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The Late ADHD Diagnosis of An American Girl

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With all the media hand-wringing about the alleged over-diagnosing of boys with ADHD, you’ll find little mention of the under-diagnosing of girls. Hence this gripping post from a guest writer.

After reading my response to Esquire‘s egregious piece (The Drugging of the American Boy), a young woman with diagnosed later in life with ADHD wrote to share her experience. Jaclyn Paul is a writer, artist, and mother to a beautiful toddler. This is her story, illustrated with her childhood report cards:

The Late ADHD Diagnosis of an American Girl

by Jaclyn Paul

Jaclyn Paul

It was a typical high school scene: My friends stood in a tight knot against a row of lockers.

My boyfriend leaned against the wall, inching his feet far out so he was precariously balanced. The hallway reverberated with chatter, whoops, and slamming doors.

What came next may surprise you: With no provocation or forethought, I swooped my leg around and landed my foot against my boyfriend’s calves. He hit the ground hard. As I stared at him sitting on the ground wincing in pain, I was horrified—almost as though I had, for a split second, vacated my own body. What sort of person does such a thing?

I’d asked myself this question all my life. In the third grade, I threw a boy to the ground during gym class, raking long scratches down his forearms with my fingernails. He had cut in front of me in line. My mother, appalled, told me that is how animals behave. Around the same time, I bellowed “DUH!” at a tablemate after listening to our teacher review a lesson with him. This necessitated yet another note home to my parents.

I would love to tell you these were isolated incidents, but they weren’t. I would also love to tell you my parents and teachers recognized the underlying problem here. They didn’t. If I had been a boy, someone surely would have mentioned ADHD.

Even though the disorder occurs in equal numbers across genders, the majority of elementary school students diagnosed with ADHD are boys. Because ADHD manifests differently in females and the telltale poor academic performance is often absent, many diagnoses aren’t made until adulthood. ADHD girls suffer through especially challenging childhood and teenage years because they experience social isolation, anxiety, depression, and low self-esteem as a result of their ADHD—often to a greater degree than boys.

Despite my social and behavioral challenges, I earned As and Bs and placed in the 99th percentile on standardized tests. Shrugging off any praise I received for these so-called accomplishments, I said the tests were “stupid” and “anyone could pass them.”

Frankly, our public education system compensated for my ADHD. As a linguistic learner who tested well (as opposed to being visually oriented, like many boys with ADHD), it was only in my adult life, stripped of academia’s structure and rules, that the house of cards began to fall apart. I no longer knew what to do—or what it meant—to get an A.

As I reached out for support, my friends and family struggled to sympathize. After all, I looked smart and successful—from the outside. My friends assured me I was either expecting too much of myself or making excuses for not bringing my behavior in line with that of other adults. My occasional verbal outbursts just meant I had to think before I spoke. Of course my desk got messy sometimes, but didn’t everyone’s? Surely I didn’t think I was the only one who felt overwhelmed from time to time?

Surely not, but my struggles extended beyond what could be considered “average.” I lived in a constant state of frantic anxiety, knowing I had too much to do but unable to bring specific tasks into focus. Bills went unpaid. Close relationships felt insecure and suffered from my irritability and overemotional behavior. Feeling others’ trust and respect was misplaced, I battled persistent guilt and a fear of being found out.

Jaclyn’s report card, Third Grade

I had also carried my problematic behavior habits into adulthood: I became irrational and overwhelmed in simple situations and barely contained my impulsive nature. My close friends laughed at my idiosyncrasies—though sometimes not until the dust had settled—but I lost sight of the humor. They saw surface-level quirks I could fix with a bit of effort and self-control, but I knew better: this was only a tiny window into the painful reality below.

Women and girls are bombarded by invalidations like “You’re overreacting,” “You’re too sensitive,” or “Calm down.” For those with ADHD, it’s all too easy to assume we’re just hypersensitive and need to learn to handle our wild emotions. Even our closest confidantes often fail to realize the truth: we can’t stand our disproportionate reactions, either, but we feel utterly powerless to stop them.

Eventually, I hit a breaking point. I was sick of forgetting everything and anything, no matter how important; starting a new project as soon as the novelty wore off on an old one; leaving mail sitting unopened for weeks (or months); picking endless fights with my husband; the list wore on.

