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Attention! Thousands of ADD girls going unnoticed and undiagnosed

For most people, ADHD conjures up a mental picture of a hyperactive male child bouncing round the room and climbing on everything in sight. A quiet, shy, slow-moving, daydreaming girl would in all probability be furthest from people’s minds when thinking about ADHD and yet every day these girls are failing or suffering from low self-esteem because their ADHD has not been detected and they remain undiagnosed and labelled as ‘lazy’, ‘slow’ and ‘dreamy’.

These girls have a non-hyperactive type of ADHD known as ‘ADHD inattentive type’. Referred to by some, although incorrectly, as ADD, girls with this lesser-known form of the disorder are more likely to develop depression as they fail to meet the increasing demands of academic and social life.

It is important to educate people on this aspect of ADHD to help such girls live a happier, more productive life.

If you, or someone you know fits six or more of the following criteria, it may be a case of inattentive type ADHD:
1. Often fails to give close attention to details or makes careless mistakes in schoolwork, work or other activities.
2. Often has difficulty sustaining attention in tasks or play activities.
3. Often does not seem to listen when spoken to directly.
4. Often does not follow through on instructions and fails to finish schoolwork, chores or duties in the workplace (not due to oppositional behaviour or failure to understand activities).
5. Often has difficulty organising tasks and activities.
6. Often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework).
7. Often loses things necessary for tasks or activities (e.g. toys, school assignments, pencils, books or tools).
8. Is often distracted by extraneous stimuli.
9. Is often forgetful in daily activities.

Do these sound familiar? If the answer is ‘yes’, please read on…

General areas of difficulty

The general areas of difficulty in the inattentive ADHD girl are listed below with descriptions. First however, it is important to note the following:
· although this information talks about girls, the same can be said for boys with inattentive type ADHD. Boys can have this form of the disorder, but it is much rarer, just as there can be found the rare girl with hyperactivity.
· technically, ADHD is called ADHD regardless of type, however it is commonly known as ADD and will be referred to as such as ADD from hereon, with the combined/hyperactive-impulsive type ADHD referred to as ADHD. This is to avoid confusion and for ease of reading.

‘Hyperfocus’/overfocus/underfocus

Underfocus is one of the key problems in ADD. The ADD girl may be able to focus on her chosen tasks and interests but finds it very difficult to maintain her focus on her work and necessary chores, partly because of internal distractions (thoughts, drifting off – unwilled ‘tuning out’/daydreaming), partly because of external distractions (noises, things outside the window/in the room etc.) and partly because of difficulties with prioritisation and organisation.

If it is interesting or fun or will be of benefit in the short term focusing is possible, otherwise underfocus becomes an issue.

This can often go unnoticed as, for example, her teacher may see a good piece of home-/coursework which may even be handed in on time, but the ADD girl may have had to work harder and for longer than her peers.

ADD girls may start on a task and move onto several other things before one is finished even when she doesn’t want to – she may even ‘auto-pilot’ onto other things.

As well as underfocusing, ADD girls can often overfocus on things which can cause just as many problems, as overfocus can lead to underfocus because, as previously mentioned, the ADD girl finds it hard to prioritise and organise her time effectively.

Overfocus is when too much time and energy is given to enjoyable/interesting projects and activities, with work being pushed aside in favour of these, not because she does not care about her necessary work but because she fails to manage her time correctly and effectively.

Overfocus can also be on constant ‘ruminations’ of thoughts and worries. Overfocus on current hobbies and projects may not always last long, but when it evaporates, it is often replaced by something else, leading to the ADD girl becoming interested in many things but becoming good at or knowledgeable in only a few. She may join a club she has been longing to join but after a couple of months or even weeks, her interest and enthusiasm has disappeared and she drops out.

When they are thoughts, and not worries, that are being overfocused on, they are often streams of ideas but the person cannot get started on doing them (see getting started and keeping going).

