Speaker 1is this a scenario that might be playing out in your home your daughter has been described by every teacher she has ever had as a pleasure to have in the class polite engaged tries hard fine at school but at home a completely different child the meltdowns that come out of nowhere the homework battles that leave both of you exhausted the complete inability to just do the things she managed fine last year and you're starting to wonder quietly whether you're somehow the problem or maybe it's the mornings you have been standing on that landing narrating every single step for what feels like years coat on bag packed shoes we're leaving in three minutes because the moment you step away she just stops she's 12 she should be able to do this and yet you're still here every morning because without you the getting out of the house simply doesn't happen maybe you've been down the anxiety route therapy perhaps medication and yes it helped a bit but something underneath hasn't shifted the worry keeps coming back there's a restlessness nobody has quite been able to name maybe you've thought about adhd and then immediately dismissed it because every picture you have of adhd is a hyperactive little boy who can't sit still and disrupts the whole class that isn't your daughter so it can't be that if any of that sounds familiar this episode is for you what we're going to cover today is i'm going to give you three specific signs that adhd looks different in girls and why they get missed for years sometimes decades and what you'll come away with by the end of this episode is a clear framework for recognizing these three signs in your daughter and you'll know exactly what to do if you see them i'm dr mary hann psychologist and parenting expert this is the how not to screw up your kids podcast boy self a cuppa find a comfy seat and let's do this first of all as always because it's a bucket emptying episode we are going to start with the bucket now throughout the day things go in a tricky interaction with a friend a lesson that was hard to follow being called on when they didn't know the answer the noise in the lunch hall the sensory overwhelm of 30 other children in a confined space all of it in the bucket and by the time they come home the level of that bucket tells you exactly how much capacity they have left for the rest of the day which is pretty often zero now for most children the bucket when we think about neurotypical children the bucket fills and empties in a relatively predictable way hard thing in bit of downtime bucket comes down they're okay but for girls with adhd often undiagnosed often completely invisible to everyone around them the bucket fills differently it fills faster and it fills in a way that is completely hidden from view here is what is happening for your daughter every single day at school that no one sees she's working three times as the child sitting next to her not on maths not on reading but on being okay on appearing like everyone else on holding herself together through every interaction every transition every moment where her brain is pulling her in a different direction and she is choosing consciously effortfully every single time not to let that show she's monitoring what she says suppressing the things she really wants to blurt out sitting still when still is the one thing her nervous system is desperate not to do this is called masking and it is a full time job by the time she walked through your front door the bucket is not a quarter full it is not a half full it is at the brim if not already overflowing and the smallest thing not getting the snack she wanted a tone of voice a question she wasn't ready for tips the whole thing over this is not attitude this is not bad parenting this is a child who has spent the entire day running on empty holding it all together for everyone who isn't you now the three signs let me talk you through sign one she is fine at school but completely falls apart at home this is the sign that keeps the most girls undiagnosed for the long longest time and i want to be very direct with you about something when a teacher tells you she is absolutely fine at school that is not the reassurance it sounds like and this is not being detrimental to teachers this is just the reality so let me explain why girls with adhd particularly those the inattentive type which presents with minimal or no hyperactivity are extraordinarily good at masking they have often been reading social situations and people pleasing since they were very small they learn early what the expected behavior looks like they comply they sit nicely they smile at the teacher they do the work they hold it all together and they do it by spending every last drop of energy they have on appearing normal the school environment structured at it as it is actually helps them there is a timetable there are clear expectations there is constant external scaffolding for a child who struggles with self-regulation and executive function that scaffolding is doing the work her brain can't yet do independently and then she comes home when the scaffolding drops away in a different way it's not that we don't scaffold at home but the rigidity of the scaffolding in a school environment is a whole different ball game to at home it's just her and you where she feels safe enough and that word matters safety and safe enough she's then able to to finally stop performing the place where adhd erupts is not the place where it's hardest to manage counterintuitive of course it is actually the place where she feels safest to let go so when the teacher says she's fine at school ask yourself what does the hour after school look like and if the answer is that it is reliably predictably consistently the most difficult hour of the day that's not a coincidence that is a full bucket so that's sign number one sign number two she cannot sequence through tasks her peers manage independently now i'm mindful of this because you know how i feel about age and stage so you need to look at this in a pragmatic way but this one is about executive function and we know that those with neurodiversity and with adhd their executive functioning can be about three years up to three years behind others and i want to distinguish when we're thinking about this clearly between won't and can't because these can look identical from the outside and the distinction obviously matters enormously the prefrontal cortex which governs planning sequencing initiating and completing task is estimated to develop approximately 30 percent more slowly in children with adhd than in their neurotypical peers which means a child who is 12 or 13 in chronological age may have executive function closer to a 9 or 10 year old and the task we expect them to manage independently at 12 are calibrated to a 12 year old brain so getting started in the morning in a sequencing task packing a school bag is a sequencing task starting homework without being prompted is an initiation task writing an essay involves planning structuring organizing and following across sustained time all executive function task so she's not being lazy she's not refusing she's not doing it to push your buttons her brain genuinely does not yet have the circuitry to do this without external support this is why the problem is you step away from the morning routine she stops not because she has decided not to bother but because the internal scaffold that you provide when you stand there saying now shoes now coat does not yet exist independently in her head the sign to watch for she is significantly behind her peers and what she can manage independently the gap has been there for a while and it is not narrowing at the rate you would expect if you are