Not sure where else to turn, I called my company’s Employee Assistance Program. They brought me in for a consultation, and a few days later I held a bottle of Ritalin and a cautious hope that my life could change.

And change it did. The first day I took the Ritalin, I was afraid to break for lunch because I couldn’t imagine such good luck (i.e. productivity) would strike me twice. When I learned it could (and did), it felt like a miracle.

I didn’t just get more done, either. One day, after a long week at work, I had an epiphany: A week is just a week. We start over every Monday. After years in the clutches of the now, of not being able to see outside the emotion of the moment, I felt so liberated to see my feelings and experiences as finite.

A wide buffer opened up in the moment between when I heard or felt something and when I spoke. The Ritalin literally seemed to slow time down and give me a chance to consider what I said before I said it. Sometimes I even realized it was most appropriate to say nothing at all.
In other words, I began to learn how the rest of the world functions.

Of course, I got my share of raised eyebrows.

“Ritalin? Ritalin?” my dad asked on the phone one night. Because I’d always received good grades, ADHD seemed implausible, especially to the people who felt they would (or even should) have known.

Indeed, my intelligence likely worked against me as much as my gender. According to ADHD expert Kathleen Nadeau, Ph.D., girls with high IQ are least likely to receive a timely ADHD diagnosis.

“The smarter she is, the more easily she can coast without exhibiting overt symptoms. The smarter she is, the more easily she can compensate for her difficulties. The smarter she is, the more easily a teacher is willing to ignore some odd or shy behaviors. The smarter she is, the more easily her grades convince people that “there’s nothing wrong.” The smarter she is, the more she knows intuitively that something is very different about her and that she’s the only one who can see it.”

Girls are expected to be much more aware of the feelings of others, to read and respond accurately to subtle social cues and to maintain more emotional control.

Perhaps this explains, if only partially, my tomboyish childhood and adolescent years. In fact, I had very few female friends until my son was born. I felt I just didn’t understand or relate to them as well.

Jaclyn’s report card, Second Grade

I still struggle with this, even though motherhood has drawn me closer to the women in my world. I still have no idea why some girls hated me so much in grade school—what made them drive a field hockey ball at my foot after practice and sneer “good” when it hurt me, what made them suddenly stop speaking to me after years of amiable friendship, what made them chummy in study hall but never interested in inviting me to a party.

Despite these social mysteries, and despite the fact that I still struggle with my ADHD on a daily basis, putting a name to it and seeking professional help turned my life around. I don’t dwell on how things could have been different had I received an ADHD diagnosis as a child, but I’m disheartened that we continue to leave so many girls behind every year. By defining ADHD with an image of hyperactive little boys who get poor grades, we’re doing these girls a tremendous disservice. It’s time for us to redefine what ADHD means to us—to give these girls the support they need to grow up into the confident, successful women they deserve to be.
_____________________
Jaclyn Paul is a fiction writer, blogger, and occasional freelancer. Her writing has appeared online in Offbeat Families and The Write Life. She maintained the blog Mix Tapes & Scribbles, a collection of ruminations on creativity and ADHD, for four years.

A proud Baltimorean, Jaclyn represented the city’s art blogging community at a press conference for the Baker Artist Awards public launch. She has also served as blogger, public relations writer, and technical writer for Greater Homewood Community Corporation.  Visit her website: JaclynPaul.com. Her Twitter handle is: jaclynleewrites


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  1. Katy Rollins’s avatar

    There’s so much yes in this for me that I actually have nothing to say, other than thank you.

    Reply

    1. Gina Pera’s avatar

      Hi Katy,

      I thought you would relate. :-)

      tx
      g

    2. Virginia Knowles’s avatar

      I can sure relate to that! I didn’t realize until a few years ago, in my late forties, that I had ADHD (not hyperactive, though). As a mom of 10 and an author/teacher, you can imagine the challenges I’ve faced. Anyway, I did take the time to write down all the ways I have compensated as well as what my personal strengths are. Maybe this will be an encouragement to someone else. http://virginiaknowles.blogspot.com/2010/09/add-and-me-well-manage.html

      Reply

      1. Gina Pera’s avatar

        Hi Virginia,

        TEN CHILDREN!!! Wow! As the youngest of 7, I know what that involved (at least 7/10s of it!).