Often, the girl with ADD cannot let go of an idea, acting ‘like a dog with a bone’.

Hours of sleep may be lost from both thought and worries.

ADD girls can also sometimes ‘hyperfocus’. ‘Hyperfocusing’ is a common term for a state of intense focus on something, even if it is boring, where she doesn’t notice anything else going on around her because she is so absorbed in something. This usually isn’t a choice thing and can be rare. ‘Hyperfocusing’ can be rather energy-draining for some.

Getting started and keeping going

The ADD girl’s mind may be full of creative thoughts and ideas for projects, but due to trouble getting started and chronic procrastination, these may never be put into practice.

This can feel like being stuck in first gear and really trying to change gears but not being able to and all the cars are queuing up behind and beeping their horns. The more cars there are, the more horns that are beeping and the louder it is, but the person can’t shift the gears and go somewhere – go where they need to get to. This often leads to panic and great stress in the cases of deadlines. Sometimes it doesn’t because they may just give up trying to shift the gears and feel calm, possibly because they are so accustomed to it happening. Often, the enthusiasm and energy comes in bursts and then just disappears without a trace.

Inattentive/distractible

External distractions
If there is some sight or sound, the ADD girl can be easily distracted by it, including when she is talking – if there are other sounds around, she can find it difficult to talk at the same time. Minor irritations can be immensely distracting.

She may not even think about what she has been seeing/looking at, but it can still cause what she’s concentrating on/listening to etc. to ‘fade out’.

A restless, circling brain/a busy mind
Poems, storyline ideas, what happened the day before, ‘I wonder…’, ‘what if…?’ thinking about just about everything and anything – round and round and branching off into loads more thoughts – even thinking about one’s own thoughts. If there’s nothing going on outside, it’ll be going on inside.

All the thoughts just diverge off. For example, just seeing one thing can easily cause a whole cascade of thoughts which would probably be seemingly unconnected and completely random if spoken out loud to someone else. The ADD girl may have trouble keeping her speech on track – her thoughts change so quickly to such different things, that she may start talking about something completely unconnected, possibly even mid-sentence. Digressions and self-interruptions are common.

Some ADD girls are often very talkative, talking about everything and anything that comes into their head, sometimes also too loudly and/or too quickly.

Drifting and ‘spacing’
Drifting: often, trying to listen to someone can be like constantly trying to stop someone from turning the volume down, except it’s not the actual volume that keeps fading, but rather the meanings, or sort of, of the words as other thoughts come and go in the ADD girl’s head and things go on around her.

A common occurrence however, which makes it hard for others to pick up on, is for the girl to get distracted with thoughts/sounds more than getting distracted by seeing things. When this happens, she will usually still be looking at who/what she’s listening to/concentrating on, so it’s less evident that she’s not hearing/listening to who/what she should be. The trouble is, the harder she tries to concentrate on what is being said, the more she is concentrating on concentrating and the less she can concentrate. Often, she may really think she’s listening but afterwards, often when she’s walked away, she realises that she hasn’t actually heard what’s been said, and often she has gone ‘uh-huh’ and ‘yeah’ etc. all the way through, even in the required places, but realised she has not heard at all, but the person who spoke to her thinks she has listened and understood because she has responded in the correct places with ‘yeah’ and ‘uh-huh’ etc.

Sometimes it’s a matter of the concentration on the words going and therefore the words ‘fade’ into the background and other times she may have to consciously force herself to think and ‘decode’ the words and make them make sense. A bit like the person who’s talking is speaking another language and her interpreter is being too slow in the translations!

The ADD girl will keep drifting off in lessons even though she tries not to. Sometimes, she doesn’t even get distracted by thoughts or thinking about things she can see, but just ends up looking at something and forgetting to listen. She will in most cases not realise until she ‘comes back’.

‘Spacing’: slow moving and highly distracting from what she’s supposed to be doing/listening to. Sometimes referred to as ‘in a fog’, it often feels similar to being in a dream (but not the same).

