Why girls with ADHD are often undiagnosed, anxious and sometimes bullied

Attention-deficit/hyperactivity disorder (ADHD) is underdiagnosed in girls and women, research shows. The reasons are manifold, and include gender stereotypes and internalised symptoms. In fact, the neurobiological metabolic disorder is diagnosed four times more often in boys than in girls, although it occurs with equal frequency in both, according to Dr Astrid Neuy-Lobkowicz, a specialist in psychosomatic medicine and psychotherapy, and a member of the board of the Federal Association for ADHD in Germany, who has ADHD herself. Symptoms typically start in early childhood. In many girls, she says, ADHD presents itself predominantly as inattention. They tend to be dreamy, shy, slow and unobtrusive rather than hyperactive and impulsive. Either way, ADHD is “a particularity of being human”, remarks Neuy-Lobkowicz, the title of whose latest book translates from German as Female ADHD. Its sufferers, she says, are neither better nor worse than other people – just different. Examiner bias is why far more boys are diagnosed with ADHD than girls, says Dr Matthias Rudolph, like Neuy-Lobkowicz a specialist in psychosomatic medicine and psychotherapy in Germany. Girls, too, can have ADHD with a predominantly hyperactive/impulsive presentation, however. They are often “typical tomboys” and are told in childhood, “It would have been better had you been born a boy”, says Neuy-Lobkowicz. She describes them as feeling “lots of joy, lots of sorrow, lots of heartache, lots of enthusiasm. They are always a bit over the top.” Some girls have ADHD with a combined presentation – both inattentive and hyperactive/impulsive – and others change from one type to the other. [People with ADHD] are not inattentive during a conversation because they’re uninterested, but because their thoughts wander Dr Astrid Neuy-Lobkowicz, specialist in psychosomatic medicine and psychotherapy “A girl can begin with an attention deficit and then develop hyperactivity symptoms in puberty,” writes Neuy-Lobkowicz in her book. “The reverse can occur as well … We don’t yet know why.” Girls with an attention deficit are often bullied, she says. Ashamed, they try to conform and not draw attention to themselves. They study harder to get on well in school, but are quick to have a guilty conscience if they do not. “In contrast to boys, they try to display socially desirable behaviour.” If their inattention remains unrecognised as ADHD, they often develop anxiety disorders or depression that would otherwise be easy to prevent, and which becomes increasingly pronounced in adulthood and is then treated. “But no one suspects inattentive-type ADHD any more,” Neuy-Lobkowicz says. Rudolph reports treating menopausal and post-menopausal women who felt unable to handle the tasks life presented them. Fearing they suffered from dementia, they had themselves examined because their retention and ability to concentrate were so poor. Many of them said they had always known that “something was wrong with them”, he says. “They are often strong women who, with 120 to 140 per cent effort, achieved what other women do with 100 per cent. At some point their strength gives out.” “[Inattentive-type ADHD] in women is hard to substantiate in many cases because their behaviour [in school] was so unobtrusive that it’s not mentioned in [their school] reports,” Neuy-Lobkowicz says. “It depends on the environment the child grew up in,” says Rudolph, noting that many of the parents checked their homework every day and packed their bag, so the disorder did not attract attention at first. Should ADHD indeed be diagnosed, medication is an important element in treatment, as an ADHD brain is hypersensitive to sensory stimulation and there’s an imbalance of the neurotransmitters dopamine and noradrenaline. Medication is often supplemented with behavioural therapy aimed at teaching the patient to better organise their life. Other therapeutic elements can include occupational therapy, sport and self-help groups A patient’s relatives can help too. Neuy-Lobkowicz says it is important that they learn about the disorder so as not to misinterpret the person’s behaviour. “They are not, for example, inattentive during a conversation because they’re uninterested, but because their thoughts wander,” she says. They are also very capricious and constantly late, but not because they are reluctant to show up – they just manage their time poorly. “Someone who doesn’t know this can be easily offended,” she says. Neuy-Lobkowicz advises a partner of a woman with ADHD not to argue with them when a conflict arises, but to take a break and discuss the matter when tempers have cooled. “Female ADHD sufferers are shrinking violets with a wooden club,” she says. When they blurt out something, they put the world back in order for themselves, she says – but only for themselves. “That’s why you’ve got to explain to them that this can damage the relationship.” Rudolph, too, emphasises the importance of proper communication. He advises partners of women with ADHD not to hold long monologues, but to speak in short, clear sentences. Sometimes, he says, it helps when they summarise what they have just heard: “Have I understood you correctly that …” He also recommends setting feedback rules and making sure that important conversations are held in a quiet environment with few distractions. Like what you read? Follow SCMP Lifestyle on Facebook, X and Instagram. You can also sign up for our eNewsletter here.

Why girls with ADHD are often undiagnosed, anxious and sometimes bullied

.css-1c6uqr6{color:inherit;font-weight:inherit;font-size:inherit;font-family:inherit;line-height:inherit;overflow-wrap:break-word;}Despite signs of attention-deficit/hyperactivity disorder during childhood, it is often not diagnosed until adulthood, especially in women

Despite signs of attention-deficit/hyperactivity disorder during childhood, it is often not diagnosed until adulthood, especially in women