        Kudos!

        g

      2. Virginia Knowles’s avatar

        I’m guessing one reason it took me so long to figure out the ADD was that I always had the houseful of kids to blame for the chaos. We have seven home now (2 of them in college), and sometimes it’s just as crazy as ever. :-)

      3. Danielle’s avatar

        This is such an amazing and hard-hitting post, I only have two things I can say in response (which is unusual for me): “Wow!” and “thanks.”

        Danielle

        Reply

      4. Steve’s avatar

        This is not a boy/girl thing.
        My brain helped me not get diagnosed for 40 years.

        What I find is that people just don’t get it!

        I know professionals who don’t have a clue, in fact I know a psychologist who knows that he has ADD but he said it does not effect his life, the look that his wife gave when he said that was enough to prove my point.

        Just another thought to throw out there, I wonder what people think about this.

        I have a 130% accurate way of diagnosing ADD.
        If you know a couple where the husband seems like the nicest guy and the wife is a b–ch, guess what? The husband has ADD.

        Try it on people you know – it’s 100% accurate.

        Thanks for the great article.

        Reply

        1. Gina Pera’s avatar

          Hi Steve,

          Thanks for your comment. I’m glad you enjoyed Jaclyn’s wonderful article.

          Yes, late-diagnosis is not a “boy/girl thing.” Only 1 out of 10 U.S. adults thought to have ADHD are actually diagnosed.

          The problem is, as referenced in my lead-in, is that boys are diagnosed more than girls. Girls tend to catch up in the later years. But publications seeking controversy, such as Esquire, do not know that. They are intent on raising a ruckus because boys are being “drugged” for simply being boys.

          I might agree with your 130% accurate diagnostic, but I’d put it at about 50%. :-)

          best,
          g

        2. David’s avatar

          I was diagnosed in my thirties and never had a problem in the academic setting. I didn’t have notable behavioral problems either. I was socially awkward and tended to be extreme socially by being excessively gregarious or withdrawing. I am glad that I figured it out with the help of a counselor because my daughter exhibits the same tendencies. Most of my goals with my prescriber focus on relationships.

          As far as the nice guy/b-ch theory goes, I’d say this happens a lot. Both sides are getting something out of this arrangement. My Dad is on his third marriage and the last two were definitely type “A” and he “laid back.” Of course, he has a temper if the fuse goes off. I made sure that this wouldn’t be the dynamic in my marriage. That was the reason for the diagnosis.

        3. Gina Pera’s avatar

          Thanks for your comment, David. The public too often confuses ADHD with poor academic performance, as if the two are synonymous.

          thanks,
          g

        4. Jaclyn’s avatar

          The focus on academic performance is so unfortunate. I have a friend who teaches first grade and she recently told me that they can’t do anything for ADHD students unless it is affecting academics. This leaves most of her girls — and certainly a few boys, too — behind in terms of getting the help they need. Not much has changed since my elementary school years :(

        5. Gina Pera’s avatar

          So true, Jaclyn. I know many late-diagnosis women who exhausted themselves in school, trying to keep up their grades. At what cost was their “academic success”?

          I appreciate psychologist Tom Brown’s work with high-IQ folks with ADHD, reported here in a past blog post:

          High intelligence does not protect you from the effects of ADHD, a recent study indicates. Unfortunately, too many people mistakenly assume that high IQ rules out ADHD entirely.

          Psychologist Thomas E. Brown, a prominent ADHD expert and assistant professor at the Yale School of Medicine, has previously conducted several studies to learn more about high IQ individuals with ADHD. The latest effort is now available from the online edition of the Journal of Attention Disorders (for a fee to non-subscribers) and will be published in the September print edition.

          The scoop, according to the press release from the Yale University Office of Public Affairs:

          “Even the high-IQ (120+) ADHD group lacked self-management skills and the ability to focus. They tended to procrastinate and be forgetful and had difficulty in harnessing their talent to complete many daily tasks, the study found. In fact, 73 percent of the ADHD population showed significant deficits in five or more of the eight measures of executive function.”

