So far, I have written about Smiler, our son's, ADHD journey, but I would like to talk about our daughter and where things are with her.
Our daughter is 11 years old, and up until a year ago, we didn't consider in a million years that she may also have ADHD. But within the last year, certain things have come to light, and she too is now on the pathway for an ADHD assessment.
ADHD can be notoriously difficult to spot in girls, so I thought it might be helpful to talk about some of our experiences, in case it helps anyone else.
ADHD in Girls Can Look Very Different
Our daughter was always a very content baby. I think being the second child, and always being dragged around behind her big brother, expected to roll with it and fit in, meant that she was always really easy going.
She was very shy though, and I remember when she would be in her buggy as a toddler and people would say hello to her on the school run, she would always twist her head to the side and bury it in the side of the buggy. Thinking back, I realise I felt really awkward about this, and would always make a big deal of telling people how shy she was, in case they thought she was in some way rude!!!
She always had some sensory sensitivities. As a baby and toddler, she was always very upset by loud noises, especially things like hand driers. She also sucked her fingers from birth, and when she was a baby until she was four years old, she had this little piece of fabric that she would rub between her thumb and ring finger whilst sucking her other two fingers, and this brought her immense comfort and joy.
She was a happy, easy-going little girl, and compared to her brother, whose ADHD behaviours were becoming increasingly tricky to manage (not that we knew it was ADHD at the time), there wasn't anything that made us think there might be something going on.
Now that she is 11, we see the sensory sensitivities more clearly - she finds loud noises very challenging now, and sometimes has to momentarily leave the classroom or activity groups due to the noise levels. She can't hide her discomfort, and can often be seen with her hands over her ears, or fingers in her ears, and usually has Loop earbuds with her.
Her sensitivity to fabric has increased too. There are certain textures she will just not wear (wool is the worst!) and she has a very small selection of favourite clothes that she wears basically every day. She is mostly found in baggy shorts and t-shirts, and finding something she would accept as school uniform has been difficult. She will cry if any of her favoured clothes are unavailable, and so we need to be quite on top of the laundry.
Despite being a good-ish eater as a younger child, she now has certain foods that she cannot abide the texture - the worst foods for her are poultry and fish. She finds strong-smelling foods a challenge too.
None of these things individually would have made us think "ADHD", but when you start putting all the pieces together, you begin to wonder whether there is a bigger picture.
Anxiety and Emotional Dysregulation
One of the other key things that eventually pointed us towards something being different, and encouraged us to reach out to school, was that our daughter was displaying signs of anxiety.
This mainly manifested itself in her breathing - she would breathe really quite quickly and would let out these enormous sighs, most notably when she was lying watching TV or not doing anything particularly taxing.
She herself struggled to articulate how she was feeling, but just knew that something wasn't right.
This was one of those things that really made us question what was going on - there didn't seem to be an obvious reason for her to be anxious, and yet her body seemed to be indicating that something was going on.
The anxiety also manifests itself in her stomach, and she quite often has “tummy troubles” as we call them. She gets very conscious of her tummy when she is feeling uneasy or nervous, and complaints abut her tummy can be a nightly occurrence. We have had all the blood tests available to us, and have tried various exclusion diets, in case the tummy problems were indicative of an allergy or intolerance, but so far, nothing has been identified.
She also limits eye contact when she is feeling anxious, and I find myself wondering whether this relates back to the little girl who used to hide her face in the side of her buggy whenever somebody spoke to her.
I would say the biggest challenge now, though, is her emotional regulation, and the feelings of overwhelm that she gets when she has had a challenging day.
The “Coke-bottle effect” that I have written about previously is a great analogy of how she feels after school. With Smiler it was more obvious, but with my daughter it can be quite subtle, like just not wanting to talk after school, and getting teary over seemingly minor things. Sometimes she will walk through the door after school and I can tell almost immediately that she has had enough.
It has made me think about how easy it can be to miss ADHD in girls.
A child who is quiet, well behaved and able to hold things together at school might not immediately raise the same concerns as a child who is constantly getting into trouble or disrupting the class.
