ADD in Females - From Childhood to Adulthood

Why is an issue of ATTENTION! dedicated to women and ADD? Why not one for men? The majority of writing and research on ADD has traditionally focused on males, who were believed to make up 80 percent of all those with ADD. Today, more and more females are being identified, especially now that we are more aware of the non-hyperactive subtype of ADD. Girls and women with ADD face a variety of issues that are gender specific. This article will highlight some of those differences, and will explore some of the unique struggles faced by females with ADD.

Childhood issues for girls with ADD

Let's start with the recollections of childhood and adolescence by two women with ADD: Marie and Lauren. Marie is an introverted, "primarily inattentive" 34-year-old woman with ADD, who has struggled with anxiety and depression in addition to ADD, both in childhood and in adulthood:

"The thing I remember the most was always getting my feelings hurt. I was a lot happier when I played with just one friend. When someone teased me I never knew how to defend myself. I really tried in school, but I hated it when the teacher called on me. Half the time I didn't even know what the question was. Sometimes I would get stomach aches and beg my mother to let me stay home from school."

These recollections are very different from those of a typical elementary school age boy with AD/HD. Marie was hypersensitive to criticism, had difficulty with the rapid give-and-take of group interactions, and felt socially "out of it," except in the company of her one best friend. She was a compliant girl whose greatest desire was to conform to teacher expectations and not to draw attention to herself. Her distractibility created agony because of teacher disapproval and the resulting embarrassment in front of her peers.

On the other hand, Lauren's "hyperactive-impulsive" ADD patterns are more similar to those seen in many boys with AD/HD. Now twenty-seven, she recalls being stubborn, angry, defiant and rebellious, and physically hyperactive. She was also hyper-social:

"I can remember in grade school that everything felt frantic. I had a fight with my mom almost every morning. At school I was always jumping around, talking, and passing notes. Some of my teachers liked me, but some of them -- the really strict ones -- didn't like me. And I hated them. I argued a lot and lost my temper. I cried really easily too, and some of the mean kids in the class liked to tease me and make me cry."

Although we see the argument attentiveness and defiance in Lauren, whom we see more often in boys who have AD/HD, we also see that, like many girls with ADD she was hyper-social and hyper-emotional. Life for Lauren, as for some other girls with ADD, was an emotional roller coaster. She was very disorganised, and had very low tolerance for stress.

Adolescent Girls with ADD

Let's take a look at Marie and Lauren's recollections of adolescence. Life for each of them seemed to become even more difficult. Adolescence is difficult enough as it is -- when ADD is added to the mix, problems are amplified and stresses are intensified.

"High school just overwhelmed me. None of my teachers knew me because I never spoke up in class. Exams terrified me. I hated to study and write papers. They were really hard for me and I put them off until the last minute. I didn't date at all in high school. People didn't dislike me, but I bet if I went back to a class reunion that no one would remember who I was. I was pretty emotional, and it got ten times worse just before my period." -- Marie

"I was totally out of control in high school. I was smart, but a terrible student. I guess I worked on being a "party animal" to make up for all the things I wasn't good at. At home I was angry, totally rebellious. I sneaked out of the house after my parents went to sleep at night. I lied all the time. My parents tried to control me or punish me, but nothing worked. I couldn't sleep at night, and was exhausted all day in school. Things were bad most of the time, but when I had PMS I really lost it. School meant nothing to me." -- Lauren

Marie and Lauren presented very different pictures during their teenage years. Marie was shy, withdrawn, a daydreamer who was disorganised and felt overwhelmed. Lauren was hyperactive, hyper-emotional, and lived her life in a high stimulation, high-risk mode. The differences in Marie's and Lauren's behaviours are obvious, but what do they have in common?

1) Severe pre-menstrual syndrome.

In teenage years, the neurochemical problems caused by ADD are greatly compounded by hormonal fluctuations. These combined dysregulated systems can result in tremendous mood swings, hyper-irritability, and emotional over-reaction.

2) Tremendous concern with peer acceptance.

Girls with ADD seem to suffer more as a result of peer problems than do boys with ADD. Although Lauren had many friends, her emotionality repeatedly got in the way. Marie, by contrast, felt overwhelmed and withdrew, and felt most comfortable in the company of one close friend. Both, however, had a strong sense of "being different" from their peers.