          If you’re like me, you know several people with undetected, untreated, or “in-denial” ADHD who’ve been trying to finish their Ph.D. thesis for, well, a long time now. Do them a favor, and forward to them this post. They might be glad to know that their challenges in procrastinating, prioritizing, and all the other executive functions probably have nothing to do with intelligence. Or willpower.
          Thttp://adhdrollercoaster.org/adhd-in-the-news/can-you-be-too-smart-to-have-adhd/#.U26F6C-YvZo

        6. BlackNurvana’s avatar

          // “The smarter she is, the more easily she can coast without exhibiting overt symptoms. The smarter she is, the more easily she can compensate for her difficulties. The smarter she is, the more easily a teacher is willing to ignore some odd or shy behaviors. The smarter she is, the more easily her grades convince people that “there’s nothing wrong.” The smarter she is, the more she knows intuitively that something is very different about her and that she’s the only one who can see it.”

          Girls are expected to be much more aware of the feelings of others, to read and respond accurately to subtle social cues and to maintain more emotional control.//

          By the time the girl becomes an adult … managing behavior takes its toll particularly when you realize you don’t have to do it any more … its like a crash. And then the slow recovery begins

          BN

          Reply

          1. Gina Pera’s avatar

            Yes, indeed. Well said.

          2. AlisonM’s avatar

            Whenever I read something like this and think “Wow, I could have written that,” it amazes me even further that people could dismiss ADHD as something Big Pharma made up to sell pills. . .

            Reply

            1. Gina Pera’s avatar

              Hi Alison,

              I know. And yet…and yet…the New York Times’ Alan Schwarz is at it again in this morning’s paper, more fearmongering about ADHD with facts out of context and calling upon fringe experts.

              There is definite money to be made from bashing ADHD.

              best,
              g

            2. BillD’s avatar

              I had so many problems in grade school that the school authorities called my parents in, and in a conference, they decided to have the school psychologist check me out. His conclusion – keeping in mind I was 3rd grade and I’m now 57, “genius IQ, he’s bored”. Yes, his comment to my mother “doesn’t it scare you” and she almost panicked – then he explained my IQ was so high that I was simply bored and would naturally be impatient with anyone who couldn’t keep up with me. He was partially correct! That last part is true. My report cards – ouch. My parents recently passed the scrapbooks they kept on each of us boys to us. I got mine and was afraid to look – and didn’t for months. Then finally I got curious – getting older and getting more frustrated wanting to know what the heck was wrong with me – I was finally getting clues and starting the diagnosis process and wanted to see if it was true – did my report cards REALLY say what all the professionals said they would? Any clues in here? I literally broke down – why didn’t someone find this all those decades ago? How could they miss this? If I had been diagnosed back in the 60s, my life would be SO different! I’d not have lost marriages, cars, had severe injuries, and been able to be at a job I liked for more than 5 or 6 years before having to move on. Smart – no problem there – tests I could pass (unless it was math where they wanted to see my work!, I could do, but not explain). I was always in the top 5 or 10 % of any national or state test, but my grades were bad because ….. I didn’t do homework – usually at all, if I did it was late. I was disruptive, argumentative and always asked for proof and why there weren’t smarter alternatives. Social outcast, doesn’t get along well with others and yes very impatient if you can’t keep up my pace or meet my perfectionist expectations. When I got to college I was the opposite – I loved the subject material – it was what I truly loved – CARS. I kept A’s, was on the dean’s list, 4.0 GPA, top student the teachers said I was “respected and looked up to” by the others. I was still a bit of a “freak”, but had a few good friends. But in the work routine – more troubles. Boss’s are never very smart, I almost always knew more and had better ways (LOL – often it was quite true but they didn’t like hearing it!) So I moved around a lot in jobs. I could solve things no one else could, figure out problems no one else even saw, could connect dots easily that others asked – “there’s dots? I don’t see any”. Finally thanks to a TV show, I saw them talking about me – hey, that’s me, how the $#@% do they know all that? Is this some sort of joke? You mean there’s OTHERS like me? With similar problems? It prompted me to finally, in my mid-50s, get diagnosed. Family doctor – man, do not EVER rely on them for anything ADHD connected. They are clueless and rely on that simply DMV whatever test. And in my case “I won’t prescribe anything because at your age your heart won’t take it, too risky”. I proved that wrong in spades. So in school, I was in like 3rd grade and there were problems, and decades later at roughly age 55 I finally get enough clues to insist on answers. And I had to force my way through the system and insist – there’s a problem here, won’t anyone listen to me?? But then where I live, good luck getting treatment. Once you are diagnosed – that’s pretty much it. Here’s some drugs, but they don’t know how much, or how or when or which. Of course in my case, the 3rd things tried sort of worked a little for a year, then stopped working and no nothing at all helps, nothing. No drugs we’ve tried work any longer. So I guess I was too old, it was too late, and my body laughs at what I take in and all it does it keep me from actively yawning when others are talking. I guess that’s worth something, though, eh?
              I’m the posterboy for Dr. Barkley’s videos – diagnosed severe ADHD, social anxiety likely caused by the troubles of childhood and teens….. and even adulthood because I lived through it for over 5 decades, it sort of becomes part of you. I’m the unsolvable case, exhibit pretty much all the traits Barkley talks of – in spades.
              It’s not just gender, it’s where you live, too, that helps determine if or when you get diagnosed, if anyone believes it, or anyone will work with you.
              The clinic I’ve been going to for a couple of years to experiment on finding a drug that MAY help – they are CLOSING DOWN this summer, so I’m out totally. No where to turn at all.