still narrating every step of the morning routine for a 12 year old and it has always been this way it's worth paying attention to now if you listen to the longer episode that I did with Olivia Kessel talking specifically about ADHD and girls and how we can empower them she talked through some specific strategies that she has put in place that she put in place with her daughter Alexandra that worked brilliantly post-it notes and how that helped scaffold the prompts that Olivia did for her until they reached a point where Alexandra was able to take over that and that kind of executive functioning scaffold was put in place. So that was sign number two. Sign number three is her emotional reactions are completely disproportionate to the trigger. Now this is the sign that gets misread most often as a behavior problem. So the explosion over a minor frustration, the complete meltdown because something went in the wrong order, the rage that comes out of nowhere and doesn't make sense given what actually happened. Now emotional dysregulation has not always been part of the the official diagnostic criteria for ADHD and it was removed in the 1980s because it was considered but basically too difficult to measure objectively and of course when we're looking at these sorts of things and very much that medical model it's all predicated on this need to be able to look at something objectively. But clinically it is one of the most consistent features of ADHD in girls and the research is increasingly putting it back where it belongs. The ADHD brain has a different relationship with emotional intensity. Feelings do not arrive as a gentle wave they arrive as a surge and the circuit that in a neurotypical brain puts a small break between the feeling and the response. In an ADHD brain that circuit is slower so the feeling hits before the break has time to engage. She's not and here is what matters. Add on to that the fact that she has already been running at full capacity all day managing herself, managing others and holding everything together. The emotional regulation at the end of the day is not just difficult it is neurologically almost impossible. So if you are consistently seeing emotional reactions that are completely out of proportion and especially if that is a sign that you have to be taken seriously. I don't know why I did that. I just couldn't stop or I'm such a bad person. That is a sign worth taking seriously. Now why do girls get missed? Now ADHD was described, researched and diagnosed almost entirely in boys for most of the 20th century. The diagnostic criteria were built around the hyperactive, impulsive, disruptive presentation. The child who couldn't sit still, the child who couldn't walk, the child who couldn't sit still, who interrupted class, whose teachers noticed that his behaviour was impossible to ignore. Girls with ADHD are on average diagnosed three to four years later than boys and many are never diagnosed at all. Instead they get referred for anxiety, for depression, for eating disorders, for low self-esteem. They're treated for years for the conditions that grow on top of an unmanaged ADHD and no one looks for what's underneath. The hyperactive, hyperactive boy is a red herring and as long as parents, teachers and doctors are looking for him, these girls will keep getting missed. So I want you to hold that for a moment because if you have been wondering for years why nothing quite fits, I'm not saying it's definite, but this might be why. So what to do if you recognise the signs? First, I would say is trust what you are seeing. The school report is one data point. What you observe at home, is also a data point. Both are valid. If something has felt consistently and persistently off, even if you can't quite name it, you are entitled to pursue it. Second, a formal diagnosis is not the only route. In the UK, NHS waiting lists for ADHD assessments can run two years. A private assessment is an option if it is accessible to you, but they're also, supremely expensive. But a label is not what determines whether your daughter needs support. The need for support is visible in front of you right now with or without a diagnosis. And thirdly, and this is the most important thing, is start looking at these signs through the lens of skill. You know, I love a bit of a skills gap of skill and not behaviour. She isn't holding it together at school and choosing not to at home. She can't sequence through the morning because her executive function is not good. She just isn't there yet. She's not being dramatic. She's dysregulated. Naming that internally and then with her changes everything. Because when a child understands that her brain works differently, not wrongly, but differently, she can stop spending all her energy being ashamed of it and start spending it on building the skills she actually needs. So two things to watch out for. The first, expecting school to validate what you're seeing at home. Teachers are looking at a child who is performing adequately and presenting no disruption. From their vantage point, there is no problem. What you experience at home is invisible to them and it will often remain invisible until you name it explicitly and ask them to look out for it. If you need to push back, gently but firmly do that. The second thing is rushing to fix her from her feelings when she's in the middle of a meltdown or an emotional surge. The instinct to say it's okay, calm down, it doesn't matter. I understand that instinct completely. We want to nurture our children. We hate to see them in pain. It comes from love. But trading her out of the feeling, distracting her, minimizing it, solving the external problem so the feeling goes away does not build the one skill she needs. The knowledge that the feeling is survivable. It will pass. She can come through it. She needs to experience that, not just be told it. So stay with her in the feeling. Keep yourself regulated. Let her see that you are not frightened of it. And slowly, she will start to believe that she doesn't have to be either. Now, let's just pull this all together. So there are three signs. Fine at school, falls apart at home, cannot sequence through, tasks her peers manage independently, and in emotional reactions are completely out of proportion to the trigger. Now, any of these taken alone might have a different explanation. All three together, consistently over time, that is something worth pursuing. You haven't caused this. You haven't missed something obvious you should have caught sooner. These signs are designed almost by accident to look like something else, like bad behavior or difficult temperament or bad parenting. What I want you to walk away with today is this. You know your daughter. If something has been feeling consistently off for a long time and the explanations you've been given haven't quite fitted, trust that. And now you have the language to take the next step. My give this week is your three signs your daughter struggles might be ADHD awareness guide. A one-page reference you can use yourself, share with your partner, take into the GP appointment or a school meeting to help start a conversation. Grab that, head over to my free resource library at drmaryhand.com forward slash library. Pop in your email address and you'll get instant access, not only to this week's resource, but all the other free resources across all my podcast episodes. And if you found today's episode useful, please do share it with a friend, a sister, a school parent who you think might need to hear this. These are the conversations that get girls the support they need sooner, and that matters enormously. So until next time.
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