 times more likely to have Oppositional Defiant Disorder (ODD)
  • 9.4 times more likely to have conduct disorder (CD)
  • 3.2 times more likely to have anxiety 
  • 4.2 times more likely to have depression. 
  • There is also a significantly higher risk of suicide in people with ADHD (for boys and girls with ADHD across all age groups). Some studies have shown adolescents with ADHD are 10 times more likely to attempt suicide than adolescents without ADHD. The Black Dog Institute reports that suicide is the leading cause of death from people aged 5-17 years old.
  • More likely to have lower IQ and achievement scores. However, a higher IQ and satisfactory achievement at school should not rule out an ADHD diagnosis. Many girls with ADHD perform well at school, particularly in the primary school years. 

By now, I have probably scared you, and you are now panicking, thinking that our girls with ADHD are doomed. Take heart; studies do indicate that we can reduce the impact of ADHD with treatment. Gold standard treatment at this stage is both pharmacological treatment (medication) and psychosocial whole family interventions. 

As parents, carers, teachers, health professionals, and others who love, live, and work with girls with ADHD, we need to be aware of the difficulties that girls with ADHD may face. We must be proactive in providing the environment and supports they need. 

Here are some of my top tips for supporting for girls with ADHD – (I also want to be clear here that these are important and beneficial with boys with ADHD too!)

Proactive Professional Help

Before we dive in, I am not a psychologist. Every child with ADHD is different, and a one size fits all approach will not work. It is crucial to seek out support from a trained professional. Talking to your GP about options for psychology is a fantastic first step. In Australia there are many online programs, some of them free, that you can link into.

You don’t have to wait until there is a problem before booking your daughter in to see a psychologist. As a society, we often think that we must be in dire straits before reaching out for help. Girls with ADHD will often internalise their difficulties, opting not to discuss them with her parents or carers. You may not know she is struggling until it is too late. A ‘head in the sand’ approach to your child’s mental health could cost your daughter their life. 

It is crucial to be proactive and not reactive when working with a child’s mental health. Reactive mental health care means waiting until the child has a mental health problem to get help for it. Proactive mental health care can help people with life skills and coping competencies before they have any mental health issues. It can give her tools (e.g. problem-solving skills, strategies to deal with stressful life events, challenging negative thoughts) to deal with any mental health issues before they arise. As well as having a mental health professional monitoring her for any potentially concerning areas.

I have been both reactive and proactive with my children. With my son, by the time we really “needed” a psychologist, our family was at breaking point. His levels of aggression and anger were unbearable. We ended up having to wait months for an appointment (this was even privately). After several months, we had seen such a change in him and us! We didn’t stop the appointments there though. He would chat with his psychologist once every couple of months, about anything that was on his mind. Several more months down the track, he was having a hard time at school, as his best friend had left and changed schools. One day after school, he got into the car and asked me to make an appointment with his psychologist to chat about it. There was no shame in it for him. At the age of 9, he saw the value and importance of seeking help when you are having a hard time.

Prepare her   

Alexander Graham Bell (the inventor of the telephone) said “Before anything else, preparation is the key to success.”

I love this quote so much, and I believe it is vital for our children with ADHD. Research shows that girls with ADHD live with lower self-esteem and significantly more shame than their peers without ADHD. The shame of trying their best and still often falling short, continually having to say sorry, or consistently having to put up a mask to cover their difficulties.

If she is prepared for the difficulties that she may experience, (and be given strategies for support along the way), it can lessen the impact and her view of her challenges. It allows her to view them as a by-product of ADHD and not that there is something innately wrong with her.

Make discussions about ADHD and mental health commonplace. This not only takes away the stigma of mental health being shameful but also increases the chances that she will talk to you about them.

Read books together about feelings and mental health. My daughter with ADHD often struggles with anxiety. When she was younger, she asked almost every day to read the book In my heart: A book of feelings. Now, she is older, we read the book Hey Warrior. She loves it (as do I!) and now will tell me that her amygdala thinks there is a problem and is overacting. Hey warrior also has fantastic strategies for them to learn (such as deep breathing and positive self-talk).

My children know they have “ADHD brains.” They understand why they act and feel the way they do, and that doesn’t mean there is anything “wrong” with them, their brains just work differently. They also are very aware that puberty adds an increased risk of depression and anxiety due to having ADHD and family history.

Share with your child the difficulties that you face and overcome. By talking about mental health and making it a regular part of her life, she will be much more likely to speak with you about it.

We have a Building Emotional Literacy package that contains 12 gorgeous emotion flash cards and more.

Prevention strategies

There are so many evidence-based lifestyle strategies that can benefit girls with ADHD (as well as all children). Research tells us the main activities linked with the prevention of mental health disorders are:

  • Regular engagement in sports or moderate to vigorous physical exercise. 
  • Maintaining a healthy body mass index by healthy eating
  • Not smoking and responsible drinking
  • Regularly participating in mental activities (e.g., visiting museums, reading books, listening to calm music, playing instruments.)
  • Daily practising yoga (we play this game at our place to make it fun!) or mindfulness (here is a great app to get started), keeping gratitude journals, thought journals and deep breathing are also linked to better mental health.
  • Regular social rhythms (e.g., going to bed or eating meals at the same time each day, or engaging in daily activities with peers and family). 
  • Regular “green time” has also been extremely beneficial for mental health in people with ADHD. Interestingly it has also been shown to improve symptoms of ADHD. 
  • Engaging in preventative mental health courses can also be extremely beneficial. The BRAVE program is one such example. It is an interactive, FREE online program useful in the prevention and treatment of childhood and adolescent anxiety. 