              Reply

              1. Gina Pera’s avatar

                Hi Bill,

                If you have ADHD, it shouldn’t be that hard to find a medication that helps.

                If what you’ve tried in the way of first-line medications (the stimulants) haven’t worked — and the method described in my book was followed — then I’d encourage you to do some sleuthing and examining of “lifestyle.” For example, are you taking the generics? Are you consuming citric acid? Are you smoking cigarettes? Sleep-deprived? Have diabetes?

                Ask the clinic to help identify a local professional who can help you after it closes. Or try to recruit a helpful GP who is interested in learning so he/she can also help other patients who have ADHD.

                Good luck!
                g

              2. AlisonM’s avatar

                Mix in hyperbole with facts, and they cease to be facts. I want a machine that will plug people into another person’s brain, and every time someone says it’s not real, hook them up to my head and see if they can last even one hour. . .

                Reply

                1. Gina Pera’s avatar

                  You know, Alison. Even that would not be enough for some people — especially for the people with ADHD who are in the most denial of its existence. ;-)

                  Otherwise, people would still attribute the “result” to other causes. Cognitive dissonance and selective perception dies a very hard death.

                2. Patty@homemakersdaily.com’s avatar

                  This is such an encouragement to me! I didn’t have the impulsive behavior but I can so relate to everything else. I held it all together in school but it all fell apart once I had kids. I wanted my ducks to be in a row so I worked my tail off to make it so. But I fell into bed exhausted every night! I was holding it together but it took a huge amount of effort. I talked to other women friends about it but they all looked at me like I was from outer space. None of them could relate. They said all the things you mentioned: “Calm down. You’re trying too hard.” etc. etc. They just didn’t get it. I never have received an official diagnosis although I know and my family knows I have ADHD. I’ve never taken meds but I’ve done a lot of lifestyle stuff to cope with it. And unfortunately, many people don’t believe I have it because I SEEM to have everything together. But they don’t get that it takes SO very much work to do so.

                  Now I’m 52 and I’m tired. I’m tired of holding it all together. I’m tired of trying so hard. And I’m going through menopause and that’s making everything worse. ADHD is tough but it definitely helps knowing what it is and know how to work with it. I wish I knew early enough what I had so I could have taught my children how to cope. Both of them have it, too. My daughter actually does very well but my son struggles.

                  Anyway, I’m rambling. All that to say it’s not to hear a similar story.

                  Reply

                  1. Gina Pera’s avatar

                    Hi Patty,

                    You’re not rambling at all.