· You see and hear what’s going around you but it feels like just as it’s described – in a fog; everything is sort of unclear and it’s like you’re just sort of floating amongst it all, but in a mental sense, not in a physical sense.
· It’s like your brain won’t quite work fast enough or is on a sort of ‘auto-pilot’ with minimum input ability from you. You seem to reply/respond/act automatically while your brain is off somewhere else, trying to take in and think about too much and not succeeding.
· It’s a bit like you’re ‘muddling through’ everything.
· Sometimes it’s a bit like when the computer is playing a DVD and the picture goes jerky but the sound carries on and the picture has to catch up – they don’t go together properly for a bit – it’s like your brain goes jerky, but everything else carries on and you’ve got to catch up.
· It feels like other things too, but these are extremely difficult to put into words.

If the girl has a comorbid tic disorder, sometimes drifting off and ‘spacing’ (being ‘in a fog’) is caused by mental tics or tics which require concentration to perform. The same can happen with obsessions and compulsions.

One girl with ADD said:
‘A lot of the time I feel sort of (I say ‘sort of’ because it’s not quite right, but it’s the only way I can explain it) as if I’m inside my head – like I’ve sort of ‘gone backwards’ into my head and the world’s there, but it’s like I’m not quite all there – I’m not making contact with what’s going on and what I should be doing and how I should be reacting and what I am, or rather should be, or maybe shouldn’t be doing. Or like all the reactions/perceptions etc. are sort of ‘blunted’. It’s almost as if I’m wasting time because, well, the best way I can think of describing it is ‘as if I’m not in the moment’ which sounds a bit strange really, because I don’t feel like I’m anywhere else in time or physically, but as if I’m not quite ‘in the moment’/‘in the situation’ mentally. Actually, what now comes to mind is an expression I remember from somewhere: ‘the lights are on, but no one’s home’. Maybe this explains it a bit better.’

Retaining and remembering

A poor short term memory is common in ADD but is often accompanied by a very good long term memory.

Not everyone with ADD has a poor short term memory and some have an excellent memory for some things but not for others, as one girl with ADD explains: ‘I think one of the reasons for forgetting to do something is that I have to ‘remember to remember to do it’ – i.e. the thought doesn’t enter my head when it should do. The memory was there, but because I don’t remember that there is anything to remember, I don’t remember to do and therefore do whatever it is I’m supposed to have remembered to do! (Which would explain when I can do well at a memory test but not other things in day-to-day life – because, when sitting in front of a memory test, you know what you’ve got to do and that you’ve got to remember something(s) – you don’t have to remember to remember something.)’

Those with ADD may also remember something they like, but forget something they don’t want to do. This is not a ‘selective memory’, or rather not a ‘voluntarily selective memory’, although can be in some cases, but is simply how the ADD brain works. Threatening to withdraw privileges if the ADD girl fails to do/complete something may make them remember it better, but this does not mean that they could have easily remembered it before.

Another reason for forgetting to do things one is told to do is probably because the girl doesn’t listen properly to what she has just been told to do. or becoming distracted, either internally or externally on their way to do the job. Other times, the instruction just does not go in.

She may remember useless details from things she is interested in and things that happened a while ago, but not what she has just been told.

Another example of things that seem to just not go in, is looking at one’s watch/checking the time – the ADD girl may look at it and read the time in her mind, but as soon as it’s gone from in front of her face, she has absolutely no idea at all what the time is. She may check her watch about five times in a row and still not know what the time is, even if she reads it out loud.

One annoyed girl with ADD:
‘There is so much people are expected to remember and to remember to do! I never understand it – are people constantly thinking about what they should be remembering to do?!

‘All I want to say is that if I could remember, I would, but the fact remains that I can’t help being this way.’

‘What did I come in here for?’ situations are common with ADD and also getting stuck/’blocked’. The ADD girl can be doing something and just ‘freeze’, not knowing what to do. This getting stuck/’blocked’ isn’t always just to do with memory (see organisation).

