ADHD in Girls Is Misunderstood, and the Repercussions Can Be Devastating
An honest look at the ways women are taking care of their minds and bodies in 2018.
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I was a 15-year-old sophomore in high school when I received a diagnosis of ADHD. I didn’t really believe the diagnosis at the time, but now I realize it was true. I’m 32, I’m a woman, and I have ADHD.
The doctor who gave me this diagnosis was a compact, white-haired man in late-middle age who always wore ultra-tailored suits and spent most of our hour-long appointments bragging about his sons. His office was always outfitted with notepads and pens stamped with the brand names of whatever the newest pills were for the various mood symptoms I would tell him about — anxiety and depression, body dysmorphia and weird issues with food — and he was eager for me to try these new drugs and more. So, I told him something that wasn’t exactly a lie: I was having trouble concentrating at school, and my grades were suffering.
I’d gotten decent grades my first year of high school — not amazing, but good enough to squeak onto the honor roll. But it took me a lot of energy and effort to keep track of what I needed to do in the big picture and focus on tasks in the immediate term, even for things that I enjoyed doing. I figured it was because I didn’t try hard enough, didn’t have enough discipline. But I didn’t know what to do differently, how to make my “trying” translate into a better sense of control over my own life and responsibilities.
My doctor gave me a prescription for a psychostimulant drug called Adderall — a 30 mg extended-release capsule I was instructed to take in the mornings, and then a 10 mg tablet for late afternoon. I was pleased about this, because I knew kids at school liked to take these pills to get high and lose weight. I thought I’d tricked the doctor into giving me a medication I wanted but didn’t actually need. This huge dosage of legal speed didn’t improve my concentration or make me lose weight (which, at a school of size zeroes, was a major priority), but it did increase my anxiety and kept me up all night. My grades, and everything else, got worse.
According to a 2015 study in the Journal of Clinical Psychiatry, parents reported a 55 percent increase of ADHD diagnoses for girls between 2003 and 2011 — a window that began not long after I received my own diagnosis. And yet, according to a 2016 article by Quartz, girls with ADHD continue to be frequently misdiagnosed. That’s because ADHD looks different in girls than in boys, but it’s also because of cultural expectations of how girls should behave.
While ADHD is typically detectable in boys by the age of seven, it often manifests later in girls. Instead of hyperactivity, it presents in girls as a tendency to daydream and trouble following instructions, traits that fly in the face of gendered expectations of girls to be dutiful and compliant. Where girls and women are stereotypically celebrated for being natural multitaskers, female ADHD sufferers have trouble keeping organized, which can be interpreted as character failings like carelessness or poor work ethic. I think of my lifelong inability to keep track of the rules for card games or follow movie plots, the extra five minutes I inevitably take to find my keys or glasses or Metrocard before darting out the door of my apartment — inconsequential quirks that have been, throughout my life, sources of outsized personal shame.
“Pressure to perform means many girls internalize their symptoms — disorganization or carelessness — as personal flaws rather than medical issues to be treated through medicine and therapy,” the Quartz article states. Then, there’s this: “Girls with ADHD are significantly more likely to experience major depression, anxiety, and eating disorders than girls without.” The article also mentions low self-esteem and few friendships. It refers to these misdiagnosed girls with ADHD as a “lost generation” of women.
When I recently read that Quartz article, I saw much of my own childhood experience. And, not gonna lie, it broke my heart. Because, from my memory, it isn’t just girls like me whose self-blame leads to misdiagnosis (or uninternalized diagnosis): it’s the culture around us, and the adults who are supposed to have our backs, whose judgments reinforce unrealistic or unfair standards.
Kids absorb what adults say about who they are as people. I remember overhearing my second-grade teacher, Ms. Allison, saying I was “a little bit lazy” at teacher-parent conferences as I waited for my folks outside of the classroom. At the time, my parents were both going to school on top of working full-time and raising three kids under eight; “lazy” was a mortal sin, a word that did not exist in our family’s vocabulary. I remember, a few years later, a similar remark reported back from a different teacher-parent meeting, in which a beloved teacher suggested to my parents that my distractedness was “a ploy for attention.” A year or two later, when I was the lead in a school play that the same teacher was directing, he made an offhand remark to another adult about my trouble remembering stage blocking instructions during rehearsals: “Oh, with Kelli, you have to say things at least twice.”
I had always been rewarded by adults in my life for being smart and good at things; I was roundly criticized when I faltered in my designated smart-kid role. By the time I got to high school, it threatened my identity to struggle where I tried to succeed. Who was I, if not smart and good at things? Smart people don’t get Cs on algebra tests. I felt like a fraud on the verge of getting found out. It was less scary to just not try at all.
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While an ADHD diagnosis was an astute first step on the part of my doctor (or, let’s be real, young me who brought it up), it turned out that the drugs I would be prescribed were useless without accompanying strategies and tools for assessing my workload, my time and, most of all, my own happiness and its value. The medications that were thrown at me as a crutch without context, by a physician who really liked writing scripts, weren’t enough at the time to help me make sense of my brain or repair my self-esteem. I’d had the sadly typical experience of a girl growing up with a misunderstood disorder. It sucked, a lot.
Learning to recognize my limits, accept them, and thrive has come over a course of years (and a lot of therapy). I continue to work hard to internalize the reality that my emotional and physical well-being merit the time for self-care and moments of non-productivity. I still sometimes take on more than I should just to prove that I can, but I also cut myself slack and give myself permission to say no. Weirdly, in doing so, I seem to get more things done, and better.
But that’s not the point.
For women who experience distractible brains, our heaviest lifting involves unlearning ideas that link a person’s value to their performance. We are not machines, and there’s nothing empowering about pretending to be. Our worth, our capability, is so much more.
(Illustration by Sarah Tate)