Girls with ADHD are less likely to be diagnosed because they are more likely to present with Inattentive Symptoms
According to the DSM-5 ADHD affects about 5% of children but occurs in boys more than girls at a ration of 2:1.1
Often girls with ADHD stay ‘under the radar’ in the classroom because girls are more likely to have the Predominantly Inattentive Presentation of ADHD, rather than Combined or Predominantly Hyperactive/Impulsive Presentation. See my guide here to understand the terms and to gain an overview of the different symptoms that are linked to each presentation.
I was one of those girls, albeit at a time before there had not been as much research into ADHD – particularly in the UK. That’s me in the photograph up there, ironically highlighted when the reality was just the opposite. I am 7 years old in that picture and in the equivalent class of Year 3. That year my parents would be told at parent’s evening that I was a daydreamer, I never seemed to be listening and I wouldn’t finish my work as quickly as other children. I could do better if I just applied myself, if I just made more effort. I didn’t look particularly different and I certainly didn’t know I was different, I just though I was bad.
But Training has Moved On Hasn’t It? These Days Teachers and Teaching Assistants are on the Lookout for It… Aren’t They?
I trained as a Special Needs Teaching Assistant before I had children, and recently trained as a Higher Learning Teaching Assistant, and took an Advanced SEN course through Oplex Careers. What has became very apparent during my training is how little focus is directed to identifying children with inattentive symptoms of ADHD.
There has only being a small segment in each course that I have taken that describes and discusses ADHD and it has all been based around the image of the hyperactive boy who won’t stay in his seat, shouts out all the time and gets angry and lashes out at the other children. There are usually a few techniques and ideas for helping these children to manage in the classroom, a mention of medication and then it moves on to the next condition.
That picture of ADHD does not describe me at school, nor does it describe the girls in classrooms up and down the country who are sitting quietly, keeping themselves to themselves, lost in a million thoughts and struggling to get her thoughts down on the paper because she can hear some construction work outside, or there’s a plane going overhead, or the person next to her has a stuffy nose and is breathing loudly. The girl who takes forever to complete her work some days and then on others produces an amazing piece of work because it’s something that has caught her interest. ‘She can do the work when she wants to, she just doesn’t put the effort in most of the time‘. How many teachers thought that about me?
What was I like in School?
I always turned up late, I forgot my pencil case or it had spilled in my bag when I was trying to find something because I hadn’t closed it right. I left my homework at home, which most times I had actually completed, albeit at the last minute, but then forgotten to put it in my bag. I doodled in the margins of my book and wrote notes to whoever sat next to me, not really understanding why they’d get more and more frustrated with me. I was mortified when I got told off and burst into tears when I was told I would get zero in a test because I’d muttered the word ‘done’ under my breath when I’d finished and they thought I was cheating.
I didn’t need the teacher to tell me off for missing a deadline because I would already feel terrible about it, I was scared of failure, still am in many ways. I hated being put on the spot in class, if I knew the answer I would put my hand up, eager to gain a bit of praise but would dread being asked if I looked like I wasn’t listening. I was listening most of the time, trying to pick out the important bits in between the bell going off for other classes and the smell of lunch emanating from the dining room. I would ignore bits that I’d been told before, I didn’t see the point in being told them again and that would lead me to get lost in my thoughts ‘What do you think the answer is, Emma?‘ Even if I knew the answer the words wouldn’t come out and I’d feel stupid, they’d tut and shake their heads and ask someone else while I would let it fester for hours afterwards thinking ‘I should have said…‘
I didn’t like playtime, I hated going out to play as I got older. People assumed it was because I didn’t like the cold or the rain or getting exercise but it was because it was boring. It was unstructured and pointless. I would volunteer to sharpen pencils or tidy the bookcases at lunch times because at least then there was something to show for the time spent. I would rather have got the lessons out of the way and gone home earlier!
