The Quiet Struggle: Understanding ADHD in Girls in Singapore

Ten-year-old Mei loved art class. She’d get lost in her drawings for hours, meticulously shading each detail. But when it came to math, a different Mei emerged. She fidgeted, doodled in her notebook, and struggled to follow instructions. Her parents, initially puzzled, began to notice a pattern: Mei could focus intently on things that captivated her, but struggled with tasks she found less engaging. Could this just be a quirk, or was something else going on?

Mei’s story, reflects a reality many parents in Singapore face: the often-hidden struggle of girls with ADHD. Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. While often associated with boisterous boys, ADHD affects girls as well, though it often presents differently, leading to underdiagnosis and missed opportunities for support.

The Hidden Epidemic: ADHD in Singapore

While the prevalence of ADHD in Singapore is estimated to be less than 5%, it is the fourth-highest contributor to disease burden in children aged 14 and below. This indicates that while the diagnosed cases may seem low, the impact of ADHD on the lives of children and their families in Singapore is significant.

One concerning trend is the disparity in diagnosis rates between boys and girls. Studies suggest that ADHD is diagnosed 2 to 9 times more frequently in boys than girls. This suggests that girls with ADHD are “flying under the radar” and their struggles may be going unnoticed. In adulthood, the numbers even out, suggesting that many girls are not diagnosed until later in life.

Why are Girls with ADHD Often Missed?

Different Symptoms: Girls with ADHD often exhibit less disruptive hyperactivity and impulsivity than boys. Instead of outward restlessness, they may internalize their hyperactivity, leading to symptoms like inattentiveness, daydreaming, and difficulty organizing tasks. These symptoms can be less noticeable in the classroom, making it easier for girls to slip through the cracks. Dr. Donna Palumbo, Medical Director at Pfizer, highlights this key difference: “Recognizing that the symptoms of ADHD are different in girls compared with boys… is the first step toward getting help.”

Masking: Girls with ADHD may become adept at “masking” their symptoms, putting in extra effort to appear organized and focused. They may work harder to maintain good grades, even if it takes them longer and causes significant stress. This can lead to delayed diagnosis, as parents and teachers may not realize the extent of the struggle behind the facade.

Societal Expectations: Societal expectations of girls to be quiet, compliant, and well-behaved can further obscure ADHD symptoms. Behaviors like talking incessantly or being bossy, which could be signs of ADHD, might be dismissed as typical “girl” behavior.

Signs of ADHD in girls

While every child is unique, some common signs of ADHD in girls include:

Inattention:

Difficulty focusing and staying on task, especially with tasks they find uninteresting.

Easily distracted by irrelevant sights and sounds.

Forgetfulness and losing things frequently.

Difficulty following instructions carefully and completely.

Appearing to daydream or “zone out” frequently.

Hyperactivity and Impulsivity (Often Internalized):

Excessive talking, fidgeting, or doodling.

Difficulty waiting their turn or interrupting others.

Internal restlessness and a feeling of being “on edge.”

Emotional sensitivity and reactivity.

Other Signs:

Low self-esteem and difficulty with peer relationships.

School anxiety or complaints of headaches and stomachaches.

Family history of ADHD.

It’s important to note that not all girls with ADHD will exhibit all of these symptoms, and the severity can vary significantly. However, if you notice several of these signs in your daughter, it’s crucial to seek professional evaluation.

The Impact of Untreated ADHD: A Lifelong Concern

Untreated ADHD in girls can have far-reaching consequences, impacting their academic performance, social relationships, emotional well-being, and overall quality of life.

Academic Struggles: Girls with ADHD may struggle to keep up with schoolwork, despite their best efforts. They may experience difficulty with organization, time management, and staying focused in class, leading to lower grades and frustration.

Social Challenges: Girls with ADHD may have difficulty forming and maintaining friendships. Their impulsivity and emotional sensitivity can lead to misunderstandings and conflicts with peers.

Emotional Distress: Girls with ADHD are at a higher risk for anxiety, depression, and low self-esteem. They may internalize their struggles, leading to feelings of inadequacy and self-doubt.

Increased Risk of Co-existing Conditions: Girls with ADHD have a high rate of co-existing conditions, such as anxiety disorders, depression, and eating disorders. According to research conducted at Harvard University, 45% of girls with ADHD have another serious condition.

