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By Linda Aber & MA, Psychotherapist, Sheila Ostroff
Statistics reveal that male children are diagnosed with ADHD approximately four times more often than their female counterparts. Girls often go undiagnosed because many are predominantly inattentive, thus harder to identify until adulthood. ADHD predominantly inattentive [ADHD-I] is one of the three subtypes of Attention-deficit hyperactivity disorder as defined in the DSM IV.
ADHD-I differs from the other subtypes of ADHD in that it is predominantly characterized by inattention, distractibility, disorganization, procrastination, forgetfulness, and lethargy (fatigue). Children with ADHD-I demonstrate fewer or none of the symptoms of hyperactivity or impulsivity normally associated with the hyperactive and combined types.
As a result, non-hyperactive girls who did not act out often fell through the cracks and were not diagnosed with ADHD as children. Lack of proper early identification placed them at greater risk for academic failure and high school dropout, and led to misinterpretation of their behaviour on the part of teachers and parents. Girls with ADHD-I often received comments such as, "You’re irresponsible", "you're lazy", and "you just aren't trying." This sort of negative feedback causes a self-reinforcing, fragile self-image.
Sari Solden, a psychotherapist specializing in inattentive ADHD and woman’s issues author of Women with Attention Deficit Disorder and Journey through ADDulthood points out that many women with ADHD-I are likely to internalize their problems instead of acting out, which oftentimes causes them to feel depressed and anxious. In a recent virtual conference (unwrapping the giftofadd.com/index.php), she stated that “The real detriment for girls, especially if they were smart or had support, is that they don’t often hit a wall until later...women had no idea, that when they didn’t meet the stereotype of hyperactivity, that the diagnosis [of ADHD] could ever apply to them.” Many women with ADHD-I lived through a childhood of strange experiences and difficulties. They were at a loss to explain their contradictory patterns – highly skilled in some areas and clueless in others. Having grown up with a confused self image, they became adults lacking understanding and the ability to self-soothe –wedged deeply within their core of identity is an intense sense of shame.
Solden speaks from personal experience of how women with ADHD-I encounter feelings of humiliation and guilt once their symptoms impact their lives to the extent that they realize theyneed support - the tendency then unfortunately is to dodge assistance. No matter how successful or educated they are, many continue to hide their difficulties and organizational problems. Executive functions, problematic for people with ADHD, collide with the well rehearsed role women learn early on, based on idealized cultural expectations and societal messages. Traditionally, women are the ones expected to organize social events and the niceties of life. Faced with more diverse roles with work, marriage and family, many feel badly about their failure.
Some women with ADHD-I are so over-focused on their deficits; they fail to see themselves holistically - as people who also possess strengths. Some appear intent on waiting until they get over who they are, or become perfectly organized before allowing themselves to have a life. Solden developed a conceptual framework to help women identify where they are on their own voyage which she describes in her book “Journeys Through Addulthood.”
Journey 1 focuses on the brain and understanding ADHD, asking such questions as “Do I need to tweak the medication, do I need to expand the support, what do I need to help my brain work optimally?”
Journey 2 is a huge step - the crisis of identity – finding yourself, asking questions such as, “Who am I? Can I pick up some of those dreams that I let go of and that I am afraid to look at?”
Journey 3 is the crisis of success, focusing on yourself and the world – accepting your strengths, weaknesses and ability to state your own needs to those around you, make choices, learn to say no, and value and believe in yourself more.
ADHD-I women often grow up hiding their true selves - it is painful not to fit in when considered ‘way out.’ Although they admittedly struggle with issues such as organization and balancing a cheque book, they are potentially responsible mature women in every other way. That which makes someone unique is the real gift. Women with ADHD-I should be encouraged to redefine themselves – accept and expand upon their special qualities – share their unique gifts with the world. By learning to appreciate and explore their distinctiveness –“unwrapping their gifts” as Solden puts it, they have the chance to blossom and begin to see the world with new eyes.
Learning to set boundaries and make good choices starts with a positive self-image. Difficulties will not necessarily disappear, but embracing one’s gifts allows for a more realistic, healthy self concept. Solden suggests encouraging women with ADHD-I to show self-respect - this may teach others to treat them in kind. When women begin to expand their view of themselves and their differences through identification, education and support, they will have the opportunity to become truly successful at coping with ADHD-I.
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