ADHD and me: Why young girls go undiagnosed

Kinderling News & Features

When I was a little girl, my school reports always told my parents that if I tried harder and paid more attention, I'd do well. I was the student who always had potential. But something wasn't quite right.

It turns out I had (and have) a condition more commonly assigned to boys, Attention Deficit Hyperactivity Disorder or ADHD.

So pervasive is the misconception ADHD doesn’t affect girls, some studies have reported anywhere between 50-70% of cases of girls with ADHD go undiagnosed.

Why are girls going undiagnosed?

Dr Caroline Stevenson from ADHD Australia explains that, contrary to popular belief, hyperactivity is not essential to an ADHD diagnosis. In fact, it only makes up one of the three ways it presents itself.

  1. The inattentive type
  2. A combined subtype where you’re inattentive and impulsive
  3. Pure impulsive hyperactive type

"The issue in [the] classroom is that [girls are] much more day-dreamy. Because they're not causing problems, our biggest flag is that they're academically underachieving. You'll probably find that they're quite disorganised and that they may have aversion to mental effort. They don't actually want to do their homework, complaining of being bored."

Caroline says that ADHD manifests in girls as being inattentive and anxious, while boys are often hyperactive, impulsive and have more problems with aggression.

"The girls get missed, [because they appear to be] wallflowers that cause no problems," she adds.

My parents' favourite buzz word when it came to anything I didn’t do or put all my effort into was the big L. Lazy.

But Caroline says that it's rooted in something greater than a lack of care.

"It's a common theme that comes up for girls in particular, that they're lazy and just couldn't be bothered. Lazy means 'I'm not doing it and I don't care'. The issue for many of the girls is that they care enormously and they're quite distressed about the fact that they can't actually do the work and then they become anxious. The most common diagnosis or misdiagnosis for ADHD in girls is anxiety."

So why is it so hard to diagnose?

Caroline says that the most common ages for diagnosis are usually when there is a big shift in something called 'cognitive load'. This is in Kindergarten, Year 3 and finally Year 7; crunch times when children are usually given more challenges, both academically and socially.

Elise, bottom left, aged 8 with her family

I managed to avoid total and utter academic annihilation during primary and secondary education. For me, this shift in cognitive load came when I was in university. I was failing classes, I'd been dumped by my first boyfriend and, most influential of all, one of my younger cousins had been killed in a car accident. My brain went into overdrive and I teetered on the edge of a mental breakdown.That is until I revealed to my own mother how poorly I was coping, how anxious I felt all the time, and that I was failing. And like most mothers would, she scooped me up and off to a GP.

I was sitting in my GP's office silently crying, mostly out of shame that I hadn’t been able to keep it together. I still remember his friendly smile as he said, "We should definitely talk to a few people about this."

Elise as a toddler with her dad

How is it treated?

Many parents believe that medication is the only answer and medicating a child is some kind of parental failure. Caroline says that while medication is certainly a viable treatment option, there are a myriad of other ways to treat ADHD that revolve around equipping people with the skills they need to cope.

At the moment, I've equipped myself with the medication section of the ADHD tool box. I hope one day to rely more on strategies than medication but, for now, it's doing pretty great things in terms of me being able to get work done (and writing whole articles like this without giving up a hundred words in).

Listen to Dr Caroline Stevenson on Kinderling Conversation

What it means to go undiagnosed

The stigma around ADHD has stopped me from telling many people about my diagnosis. There's a shame that comes with it; that I've somehow failed because I need to put in much more effort to keep on top of my work, to be organised at home and in the office. It’s something that has followed me all the way through school and university, and still now as an adult.

Teachers and lecturers would remark that I was the most disorganised student they'd ever taught and that "if only Elise tried harder or applied herself to her studies, she would see real results."

That just made my anxiety worse. It wasn't that I didn’t want to do well, or that in some act of pre-teen and teen rebellion that I just flip-flopped my way through school. I just wasn’t interested enough. I often couldn’t engage with the content for more than 15 minutes at a time and most classes were at least 45 minutes.

I look back on all my primary school report cards, my inability to make lasting friendships, my half attempts at almost everything in my academic life, and now the ADHD diagnosis makes so much sense. It annoys me from time-to-time that it wasn’t picked up earlier.

That said, I wouldn’t be the woman I am today without it and I thank science that I had a GP insightful enough to pick it up when I walked into his office as a snotty and nervous wreck; a girl who couldn't possibly have ADHD because she didn’t cause a fuss.