3) Among impulsive-hyperactive girls, a sense of shame.

Adolescent boys who are impulsive and hyperactive may be viewed as simply "sowing their oats." They may even gain peer approval as they rebel against authority, or as a result of their hard drinking, fast driving, and sexually active lifestyle. Girls, however, tend to receive much more negative feedback from parents, teachers, and peers when they behave in such a manner. Later, as young women, they often join the chorus of accusation and outrage, blaming themselves and feeling a strong sense of shame for their earlier behaviour.

Raising Girls with ADD - Some helpful approaches

Just like adolescent boys with ADD, these girls need structure and guidelines at home. While males with ADD may behave in a very angry and rebellious fashion, for many girls, their life is an emotional roller coaster. They may withdraw and become depressed if they feel overwhelmed and socially rejected at school. Highly hyperactive-impulsive girls may engage in constant, dramatic screaming battles at home, where it feels much safer to release their fears and frustrations. Helping them to re-establish emotional equilibrium, especially in relation to hormonal fluctuations, is critical. For girls, more so than for many boys, home needs to become a place to calm down and to refuel emotionally. All too often, however, parents are drawn into tumultuous battles, rather than providing a much needed calming influence. How can you help as a parent?

1) Teach your daughters to establish a "quiet zone" in their lives.

Whether shy and withdrawn, or hyper and impulsive, girls with ADD often feel emotionally overwhelmed. They need to learn stress management techniques from an early age, and to understand that they need emotional "time out" to regroup after an upset.

2) Try to minimise corrections and criticism.

Too often, parents -- with the best of intentions -- shower girls who have ADD with corrections and criticisms. "Don't let them hurt your feelings like that." "You'd forget your head if it wasn't attached to your shoulders." "How do you expect to go to college with grades like that?" "If you just relaxed, dressed a little better..." These girls, whether loud and rebellious, or shy and retiring, typically suffer from low self-esteem. Home is not only an important place to refuel, it is where confidence -- so frequently eroded during the day at school -- must be rebuilt.

3) Help them look for ways to excel.

Girls with ADD typically feel that they are "not good at anything." Their distractibility, impulsivity, and disorganisation often result in mediocre grades. Likewise, they often don't have the persistence, the "stick-to-it," to develop skills and talents like many of their friends. Helping girls with ADD find a skill or ability, and then praising and recognising them for it are terrific positive boosts. Often, the life of an adolescent girl with ADD reaches a positive turning point when she is lucky enough to find an activity that can raise her self-esteem.

4) Seek medical treatment if PMS is severe.

PMS is something that many females with ADD may need to carefully manage throughout their lives. If PMS is severe in adolescence it should be taken seriously, and managed carefully. Sometimes severe PMS is managed through the use of anti-depressants with the dosage level being varied according to the menstrual cycle.

Special issues faced by women with ADD

The same themes of social and physiological differences between males and females with ADD continue to play themselves out as adolescent girls become women with jobs, marriages, and families.

For a woman with ADD, her most painful challenge may be created by her own overwhelming sense of inadequacy at fulfilling the roles she feels that her family and society expect her to play. Both on the job and at home, women are often placed in the role of caretaker. While men with ADD are advised to build a support system around themselves, not only do few women have access to such a support system, society had traditionally expected women to be the support system.

The emergence of "dual career couples" have intensified the struggles for women with ADD. Over the past two decades, more and more women have been required to fulfill not only the more traditional roles of wife and mother, but also to function efficiently and tirelessly as they juggle the demands of a full time career. Divorce is also hitting women with ADD harder than their peers who do not have ADD. Divorce rates are close to fifty percent among all marriages in the United States; divorce becomes even more likely when ADD is added to the list of marital stressors. Following divorce, it continues to be predominantly mothers who act as primary parent for children. By adding ADD to the huge burden of single-parenting, the result is often chronic exhaustion and emotional depletion.

The hormonal fluctuations that commence at puberty continue to play a strong role in the lives of women with ADD. The problems they experience due to ADD are greatly exacerbated by their monthly hormonal fluctuations. Some women report that the stresses of parenting their children -- who may have ADD -- while attempting to struggle with their own ADD, reaches crisis proportions on a monthly basis as they go through their premenstrual phase, often lasting as long as a week.

