How to Help Girls With ADHD

What parents can do to support learning and self-esteem

Rae Jacobson

 

Helping kids with ADHD is a big job. Both sexes benefit from medication, organizational assistance and accommodations. But girls with ADHD—like me—face a different set of challenges than boys, and when it comes to helping, parents need an approach that addresses these differences head-on.

Make the invisible visible

In girls, ADHD is often referred to as a “hidden disorder,” and with good reason. Most girls with ADHD have the inattentive type, which means that they have problems focusing but are not hyperactive and impulsive. But even those who are hyperactive and impulsive present with less obvious symptoms than boys, so it often goes unnoticed or unacknowledged. Instead of a diagnosis, girls with ADHD often get criticism from parents, teachers, and peers, and the fallout takes a serious toll on self-esteem.

“Pardoxically,” says Dr. Stephen Hinshaw, who chairs the psychology department at UC Berkeley, “Stigma is stronger against subtle disorders than obvious ones: ‘You’re bright. You should have it together! What’s wrong with you?’ The very subtlety and inconstancy of the symptoms fuels stigma—it doesn’t reduce it.”

Educating yourself about ADHD can help build understanding around a frustrating, complex disorder. It will also give you the arsenal you’ll need to become a strong advocate for your daughter.

I asked my dad, who doesn’t have ADHD, what he thought was the most difficult part of having a daughter who does.

“I didn’t understand it for a long time,” he told me. “It was invisible. We’d never heard of girls having ADHD. It seemed like you should be doing fine but were screwing up, and I didn’t know what it was about. That made it very hard to get on your side.”

Reach out to other parents

Dr. Kathleen Nadeau, a clinical psychologist who works with girls with ADHD and their parents, says that parents not understanding is a common refrain.

“The not-ADHD parent is going ‘I don’t get it!’ ” she says. “When parents have to keep repeating the same things—’You’re not getting up on time.’ ‘Put your shoes away.’—it adds up and makes it hard to see past the behavior to the causes behind it.”

Nadeau suggests that parents with ADHD daughters spend time talking with and listening to other parents whose children have ADHD. Hearing the similarities and sharing struggles and strategies helps non-ADHD parents understand the disorder better. “It really helps to have people who can relate,” she says.

Help with friends

Girls with ADHD sometimes struggle to make and maintain friendships, and the relentless complexities of the girl social world are overwhelming. Dr. Patricia Quinn, co-founder and director of the National Center for Girls and Women with ADHD, recommends helping girls with ADHD find social outlets that make them feel comfortable and play to their strengths. “If your daughter is socially awkward, find environments that are socially accepting—places that are more supervised and focused on kindness and treating people well and self-acceptance,” she explains.

Encourage your daughter to get involved with afterschool activities—clubs that focus on her interests or group activities that allow for individual space, like art classes or book groups—to help her learn to feel safe, comfortable and confident in a social setting. Likewise, if your daughter is impulsive or hyper, social situations where she can release some energy, like theater or sports, can make things go more smoothly.

And because boys are more likely to be diagnosed, even though lots of girls have ADHD, it’s easy for girls to sometimes feel alienated. Help your daughter normalize and legitimize her experiences by connecting her with other girls her age who have ADHD. Check out books about girls with ADHD and try reading and talking about them together. It also might help to find an older girl with ADHD to mentor your daughter, through school or a program like Eye to Eye. Meeting other ladies with ADHD, especially those who are open about their disorder, can make girls feel less alone and more hopeful.

Engineer her environment

When you have a clear understanding of what your daughter needs, you and she can work together to create situations that bolster her abilities and offer support in the areas where she feels less competent. Dr. Nadeau calls this “environmental engineering.”

For example, says Dr. Nadeau, “Extroverted, hyper-talkative girls might benefit from forming a study group. If studying alone is a nightmare but socializing is easy, find a way to make it constructive.”

Similarly, girls who are more introverted or struggle to stay focused might do well in a quiet, calm setting, with minimal distractions. As I write this, I’m facing a white wall (visual stimuli are really distracting for me) and using a white noise app on my phone—which is set to ignore all calls until I’m done working—to block out distracting sounds.

Build self-esteem

Research shows that girls with ADHD, especially those who’ve gone undiagnosed, suffer from low self-esteem.  I was no exception.

Failure, I’d think morosely, shaking my head for the umpteenth time when the teacher asked if I had my homework. I’m a stupid, useless failure.

The emotional fallout of ADHD can be as or more severe than any academic difficulties. We know now that girls with ADHD have higher rates of self-harm, substance abuse, and suicide attempts. Encourage your daughter to talk about how she’s feeling and seek further help if necessary.

Highlighting her strengths is one way to build back lost self-esteem and help your daughter see herself in a more positive light. “Look for islands of success,” says Dr. Nadeau. “Look for what she’s good at and really likes to do and arrange her world so that it’s a major focus in her life.”

Help her come out of hiding

Having ADHD can be frustrating and humiliating. Girls with ADHD often hide, minimize or compensate for their difficulties, too embarrassed to ask for help (even when we really need it). A 16-year-old I know explained how painful it was trying to cover up her struggles. “I wanted so badly to be like everyone else,” she said. “I didn’t want to ask for help because I didn’t want to be the weird girl who couldn’t get it done, but—of course—I did need help so then, after all that, I’d fail anyway. It was terrible.”

Work with your daughter to help her get comfortable with asking for help. It can be very hard for girls with ADHD to acknowledge their needs, and it may take time and practice for her to find her voice.

 

It may sound simple, but for me, learning to say, “Please repeat that. I have trouble remembering things if I don’t write them down,” instead of ducking my head and quietly panicking, has been life-changing.

In the meantime, you can model how it’s done by being her advocate. Standing up for your daughter will not only help her get the services and accommodations she needs but also send the message to her that ADHD is nothing to be ashamed of. This will help empower her to become her own advocate as she grows up. The more she is able to figure out what works for her, and ask for the help that will enable her to succeed, the more she will thrive.

The best advice

I asked my mother what was the best advice she’d gotten on raising a daughter with ADHD.

“Dan,” she said, with no hesitation.

Dan was my 3rd grade teacher, and the first person to notice I might have ADHD.

“Rae thinks a little differently than the other kids,” he told my parents. “It’s not a bad thing, but it might make some things more difficult for her as she grows up.”

My parents were confused and worried. “What should we do?” they asked. “How can we help?”

Dan thought for a moment.

“Keep her ego intact.” He said. “Make sure she knows you think she’s smart and you love her no matter what.”

“That,” my mother told me, nearly 20 years later, “was very good advice.”

How Girls With ADHD Are Different

And the emotional costs of being overlooked

Rae Jacobson

 I Have 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?

Hiding in plain sight

“We were initially taught that ADHD is boys’ phenomenon,” says Dr. Stephen Hinshaw, 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 Dr. Patricia Quinn, director and co-founder of the National Resource Center for Girls and Women with ADHD. “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, 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.”

On Wednesdays we wear pink 

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 andleave 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.’ ”

What’s in a name?

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.