                    52 is young to learn about ADHD; people as old as 84, and newly diagnosed, have come to my adult ADHD discussion group! :-)

                    Please keep learning. There has never been a better time to have ADHD, especially as a woman.

                    I encourage you to read top ADHD expert Dr. Patty Quinn’s excellent books on women with ADHD:

                    http://www.addvance.com/about/quinn.html

                    Also this one:

                    http://www.amazon.com/Questions-Answers-Attention-Hyperactivity-Disorder/dp/0763784524

                    You can do a lot more than COPE!

                    take care,
                    Gina

                  2. Susan Z’s avatar

                    Oof. This post hit me where I live. I was diagnosed very recently, at the age of 44. Academics were easy-peasy for me, up until I hit the wall in college. In high school, I got into frequent arguments with my mother over my grades. Mind you, they were mostly A’s with a smattering of B’s, but she expected straight As because of my high IQ. She *really* didn’t like it when my response was always “These are the grades I get just by showing up. Making straight A’s sounds like work.” I just kept coasting along, making decent grades. Until I moved out of the dorm and burned through entire semesters of missing classes because I couldn’t get my crap together to make it to the bus on time.

                    I sincerely hope that we can improve diagnosis and treatment for girls. I’d hate to see other young women flounder so hard, for so long.

                    Reply

                    1. Gina Pera’s avatar

                      Thanks for your comment, Susan. Diagnosis and awareness has indeed skyrocketed in recent years, and that’s what makes some people skeptical. Still, I don’t think we’re going entirely backward. Too many people have “seen the light.”

                      best,
                      g

                    2. Amanda’s avatar

                      Amen, sista! Holy cow, I’ve been trying to figure out what’s “wrong” with me for the longest time, and you just hit the nail on the head! All throughout school, I was extremely overachieving- straight A’s.. Obsessed with being perfect in that regard. However, I was always EXTREMELY socially awkward. I never quite understood what to say and when– I never fit in with my peers for this reason and I always felt like a reject.. I can’t describe exactly why.. But everything I said or did was just wrong, socially. (I’ve also been the type to daydream a ton, lose/misplace all my belongings constantly, and am chronically disorganized and late). Throughout my schooling, I suffered through constant anxiety. Fast forward to college- I was DETERMINED to make a better name for myself socially, where essentially I could start over, where no one knew me. I studied in depth, the social interactions between other students and started to mimic it. At first, all I was doing was pretending- adopting the social rules of others I had observed and applying them on my own. I had my fair share of social failures, but I went to a huge Big 10 school, so it was always easy to continue my social pursuit with new groups. Pretty soon, people started liking me and viewing me as “fun/social” person for the first time in my life. I joined a sorority and became even more immersed in social life. After college, I continued on to graduate school, after I felt fully confident with my social abilities. However, halfway through grad school (program was two years), I began to fall apart. I became extremely anxious, majorly depressed, developed bulimia and a dependence on alcohol. HOLD UP! Me?? What???? Really?? Dealing with all this mental bullshit? Anyways, with much suffering, I somehow managed to graduate. I got a job in my field, only to shortly after get fired because I had chronically procrastinated the necessary steps to obtain my state liscensure. No matter how important the stuff was I know I needed to do, I just COULDNT do it. It’s been that way for me for a long time- easily distracted by the tiniest noise or obstructive thought. I can literally stare at a wall thinking about nothing for 4 hours without getting started on a task. At the age of 24, I feel like my life is crumbling around me. I spent years studying and mastering the art of social skills, due to my failure as a child/adolescent. In doing so, I severely procrastinated any academic/career goals, due to which, I am in debt and without a job. THANK GOD I can remain on my parents health insurance for the time being.. I have started seeing a therapist a month ago, and had my pyschiatric consult last week. I was prescribed Prozac for depression/anxiety/bulimia. However, I truly believe the root cause for these problems is my underlying female inattentive ADD. I have taken Adderall on multiple occasions (from close friends) and each time I do, I feel like a normal person- like I finally understand what it feels like for the rest of the world. Unfortunately, I just have to wait and see what this prozac does to me (as of one week, I feel no difference). Thank you so much for this article and it’s such a relief to know I am not the only one who is like this. Good luck to you all!! You are amazing!

                      Reply

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