ADHD in girls: Overlooked?

ADHD is just as common in girls as it is in boys. So why are girls diagnosed less often? And why do signs of ADHD in girls tend to get overlooked? 

In this episode, hosts Amanda Morin and Bob Cunningham hear from parents who initially missed signs of ADHD in their daughters. They also hear from a fellow Understood team member about being diagnosed with ADHD at 30 and how it changed her perception of herself.

Listen in. Then:

• Learn more about ADHD in girls.

• Get a personal take from a young woman about ADHD and anxiety, and the signs she overlooked.

Subscribe to In It on iTunes, Spotify, Stitcher, or wherever you listen to podcasts.

Episode transcript

Amanda: Hi. I'm Amanda Morin. I'm a writer with Understood.org, a parent to kids who learn differently, and a former teacher.

Bob: And I'm Bob Cunningham. I'm a career educator and parent, as well as executive director for learning development at Understood.

Amanda: And we are "In It."

Bob: This is a podcast from Understood. On this show, we hear from parents, caregivers, and sometimes kids, and we'll offer support and advice for families whose kids are struggling with reading, math, focus, and other learning and thinking differences.

Amanda: Today, we're talking about ADHD in girls and why it can so easily get overlooked and underdiagnosed.

Amanda: Bob, if you were to ask, say, a random person what they picture when they think of a kid with ADHD, what do you think they'd say?

Bob: I think they'd tell you a hyperactive boy, can't sit still, disruptive, those kinds of things.

Amanda: Yeah, that's definitely the perception of ADHD that most people have. But there's a few things wrong with that picture. First of all, girls have ADHD too. It's more commonly diagnosed in boys, but girls also have it.

Bob: And second, while some girls do have that hyperactive kind of ADHD, most of the time it presents differently. Here's how one mom describes it.

Christine: So she can be in class and be totally out to lunch. You know, her mind can be elsewhere and she can look like she's completely obedient and sitting there and polite and all that stuff, but her mind can just wander.

Amanda: That's Christine talking about her daughter Siobhan, who is 11. For a long time, Christine thought Siobhan was just, you know, a daydreamer and maybe a bit defiant, since trying to get her to do something so often went like this.

Christine: Siobhan, can you please set the table? I've just asked you 10 times to stop doing what you're doing and you're sitting there staring into a book on your bed. Homework, same thing. You know, redirect, redirect, redirect, redirect.

Amanda: It took some time before Christine considered that maybe this wasn't a matter of Siobhan being stubborn or of bad behavior. Maybe it was something else.

Bob: She wishes it hadn't taken her so long to get there. And she hopes other parents can learn from her experience.

Amanda: Can you tell us a little bit about Siobhan and what she's like?

Christine: Sure. So she is 11 years old. She's in sixth grade. She's very social. She's into art and drawing and stuff like that. She has always been a bookworm. She'll reread the same book a million times. Harry Potter, the whole series has been read probably, like I have lost track. And she likes to make up stories, too. You know, she can sometimes write some down, but writing is not a strength and so she'll tell them to me.

And when we go for a walk or something in the park, she can start talking. And it almost sounds like she's reading the pages of a book because the story is just spinning in her head.

Amanda: What about that said to you, "Oh, ADHD." Or did it?

Christine: It really comes from the daydreamy aspect of her. That can really be a problem in a school setting, in a trying to get homework done setting, and a trying to keep the household running setting. You know, she said to me once after her math teacher, I think in fourth or fifth grade was complaining that, you know, she's always zoning out, this teacher said, I'm a seasoned professional. I've been doing this for decades. And I've tried all my tricks on her and nothing's working to get her to pay attention.

And so I asked Siobhan, you know, what's going on? And she's like, well, whenever I'm bored or whatever, I can just, like, watch a movie in my head. And so it's not like what I thought of as typical ADHD, which is one reason I think that went undiagnosed for longer than it should have.

Amanda: Before the math teacher said that to you, was ADHD even like on your radar?

Christine: No. I knew that something was up because her grades were very uneven despite that she's a bright kid. And I think the previous conference to that one, I had asked her teachers, do you think she needs a tutor? And they said to me, no, she gets this material. She doesn't need extra help. It's not that it's conceptually challenging for her. She's just not focusing. It was almost like a personality flaw. You know, she's lazy. She's not applying herself.

And so there was a lot of, in retrospect, wasted time. And no, ADHD was not on my radar. And now I have so much regret about that because I just was not informed.