Although the number of older women yet identified with ADD is small, it seems quite reasonable to assume that the hormonal changes associated with menopause would be expected to, once again, exacerbate ADD symptoms of emotional reactivity.

Managing Your Life

Here's a list of twelve actions (and attitude changes) that could help make your life more manageable and, therefore, less stressful:

1) Give yourself a break!

Often the biggest struggle is an internal one. Societal expectations have been deeply ingrained in many women. Even if a loving husband said, "Don't worry about it," women would place demands upon themselves. Breaking out of a mould that doesn't fit can take time and effort. Working with a therapist who really understands issues related to ADD may help shed the impossible expectations that you have of yourself.

2) Educate your husband about ADD and how it affects you.

Your husband may feel anger and resentment about an ill-kept house or badly behaved children, assuming that you "just don't care." He needs to appreciate the full brunt of ADD's impact upon you. Get him on your side; strategize how to make your life at home more "ADD-accommodating" and "ADD-friendly."

3) It's only spilled milk!

Try to create an "ADD-friendly" environment in your home. If you can approach your ADD and that of your children with acceptance and good humour, explosions will decrease and you'll save more energy for the positive side of things.

4) Simplify your life.

You are probably over-booked and chances are your children are too. Look for ways to reduce commitments so that you're not always pressed for time and hurried.

5) Choose supportive friends.

So many women describe friends or neighbours who make them feel terrible by comparison -- whose houses are immaculate, whose children are always clean, neat, and well behaved. Don't put yourself in situations that will send you back to impossible expectations and negative comparisons.

6) Build a support group for yourself.

One woman with ADD related that housework was such drudgery for her that she often couldn't bring herself to do it. One of her techniques, however, was to invite a friend, who shared similar tendencies, to keep her company while she completed some particularly odious task.

7) Build in "time-outs" daily.

Time-out's are essential when you have ADD and are raising children. It's easy to not find time for time-outs, though, because they require planning. Make them routine so that you don't have to keep planning and juggling. For example, ask your husband to commit to two blocks of time each weekend when he will take the kids away from the house without you. Arrange for a regular baby-sitter several times a week.

8) Don't place yourself in burn-out.

One mother with ADD, who is doing a great job of parenting her two children who also have ADD, is able to recognise her limitations. With two such challenging children she arranges for a month-long, summer sleep-away camp each summer. She also arranges for brief visits, one at a time, to grandparents. This allows her to spend time with each son without him having to compete with his brother.

9) Eliminate and delegate.

Look at things that you require of yourself at home. Can some of these things be eliminated? Can you afford to hire someone to do some of them?

10) Learn child behaviour management techniques.

On the outside looking in, it may be easy for other parents to judge you if your children misbehave. What any parent of a child with ADD knows is that they don't respond to the usual admonishments and limits the way other children do. You have a super-challenging job. Get the best training you can find. There are excellent books on behaviour management techniques for children with ADD.

11) Get help for PMS or Menopausal Symptoms.

They are likely to be more severe in women with ADD than they may be in other women. Managing the destabilising effect of your hormonal fluctuations is a critical part of managing your ADD.

12) Focus more on the things you love.

There are many aspects of keeping a house and raising children that are rewarding and creative. Look for positive experiences to share with your children.

Women with ADD need to understand and accept themselves. They need to quit blaming themselves for not meeting the expected demands of two of life's most "ADD-unfriendly " jobs: that of housewife and mother. They also need the understanding and acceptance of their husbands, their families, and friends. These are women who are struggling valiantly against demands which are difficult, if not impossible, to meet. Instead of measuring success in terms of clean dishes and folded laundry, women with ADD must learn to celebrate their gifts -- their warmth, their creativity, their humour, their sensitivity, and their spirit -- and to look for others who can appreciate the best in them as well.

This article is adapted from Adventures in Fast Forward, by Kathleen G. Nadeau, a book on life, love and work for adults with ADD, to be published by Brunner/Mazel in the spring of 1996.  Kathleen G. Nadeau, Ph.D. is Director of Chesapeake Psychological Services of Maryland, a private clinic that specializes in diagnosing and treating adolescents and adults with ADD. She is the editor of A Comprehensive Guide to Attention Deficit Disorder in Adults: Research, Diagnosis, and Treatment, the first guide for professionals on adults with ADD and is the author of several books on ADD.

by Kathleen Nadeau, Ph.D.
CH.A.D.D.