The ‘what did I come in here for?’ occurrences don’t just happen in a physical ‘what did I come in here for?’ sense; for example, on the computer, the ADD girl may open the start menu and then, in those few seconds, forget what she was about to do and what programs she was going to open.

A lot of the time, she may get a thought for a couple of seconds, and before she’s ‘caught hold’ of it fully, it’s slipped away again (like trying to catch a fish!) and she’ll spend the next few seconds to minutes trying to remember what it was.

Sometimes when she forgets what she’s doing, she may go into a sort of automatic mode where she does some useless actions which make it look and feel like she’s carrying on, but she’s not doing what she should be doing, a bit like saying ‘er’ when you get stuck for words. An example of this would be to knock up and down the wall until she switches back on and remembers what she should be doing/was going to do – the knocking is automatic and she probably won’t realise she’s doing it until she gets ‘unstuck’ and remembers what she was going to do.

Another example would be to open the file menu on the computer and, because she’s forgotten what she was going to do, carry on with a similar sequence by clicking in exit, where she was supposed to click on open.

Writing down things she has to remember to do later is often, although a logical, potentially simple solution, of little help, because then she has to:
· Remember that she has written it down
· Remember to check the list
· Remember where she has put the list
And if she puts all her reminders in the same place, you can almost guarantee that she won’t be anywhere near that place when she writes it or she’ll forget to put it there, or to look there at the right time!

One annoyed girl with ADD:
‘I’ve tried the lists, I’ve tried the post-it notes and I’ve tried the electronic personal organiser (including the watch with schedule). I’m still working at the diary, but even if, by some miracle, I remember to write in it, I won’t remember to look in it again.’

Poor time management

It is common for people with ADD to have a poor sense of time and may have a hard time with deadlines. This is due to difficulties with prioritisation and organisation and also due to over/underfocus problems.

The ADD girl may not be able to ‘feel’ where the deadlines are – when you are given deadlines, you are supposed to, be able to sense the distance/the amount of time both between each deadline and between where you are, time wise, and where each deadline is. People with ADD don’t seem to be able to do this, at least not as effectively.

Because of this and problems with getting started, procrastination is common; not only with work but also with putting ideas into practice.

Disorganisation

This is probably a combination of distractibility, forgetfulness and poor time management. There is also a common problem with sorting things in ADD. Not only that, but when the ADD girl tries to sort out the stuff accumulating in piles on her bedroom floor, desk and shelves etc., she may experience ‘mind blocks’ and I end up staring at individual pieces of paper, not being able to think what to do with them. This getting blocked thing can sometimes be seen from the outside when it happens.

She may not know why she gets stuck – it may be due to mental tics or tics she has to concentrate on if there’s a comorbid tic disorder involved, but it usually feels like there’s a thought there, but it can’t ‘get through’ so that she can carry it out or think about it. This could be to do with having too many thoughts, trying to process too much at once or having half drifted off and not coming back fast enough, or simply ‘blanking out’.

A lot of ADD girls find that when they do manage to put things into logical places/folders etc., they can usually find them even less easily than when they weren’t ‘organised’.

Basically, these blank stares feel like your brain gets ‘blocked’, like if you’re trying to sort out some papers, for example, and you sit there and look at them and you just feel, well, ‘blocked’ like there are thoughts which need to come through but just can’t/won’t and you don’t know where to put the piece of paper because you just cannot think what to do with it even though, say, you just need to put it in a folder, any folder.

Or if you see a car and something’s not getting through and you’re staring at it and the thoughts just won’t come through and when they finally do, all it was was ‘oh, I like that car’ or something stupid like that.

Or if someone tells you to do something and you’re trying to process exactly what you have just been told to do and you just cannot get the thoughts past that ‘block’.