Bob: We asked other parents who have girls with ADHD if it took them a long time to arrive at the diagnosis. Here's what Margie told us.

Margie: Yes. The thing is, when she was 10, we took her to an educational psychologist because we knew she was having learning issues. We knew something was wrong. She was coming home in tears and insistent that she was trying as hard as she could and actually vocalized that she felt that some of the other children had some kind of magic that she didn't have, that the teacher would say what to do, explain a project, explain the next steps. And they all seem to get on with it. And she didn't know where to start. The teacher said she was daydreaming, spacey, you know, et cetera.

I told the ed psych, after doing research of my own, I thought she had auditory processing issues and that she had ADD inactive, which was what they called ADHD without the H six years ago before they started looking at it as presenting differently than the typical hyperactive boy diagnosis. And the ed psych came out and said, no, it wasn't ADHD. Everybody kept saying she's just not trying hard enough. She was trying so hard and she would force herself to try and focus. And because she was bright, because she was trying so hard, she was succeeding just enough for them to say, no, she didn't have it.

Bob: So you said that you noticed things about Siobhan, and the way she was participating in school and what she was doing at home, that kind of made you think I wonder what's going on here. How about for Siobhan? Did she seem to recognize anything? Did she know that things weren't going for her the way they might?

Christine: Yes. I think for a while she has not had a great sense of self-esteem around schoolwork, around homework. And I think for a long time, she also was confused about exactly what was going on and probably frustrated by all the negative feedback coming her way, both from her teachers and from us at home, honestly. Because I, too, thought it had a lot to do with her not working hard enough, not applying herself.

Amanda: We often think of ADHD as sort of a boy thing. Did that have anything to do with ADHD not necessarily being on your radar?

Christine: I think so. I think that's what's in the public perception, right? That it's a boy who's kind of bouncing off the walls.

Bob: When it is a girl, it usually stands out a lot when they have that hyperactivity or the impulsivity, that sort of stuff, because it's so counter to sort of what we stereotypically expect from girls. But what you describe is so much more frequently what girls experience in school when they have ADHD.

Amanda: I want to pause here for a second just to note that even when a girl does have what people think of a more typically boy kind of ADHD, she may not get the support she needs. This is something we heard about from Rob. His daughter, who's college-age now, had a lot of difficulties in school that only later were attributed to ADHD.

Rob: You know, particularly when she went to Catholic school, the first- and second-grade teachers that we had seemed to have this expectation that little girls are all like A, B, and C, and my daughter was doing D, E, and F. And like the second-grade teacher told me flat out, in my 25 years of teaching, I've never encountered a little girl like that. And I was like, well, gee, that's really sad. You know, that your experience has been so limited.

Bob: Have you had teachers talk to you about ADHD in girls and kind of how they look at it?

Christine: No, not at all. I don't feel like any of her teachers really have expertise in this area. It's more me and my husband.

Christine: Telling them what we have figured out along the way.

Amanda: Christine told us that figuring this all out has been a slow and sometimes frustrating process. Partly that's just the reality of being a working parent raising young kids. Siobhan has two younger siblings.

Christine: One time, I was very proud of myself because I had carved out this time to spend with her on homework. It's very hard at home because we have so much going on. So I had kind of left work early or something. The babysitter was going to be with our other kids and we were gonna sit down in a coffee shop so I could focus on homework with her and there weren't gonna be all these million interruptions. And she couldn't focus.

And I was so frustrated that even despite having, you know, done all these things to set the stage, her mind kept wandering. And I was later telling the learning specialist at her school about that. And the learning specialist said to me, well, you may not realize it, but in a coffee shop setting, there's all kinds of other stimulus coming at her — people talking, you know, cappuccino machine, all these other things going on. And they're taking her attention away. And that was kind of an aha moment for me. Oh, right. Even those little things.

Bob: An even bigger aha moment came when Christine took Siobhan to be evaluated by a neurologist. First, he went over the school's reports and assessments on her.

Christine: And then he did one of those computerized tests where she sits in front of a computer and it's an attention test. And she had to press the spacebar when one of two stars came up. And that was the only thing that was happening on the screen: two stars. And I was sitting behind her and she totally bombed it, you know.

That was another really telling moment for me where it was like, wow, there's no effort that goes into this beyond attention. There's nothing to figure out. There's, you know, nothing challenging to me about this. And yet she really could not sustain her attention.

Bob: So from that evaluation, Siobhan got an ADHD diagnosis and now she gets some extra support at school.