But that doesn't necessarily mean that they aren't struggling - sometimes, they may just be holding it all in until they get somewhere safe.
Inattentive or Hyperactive?
She has always been less hyperactive than Smiler - she quite often glazes over, so I would always have put her down as more inattentive than anything else.
However, I would say that she is often found cartwheeling around the house, and she seems to get more energy the closer we get to bedtime, rather than less! Quite often she starts doing roly-polies and headstands on the bed when I am literally there to tuck her in!
It is interesting to compare the two children. With Smiler, his hyperactivity was much more obvious when he was younger - you really couldn't miss it. He could be noisy, energetic, sometimes disruptive and demanding of our attention. With our daughter, the signs have been much more subtle, but no less difficult for her.
ADHD and Sleep
When she gets to sleep, she is a good sleeper and generally sleeps through the night. However, to get to that stage, she can often be lying awake for hours.
We have tried everything - baths, winding down time, audiobooks, paper books, lavender on the pillow, meditation. You name it, we've probably tried it!
If she has something reverberating around in her head at sleep-time, she will ruminate on it for hours.
It might be something that happened at school that day, something she is worried about, something she is excited about, a song, or just a random thought that has popped into her head. Once it is there, it can be incredibly difficult for her to switch off.
Again, this isn't something that screams ADHD on its own - lots of children struggle with sleep. But along with everything else, it is another piece of the puzzle.
When School Started to Notice
We realised that her school teacher had started implementing some ADHD strategies in the classroom for her - breaking work down into smaller chunks, giving her movement breaks, and letting her use the noise-cancelling headphones.
At that point, we thought we would ask if they suspected she had ADHD. I think at first they may have dismissed the idea, however when we explained that our older child had a diagnosis, they started to take it seriously and we were referred within a few weeks.
They were aware that the heritability of ADHD meant that our daughter already had a greater likelihood of having ADHD because she has a close relative with the condition (I have written about when you notice that ADHD might run in the family here).
They also had a good understanding that ADHD can be much harder to spot in girls.
Did We Miss the Signs?
Something that has really struck me during this process is that I wonder whether we had actually adapted our parenting for our daughter without even realising it.
Because we already have a child with ADHD, we have changed the way we parent. We have learned to break things down, to give warnings before transitions, to allow for movement, to understand when a child has reached the end of their emotional capacity, and to pick our battles.
I wonder if, subconsciously, we have already built quite a few of those adjustments into our family life.
Our idea of what is "typical" behaviour has also been quite skewed by having Smiler. When you've spent years dealing with a child whose ADHD can be very obvious, some behaviours that might make another parent stop and think can seem completely normal to you! Our daughter might be bouncing around the house at bedtime, struggling to get dressed because she doesn't like the feel of something, becoming overwhelmed by noise, or getting upset about something that seems relatively small, and maybe our response has been to think "well, that's just her"!
I do wonder whether having a child with more obvious ADHD meant that we were actually slower to spot it in her - we would never have found Smiler's noisy ADHD in our shy, quiet daughter.
Why Is ADHD Harder to Spot in Girls?
I think part of the reason is that society’s expectations of what ADHD looks like is still very much shaped by the stereotypical picture of a hyperactive little boy.
When I think back to Smiler's childhood, there were things that were impossible to ignore.
But with our daughter, the signs have been so much quieter.
She is shy, she is sensitive, she can hold things together at school and then come home feeling completely overwhelmed.
Of course, none of those things automatically mean ADHD. But I can now see how easy it would be to put some of her difficulties down to personality, sensitivity, hormones, tiredness or just being an 11-year-old girl.
And I feel that is why girls can be missed.
Reflection
We are still very much at the beginning of this journey with our daughter. She hasn't received an ADHD diagnosis yet, and we definitely don't want to jump to conclusions.
But going through this process has already made me think differently about what ADHD can look like.
With Smiler, I learned to recognise the obvious signs. With my daughter, I am learning that ADHD can look like sensory sensitivities, anxiety, overwhelm, difficulty switching off at night, emotional dysregulation, inattentiveness, or just a child who seems to be coping until she gets home.