Sara’s story, shared by Dr. Jo Steer, a Consultant Clinical Psychologist specializing in ADHD in girls and women, highlights the devastating impact of untreated ADHD:

“Early on in secondary school, I began to drink alcohol to deal with socialising. I self-harmed and developed an eating disorder to deal with intense emotions, self-esteem issues, feeling stupid, not good enough, a failure. I made several suicide attempts from age 18 onwards. My family didn’t understand me. I was diagnosed with generalised anxiety disorder, borderline personality disorder and post-traumatic stress disorder. The depression and medication stripped me of my creativity. I relied on alcohol and weed to get through the lonely days. After lots of therapy, I was still struggling with life when I took an online mental health course that mentioned ADHD. I had always joked I had ADHD, but now I was convinced. Now I have a diagnosis, I’m learning coping skills that could have been taught to me as a child. You can’t help but wonder if things would have been different for me if it had been recognized earlier. Would I have graduated? Would I have a job rather than being unemployed for a decade?”

Sara’s story underscores the importance of early recognition and intervention for ADHD in girls.

Seeking Help: The Path to Diagnosis and Support of ADHD in Singapore

If you suspect your daughter may have ADHD, the first step is to consult a healthcare professional. “Only a trained professional can diagnose and treat ADHD,” advises Dr. Palumbo. 

In Singapore, this can be a pediatrician, child psychiatrist, or psychologist experienced in diagnosing ADHD.

The diagnosis process typically involves:

Gathering information from multiple sources: This includes interviews with you, your daughter, and her teachers. It’s crucial to provide the doctor with a comprehensive picture of your daughter’s behavior across different settings.

Reviewing school records: This can provide valuable insights into your daughter’s academic performance and behavior patterns. This could be teacher’s notes and report cards. 

Using standardized rating scales: These questionnaires (often to be filled up by parent and child separately) help to assess ADHD symptoms in a structured way.

Ruling out other conditions: The doctor will consider other possible explanations for your daughter’s symptoms, such as anxiety, learning disabilities, or medical conditions.

Treatment of ADHD in Girls Options: A Multifaceted Approach

There is no one-size-fits-all approach to treating ADHD, and the best treatment plan will be tailored to your daughter’s individual needs and symptoms. Treatment options may include:

Psychoeducation: Understanding ADHD is crucial for both you and your daughter. Learning about the condition, its symptoms, and its impact can help reduce feelings of shame and empower your daughter to manage her challenges.

Parent Training: Parent training programs equip you with strategies to manage your daughter’s behavior, improve communication, and create a structured home environment.

Behavioral Therapy: Behavioral therapy helps your daughter develop skills to improve focus, manage impulsivity, and regulate emotions.

School-Based Interventions: Working with your daughter’s school to implement accommodations, such as extra time on tests or preferential seating, can support her academic success.

Medication: Medications, such as methylphenidate or atomoxetine, can be effective in managing ADHD symptoms. However, the use of medication should be carefully considered in consultation with your doctor, taking into account your daughter’s age, individual needs, and potential side effects.

Helping Your Daughter Thrive: Practical Tips and Examples

Beyond formal treatments, there are many things you can do as a parent to support your daughter with ADHD.

Fostering Open Communication and Building Trust

Establish “Tech-Free” Time: Designate a specific time each day, perhaps during dinner or before bed, to put away all electronic devices and engage in meaningful conversation. This allows for undivided attention and encourages open communication.

Active Listening: When your daughter expresses her thoughts and feelings, practice active listening by reflecting on what you hear: “It sounds like you’re feeling overwhelmed with your schoolwork right now.” This validates her emotions and shows you’re genuinely listening.

Focus on Solutions, Not Blame: If your daughter is struggling with a specific task, instead of asking “Why haven’t you finished your homework?” try asking “What can we do to make it easier to focus on your homework tonight?” This solution-oriented approach fosters collaboration and reduces feelings of blame or shame.

Build on her Strengths: It’s easy to lose sight of your strengths when you feel under pressure but help her remember her strengths. Don’t let her forget them. She may not be academically great but she could be a good listener or have great attention to detail. Get her to list her strengths and put them up in her room so she can see them and remind herself of them daily. Help her develop her strengths and talents. Together, recall the times when she showed her competence and was successful; notice her victories; encourage her to become more self-sufficient, to problem solve, to do new things.

Creating Structure and Predictability

Visual Timetables: Create a visual timetable together, using pictures or drawings, to outline the daily routine. This provides a clear visual reminder of what to expect and helps with transitions between activities.

Breaking Down Tasks: Help your daughter break down large, overwhelming tasks into smaller, more manageable steps. For example, instead of “Clean your room,” try “First, put away your clothes, then make your bed, then organize your desk.”

Consistent Bedtime Routine: Establish a calming bedtime routine, such as taking a warm bath, reading a book, and dimming the lights, to signal to her body that it’s time to wind down. This regularity can improve sleep quality and reduce overall restlessness.