Amanda: But having a name and a language for what makes some things hard for her hasn't meant that Siobhan's insecurities just went away.

Christine: Yes. And now that she's a couple years older, when I was talking about before, where she doesn't have a great sense of self-esteem around schoolwork, I think that's only gotten more pronounced. And now she can articulate things a little bit better and so she'll actually say to me, well, there's not really anything about school that I'm really good at. You know, and then she'll list the things that she's not good at. And she'll describe to me instances where she's experiencing symptoms.

Like she was in band the other day, and the other clarinet players were nudging her because she had spaced out when it was her turn to come in, or she took a test and she realized that she couldn't concentrate because other students were whispering and she was sitting near the door to the hallway, which was open, and there was noise going back and forth.

Amanda: Bob, while we were working on this episode, we talked a lot with our colleague Laura about what it's like to be a girl with ADHD.

Bob: That's right. Laura didn't figure out that she had ADHD until she was 30. And that delay in the diagnosis led to a lot of pain and anxiety that perhaps could have been avoided.

Laura: Growing up, I didn't know that I had ADHD. It was something that I had heard of. But it wasn't something that we talked about a lot, especially not in the Midwest. I don't know. The attitude was just, you know, work harder. Play sports. Study more, that kind of thing. And I definitely latched on to that. Growing up, I really busted my butt to get perfect grades and to be a student athlete and a leader at school. But all the while, I was really suffering because it was just so hard to focus.

Laura: And it's funny, I look back now at my journals from when I was in middle school and high school, and I would see that I would scribble the word "focus" all over them. And yet it still didn't really click for me that something like that was going on. And I just developed these really perfectionistic ways of doing things. You know, I would like give myself fake deadlines so that I would work extra hard and give myself extra time to do things to the best of my ability.

And it worked like on paper. I was very successful, if you like, looked at my grades, if you looked at how it did in sports and how it was with friends. But deep down, I was really sad and stressed out and anxious all the time.

Laura: And it wasn't until I got diagnosed when I was 30 that I finally realized what was happening and it really clicked for me. I was like, wow, this is what was happening the entire time.

Bob: What do you want teachers to know about your daughter? Or what do you want them to do for your daughter in their classes?

Christine: So my daughter has a tutor who comes from a company that focuses on executive functioning. And I wish that those skills were taught in school.

Amanda: Tell us what those skills are that she's working on with that tutor.

Christine: Focus, organization, being able to sustain a task, being able to switch from one task to another, being able to organize materials like a backpack, things like that.

Amanda: We are keeping you as the person who now describes executive functioning skills. That's perfect.

Bob: Exactly.

Amanda: Like that was spot on. How has knowing that Siobhan has ADHD affected how you interact with her and parent her?

Christine: I do try to dig extra deep to find that patience. I definitely do not always find it, but I try. It affects how I analyze the situation afterwards and see the different factors that were at play.

Amanda: Do you ever talk to her about those different factors, or I guess what I'm asking is do you ever go back and have those conversations after you have been impatient.

Christine: Yes, absolutely.

Amanda: What do they sound like in your house?

Christine: Look, I'm really sorry that I was so angry with you for X, Y, and Z. You shouldn't have done X, Y, and Z, but I shouldn't have reacted in that way. I say that a lot.

Amanda: I say that a lot, too. Yeah.

Christine: Feel like it's the next best thing if you can't muster the 100 percent patience that you want to in this situation, then five minutes later, when you've cooled off a little bit, you can.

Amanda: That's a great advice. That's really good advice.

Amanda: You've been listening to "In It," a podcast from Understood. If you want to learn more about ADHD, go back and listen to some of our other episodes, like the one that answers the question "Is ADHD real?" Or our interview with Tumaini Coker, a researcher who looks into ADHD in communities of color.

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Amanda: You can subscribe to "In It" on Apple Podcast. Follow us on Spotify. Or keep up with us however you listen to podcasts. And while you're there, please take a moment to rate and review us.

Amanda: It's a great way to let other people know about "In It." And if you like what you heard today, please also tell somebody about it. Anyone you think should hear it. Maybe even your kids.

Bob: Between episodes, you can find understood on Facebook, Instagram, Pinterest, and YouTube. Or visit our website. U, that's the letter "U," dot O R G. Our show is produced by Julie Subrin and Sara Ivry. Mike Errico wrote our theme music and Laura Kusyner is our executive director of editorial content.

Amanda: Thanks for listening everyone, and a big thank you to everyone who called in and shared your story.

Bob: "In It" is a production of Understood.