It is also important to model these strategies to prevent or reduce the impact of mental health challenges for our children.

Foster a growth mindset

Dr. Hallowell reports that children with ADHD, by the age of 12, have heard approximately 20, 000 more negative messages than their neurotypical peers. Girls with ADHD often internalise these messages as well as often have very black and white, fixed thinking patterns.  Having a growth mindset is believing that basic abilities can be developed through dedication and hard work—brains and talent are just the starting point. This view creates a love of learning and a resilience that is essential for great accomplishment. (Dweck, 2015)

I HIGHLY recommend the Big Life Journal! I bought my kids the Journals and multiple printable kits. I have also just ordered my son the journal for tween and teens as he just turned 11. They have a journal for children (ages 4-10) and the tweens and teens journal (ages 11+). They have printable kits and lots of free resources too.

I HIGHLY recommend the Big Life Journal! I bought my kids the Journals and multiple printable kits. I have also just ordered my son the journal for tween and teens as he just turned 11. They have a journal for children (ages 4-10) and the tweens and teens journal (ages 11+). They have printable kits and lots of free resources too.

We also listen to their podcast together as a family. My girls LOVE it, and even my 11-year-old son enjoys them. He often will ask to have them on while he goes off to sleep! 

The big life journal allows you to develop a fixed mindset as a family, building resilience into your child with ADHD.

Praise effort and the journey

Interestingly, girls with ADHD often struggle with perfectionism. It can lead to a negative cycle of stress, anxiety, and shame. 

My 8-year-old daughter (who has ADHD) wrote me a letter last week. Part of what she wrote was, “Mum, I am sorry I lie all the time. I am never going to lie to you again.” Two days ago, we were having a cuddle, and she said, “Mum, I’m really sorry!” with tears in her eyes. We chatted more, and it turned out she had been thinking of the letter. She told me that she was a terrible daughter because she had lied to me several times since giving it to me. 

Right there, I had the opportunity to bring shame for several impulsive decisions to lie (probably to get herself out of trouble) or to praise the effort and journey. I told her that despite whether she lied or not, the fact that she didn’t want to lie to me, made me proud of her. She beamed and gave me a big cuddle. 

Girls with ADHD often can put serious effort into their work or “good” behaviour, but still not achieve a great result. A symptom of ADHD is also poor motivation towards tasks that they find boring, difficult or not necessary. Research shows that praising children for effort over results or abilities is more likely to encourage their persistence at a task! Check out this excellent blog post by Big Life Journal to get you started.

Promote her strengths & Provide support for her weaknesses

Another saying I LOVE is, “Everybody is a genius. But if you judge a fish by its ability to climb a tree, it will live its whole life believing that it is stupid.” by Albert Einstein. 

Children with ADHD often struggle in a classroom setting. They are like the fish, that is told to climb a tree to determine their intelligence and worth. Children with ADHD are more likely to have language and learning difficulties than their neurotypical peers. But even children who have ADHD, with average or high intelligence, with no learning or language difficulties, often show a mismatch between their ability and how they perform. 

When I was a new graduate speech pathologist, I remember getting a report for a beautiful young lady from a psychologist. The psychologist wrote, “This child, with the severity of her intellectual impairment, will more than likely, always struggle in all key learning areas in the classroom. Provide her with the opportunity to shine and demonstrate her natural talents and seek out areas of interest, to ensure she is building her self-esteem.” 

I have never forgotten that report. It completely changed my perspective. If a child has a specific difficulty with learning, she may always struggle to keep up in school. But she will be good at lots of other things! Observe and foster her strengths, create an environment of success for her outside of the classroom. This will go a long way to supporting her self-confidence and self-esteem. And this is so important for all girls with ADHD, not only girls with learning difficulties.

Is she a fantastic artist, or painter, or dancer? Enrol her in an art class or a dance class, or work together to set up an online shop to sell her art. Is she drawn to babies or the older generation? Help her start a babysitting business or volunteer at your Sunday school. Can she knit? Buy her some wool and let her knit mittens for premature babies or scarves for the older generation? 

I do also believe that while it is essential to promote the girl with ADHD’s strengths, it is equally important to provide support for her weaknesses. What areas do you see your daughter struggling with? Is it maths? Hire a maths tutor. Is it language and literacy? See a speech pathologist or learning support teacher. Is it peer relationships? See a psychologist. 

One final word on this, be careful with what you take away to fit in her supports. I had a beautiful friend, who decided to take her child out of a team sport (which her child loved), to put her into maths tutoring. The child was devastated. Instead of being involved in a sport that helped her build positive relationships, and gave her an outlet for her energy, she had to go to maths tutoring.

Be creative in planning supports. There are fantastic online resources for support if you are time-poor, or your daughter would feel more comfortable learning in her own home. And she will be able to fit it in around her hobbies.

Let’s get ADHD Done Differently!

Share with me in the comments if this blog post has helped you! I love hearing your feedback!

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