If the ADD girl is organising activities, generally, they:
· Get bogged down in unnecessary details and miss the important points.
· Get all mixed up and out of sequence (e.g. a friend phones an ADD girl to ask for a lift somewhere and the ADD girl starts talking through how it was going to work so that they would both have it worked out and she says something like ‘right, so you come here, and we’ll take you…’ and the friend interrupt her and said ‘huh? How can I get there? If I could get there, I wouldn’t need a lift!’.)

Circular speech

The divergent, non-linear thought pattern of the ADD girl often means that she cannot keep her speech on track. When this occurs, she will keep adding, correcting and sidetracking, going back and adding bits as she goes along, stopping mid sentence to start on another topic before she’s finished the first, possibly going back to the original topic(s) afterwards.

She may also sometimes, find it hard what sentence to say, getting stuck because she’s trying to get two sentences out at once. Other times, she may say the end of what she wants to say before she’s finished saying the bit which was supposed to come before – sometimes with the punch line of a joke, so the joke is a bit messed up and spoiled.

ADD girls may have a tendency to talk too much, too loudly and/or too fast.

Social clumsiness

Although the ADD girl can read body language and facial expressions (unless Autism or Aspergers is involved), they can easily miss social cues, fail to pick up on sarcasm (or interpret non-sarcastic remarks as sarcasm), make little eye contact, use the wrong tones of voice, bore people with incessant talk, fail to notice when they are boring people, speak too loudly, speak too quickly, overreact, show off, react wrongly or laugh at the wrong things. They may also butt into other people’s conversations and interrupt people when they are talking. Most are also sensitive to criticism.

Some people with ADD can be very intuitive and empathetic at some times but will miss hidden meaning at others. For example, if someone says ‘do you want me to do some now?’, they mean ‘can I do some now?’ or ‘I want to do some now’ but the hint is missed.

Some with ADD don’t like social gatherings much and feel as if people are scrutinising their every action and judging them. Some, although they may talk too much at some time, can’t keep a conversation going at others, or can’t tailor their conversation to meet the needs and interests of others. Keeping the conversation going at occasions like parties can be difficult as the visual and auditory distractions can be overwhelming.

Many prefer to work on their own rather that in groups. This way, they can use their ideas at their own pace without having to tell the group about them first and waiting for their approval and keeping the social skills going at the same time.

Group work can be good, though – it can help with social skill learning and can help them keep on track and keep going but often they will either stay ‘at the bottom’ and say and do very little, or go right ‘to the top’ and be overpoweringly bossy. Being in charge, however, is when the group falls apart a bit – lack of organisation and planning makes one a bad group leader and organiser.

Also, in a group, they may persist with one or two ideas and keep contributing them and try to fit them in even when the group has rejected them or doesn’t want to know, or if the ideas don’t fit at all.

Despite this social clumsiness and lack of adequate social skills, many girls with ADD do have some friends, although some find getting on with people very difficult and constantly try not to let their guard down – as soon as they let their guard down they’ll say something stupid or hurtful without thinking.

Some of the time, they just like to be left alone to think or do what they want to, or just sit and watch what’s going on. This doesn’t mean they don’t want friends – it just means they don’t want to be with and talk with them all the time.

Impulsivity

Even if a girl has inattentive type ADHD, they may still display some impulsivity or even be a bit restless without being hyperactive. For example, they may interrupt people a lot. They don’t mean to be rude, but if they think of something to tell the other person, they’ll just start saying it, even if the other person is still talking. They’re impatient and they can’t keep it in, they’ve got to say it. If they don’t, they’ll also forget what they were going to say really soon. It’s also because it just ‘comes out’ sometimes – a thought comes into their head and they just say it/contribute it to the conversation, completely forgetting that they have to wait their turn.

Other

Another fairly common problem in people with ADD is their tendency to fail to put two and two together and make appropriate connections between things and also to put ‘two and two together to make five’, i.e. to make connections which aren’t there at all, leading to them being a bit paranoid about some things.



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