Provide an appropriate daily routine: Make sure your daughter is eating regularly and healthily, sleeping enough, and engaging in daily physical activity.

Be Consistent: Have a few clear, fair, agreed-upon rules. If there are consequences to breaking these rules, they must not come as a surprise and should be imposed quickly, without delay. All children need to practice learning what is expected of them. Some will test the limit just once and accept it straight away; others will keep on testing it over and over before accepting it. Patience is needed!

Supporting Organization and Time Management

Color-Coded Folders and Binders: Implement a color-coding system for school subjects, using different colored folders and binders for each. This visual organization can make it easier for her to keep track of assignments and materials.

Planner or Digital Calendar: Encourage the use of a planner, either physical or digital, to schedule homework assignments, project deadlines, and extracurricular activities. This helps with planning and prioritizing tasks.

Designated “Launch Pad”: Create a designated “launch pad” area near the door where your daughter can consistently place her backpack, school supplies, and anything else she needs to take with her each morning. This reduces the likelihood of forgotten items and morning stress.

Use Charts, Schedules, and Reminders: Charts, schedules, and reminders can help your daughter organize tasks and manage her time.

Encouraging Healthy Habits and Emotional Regulation

Regular Physical Activity: Encourage daily physical activity, whether it’s a sport, dance class, bike ride, or simply playing outside. Exercise can help regulate energy levels, improve focus, and boost mood. It can help alleviate ADHD symptoms and has positive effects on attention and overall well-being.

Mindfulness Techniques: Introduce simple mindfulness techniques, such as deep breathing exercises or guided meditation, to help your daughter manage stress, improve focus, and regulate emotions. Note: This suggestion is not directly from the provided sources.

Healthy Diet and Hydration: Ensure your daughter is eating a balanced diet with plenty of fruits, vegetables, and whole grains, and staying hydrated throughout the day. Good nutrition can positively impact energy levels and focus.

Focus on solutions rather than the problems when communicating with your daughter. For example, ask “What could help you go to bed on time?” rather than “Why are you staying up late?”

Use descriptive praise (speak in detail about what they have done well). When giving instructions, phrase them positively. Humor and playfulness won’t hurt when appropriate and always reward good behavior.

Remember, these are just a few examples, and the most effective strategies will be those tailored to your daughter’s individual needs and strengths. By working collaboratively, celebrating successes, and fostering a supportive and understanding environment, you can empower your daughter to navigate the challenges of ADHD and thrive in all aspects of her life.

Resources: Where to Find Help for ADHD in Singapore

Singapore Organizations that can help with ADHD:

SPARK (Society for the Promotion of ADHD Research and Knowledge): This parent support group provides caregiver education and support. You can find more information on their website.

NUH Child Development Unit (CDU): Located at the National University Hospital and KK Women’s and Children’s Hospital, the CDU offers assessment and treatment for children with developmental concerns, including ADHD. You can contact them at 6394 2211 (KKH) or 6772 6157/ 6772 2470 (NUH).

NUH Neuroscience Clinic, Child and Adolescents Psychiatry Service: The National University Hospital clinic provides specialized psychiatric care for children and adolescents. You can contact them at 6772 8686 / 6772 2002.

The Child Guidance Clinic: Located in the Health Promotion Board Building, this clinic offers mental health services for children and adolescents. You can contact them at 6435 3878.

Websites on ADHD in girls:

ADHD Foundation: This UK-based charity provides information, resources, and support for individuals with ADHD and their families. 

ADDISS (The National Attention Deficit Disorder Information and Support Service): This UK-based organization offers support, resources, and information for individuals with ADHD and their families.

Mind – Mental Health Charity: This UK-based charity provides information and support for mental health, including ADHD.

UK ADHD Partnership: This organization provides support groups and links to other support resources. 

ADHD Girls: This website offers resources and support specifically for girls with ADHD.

Books:

Understanding ADHD in Girls & Women edited by Joanne Steer

The Teenage Girl’s Guide to living well with ADHD by Sonia Ali

My Unique ADHD World by Joanne Steer & Claire Berry

Understanding ADHD in girls and women by Joanne Steer

The Gift of ADHD – how to transform your child’s problems into strengths by Lara Honos-Webb

Late, lost and unprepared – a parent’s guide to helping children with executive functioning by Joyce Cooper-Kahn & Laurie Dietzel

Atomic habits by James Clear

Social Media:

Instagram: @gracetimothy, @adhdunlocked, @adhd_girls, @howtoadhd

Youtube: How To ADHD (Jessica McCabe)

Remember, you are not alone in this journey. With the right support and understanding, your daughter can learn to manage her ADHD and achieve her full potential.