I was quiet most of the time but now and then I’d have watched something or read something that I just couldn’t wait to tell people about, it would surprise the teachers and probably amuse them somewhat looking back. I struggled with friends though, I always had a best friend who presumably had an enormous amount of patience to cope with the way that I would talk about things that interested me and glaze over when they told me things that didn’t.
I see now that these bursts of communication and pieces of detailed carefully written work were the main reason that no-one ever questioned whether there was something that affected me every day, that made it hard to be consistent. I can see why I was written off in Primary School, labelled a space cadet and saw ‘could try harder’ written on my reports. I got a B in GCSE Maths, a good grade, yet still the teacher said ‘You should have got an A‘.
If I had been able to concentrate fully during the test, if I hadn’t been up all night studying for the History exam in the morning, before the Maths exam in the afternoon, maybe I could have. If I had been medicated then I’m sure a lot of my results could have looked different, but I did OK. I have perfectly respectable grades, I am by all accounts an intelligent woman, I have an IQ of around 130, and I managed to get a BSc (Open) degree, but at school I ‘did not reach my potential’.
I was INVISIBLE
I coasted along, achieving average results and so not setting off any alarm bells. I learned to cram from exams and would take caffeine tablets to stay awake through them. I learned to write quickly, not necessarily neatly, so I looked really studious because I took copious notes. If I didn’t write something down I knew I wouldn’t remember it so I had no choice but it probably looked impressive.
I think I spoke quietly, although in my head it was loud. I would often wonder if people were just ignoring me or whether actually I hadn’t said anything. That still happens now and I still don’t know. I hated working in groups in school because I would have plenty of ideas but would have to work myself up to say anything, usually the moment would pass and I’d be angry at myself and dwell on it for hours afterwards until suddenly it would be gone and forgotten because something else had got my attention.
I was a nice girl most of the time, wrapped up in my own world so not really too bothered about what was happening around me, but thoughtful and caring. I found it very difficult to say no when someone asked me to do something, still do, but wouldn’t really volunteer myself as I’d always have a million things I wanted to do at home.
I had my moments where my impulsive side would kick in though, I do have a couple of impulsive traits. One of my friends got hurt because I got carried away playing and he hit his head. I was completely devastated, I thought he was going to die and that I’d go to prison (I was 10) but I couldn’t own up to it. I hated myself but the words wouldn’t come out, I completely froze. It felt enormous to me and stayed with me right through secondary school until I met him again and he said that other than a small scar he was fine and hadn’t thought about it in ages.
I seemed to do stupid things without thinking, kicking my foot through the porch door trying to look cool, or the most ridiculous thing, writing ‘Sex, pass it on’ on a bit of paper in class when I was 9 trying to get some street cred with the cool kids, who immediately announced to the teacher that someone had passed them a note and we were kept in all play time until someone owned up. Yep, I never did, sorry Mr Williams if you’re out there, it was me.
But that was it, maybe once a year I’d do something stupid and ‘out of character’, generally I didn’t get found out because I was so invisible they never really considered it was me. Or if they did they probably knew I was already completely mortified so didn’t really need to feel worse.
So, what needs to happen?
There needs to be more training offered to schools, the amount of time spent on additional needs during teacher training is insufficient and certainly my own experience of training has not addressed the Inattentive Symptoms of ADHD at all. Specific training courses centred around ADHD and all of it’s symptoms, not just the disruptive ones, should be accessible and affordable for schools, as well as course providers looking at improving their materials.
I didn’t do terribly at school but I could have achieved so much more with support and possibly medication. More importantly, I wouldn’t have gone through school feeling useless and broken, fearing failure and having to develop a ‘couldn’t care less’ attitude to hide the disappointment and frustration. Because I did care and so do those girls out there, and boys too, with the same problems as me who are invisible, coasting along under the radar, hoping no-one finds out what a worthless loser they are.
I have written a co-post specifically for people who work with children with a list of signs to look out for which you can read here, but I’m just one woman with a small blog and a smaller following. If you would share this or talk about it with your friends then maybe we can start to see a difference.
Thank you for reading such a long post, please comment or contact me if you have a story to share.