Tips from an ADHD Coach: ADHD going unnoticed in childhood

A lot of adults with a late ADHD diagnosis can look back on their childhood and see clear signs that they had ADHD. But, it just didn’t get noticed at the time. It can be painful to think about where we would be if we’d had the diagnosis earlier.

This week on Tips from an ADHD Coach, Jaye talks about how it can be common for late-diagnosed adults, especially women, to feel overlooked, misunderstood, and somewhat cheated out of the life they could have had. Listen for some tips to help you through this grief. 

Have a challenge you’d like Jaye to talk about in an episode? Email or send a voice memo to us at adhdcoachtips@understood.org.

• How do I emotionally prepare for ADHD diagnosis?

• ADHD in girls

• The 3 types of ADHD

(00:35) Alexis’ quote

(03:06) Why do women so often have their ADHD missed in childhood?

(07:15) What about the people whose siblings were diagnosed in childhood, but they were not?

(10:44) What can we do?

(14:01) Recap

Jaye: Were you diagnosed with ADHD in adulthood, even though it seemed like the signs were there when you were a child? What do you think led to your ADHD going undetected? What feelings do you have about it now?

This is "Tips from an ADHD Coach," and I'm your coach, Jaye Lin. Today, we're talking about when ADHD goes unnoticed in childhood and the effects that it can have on us. We're gonna hear from Alexis, who shared with us how her ADHD was diagnosed decades after her brother's.

Alexis: I got my diagnosis in 2020. I was 27. My sibling got his diagnosis around the age of probably six. When we were kids, he was very hyperactive. So, he was always physically moving. He could not sit still in class. He had severe behavioral issues, so much so that he moved to like three different schools because he was so disruptive in class. He was always talking with everyone, always causing trouble. He also would act out on the playground, and like not, he wasn't violent but he was just very disruptive and did not know how to get along with other kids.

So, that's why I guess maybe he was tested sooner than I was. I'm not hyperactive in any physical way. I have, you know, the chatter, the cyclical thoughts, just rapid thinking, a million different thoughts at once. And mine really looks like me not being unable to focus and carry out a task from beginning to end. I think my ADHD went unnoticed for so long because I am a woman, and you know girls are socialized to be, you know, mindful and put manners first.

I think it went unnoticed because my brother had such behavioral issues that were very extreme. And so, the attention sort of went more so to him. And his needs were put before mine, I would say, as well as them maybe thinking like, "Oh, if she doesn't have as bad of behavioral issues or red flags, then she's OK." I try not to think about how things would be different for me if I had received my diagnosis in childhood because it's one of those "what if" games, and I've thought about it so muc,h and I honestly think that I probably wouldn't have pursued a career in the arts.

It was the only thing that I could keep my attention and focus for so long and that's directly correlated to my ADHD, and you know it wasn't the most stable and secure choice and career path. So, I think I would have, if I actually was medicated and knew how to treat my ADHD, I would have been able to explore other options that would have maybe set me up for a more secure career path.

Jaye: There's been a recent surge in adult ADHD diagnoses in women, and it's not because we're suddenly developing it in adulthood. It's because our ADHD flew under the radar when we were growing up. I've spoken with so many late-diagnosed ADHD women. I myself was diagnosed with ADHD only five years ago in my mid-thirties. It's common for us late late-diagnosed women to feel overlooked, misunderstood, and somewhat cheated out of a life we could have had.

Alexis touches on some of the reasons why her brother's ADHD was caught earlier than hers. The rowdy, disruptive brother that Alexis described is a lot easier to notice than Alexis quietly getting bombarded with multiple thoughts all at once. To the outside world, she would just look like a girl sitting still. And because we haven't experienced what it's like to have someone else's brain, there also isn't anything we can notice as children either. What we experience feels normal because that's all we've ever known.

There are three subtypes of ADHD: hyperactive-impulsive, inattentive, and combined. Studies show that more women tend to have the predominantly inattentive subtype, which is what Alexis describes. Her hyperactivity isn't physical in her body, but in her mind. Fewer women have the predominantly hyperactive-impulsive subtype, which is how she describes her brother. Or the combined subtype, which is, you guessed it, a combination of both mental and physical hyperactivity. What the studies don't show definitively is why those differences in subtypes exist.

It's possible that it's a biological difference between sexes, but it can also be due to differences in societal expectations. Alexis mentioned that she was socialized to be mindful and put manners first. Being loud, impulsive, or acting out in any way would be unacceptable, while the acceptable threshold for boys tends to be higher. So, girls are sometimes conditioned to keep still even if they started out with physical hyperactivity.

I was one of those girls. I actually have the combined subtype. I was told to sit still, be quiet, and be obedient and was able to force myself to do so most of the time, but at a cost. Using pressure and anxiety to bottle up all that hyperactive energy led to generalized anxiety disorder, panic disorder, and random moments when the dam would burst, and I would get in a lot of trouble for being rude or disruptive. My teachers and other authority figures saw it as acting out, since I didn't normally behave that way.

As it turns out, while I am capable of sitting still, fidgeting and moving around relieves pressure and makes it easier for me to focus while forcing myself to sit still speeds everything up in my brain. I wonder how many women who consider themselves inattentive only would benefit from allowing more movement with their bodies to offset the buildup of energy going on in their brains. But there's no way to know.

Behavior can also be viewed differently depending on whether it's coming from a girl or a boy. There are a lot of stories I've heard from late-diagnosed ADHD women where they were punished as children for ADHD traits, but it wasn't seen as an ADHD trait. Examples of this include being too chatty in class, having to get out of their seats because they're too antsy, not doing their homework, etcetera. In many of these situations, ADHD wasn't even considered because their behavior was seen as disobedience and not as challenges in focus, hyperactivity, and impulse control.

ADHD girls and women have been labeled as flighty, inconsiderate, snobby, rebellious, etcetera. All words that imply intention. In these scenarios, disruptive behavior from girls can be considered a choice, while behavior from boys can be seen as uncontrollable actions.

A lot of late-diagnosed women, myself included, have accepted that parents and authority figures didn't catch the ADHD because they weren't aware of what ADHD was. But what about the women whose siblings were diagnosed with ADHD in childhood? If their parents were aware of ADHD, why did it go unnoticed for so long? Alexis mentioned a few of those reasons.

Aside from the fact that her brother's ADHD seemed a lot more troublesome to other people and his future, she also mentions that her ADHD didn't present the same way his did and that she seemed to lack the red flags that made seeking an ADHD diagnosis for her brother feel more critical to her parents. From my conversations with women whose brothers and other siblings were diagnosed in childhood, this is extremely common. The contrast in behavior between two siblings can often lead parents to dismiss concerns about one child having ADHD because it might not look the same as their sibling's ADHD.

Many of my clients had parents tell them they don't have ADHD because they know what ADHD looks like. Their parents were so acquainted with one child's ADHD journey that they considered themselves experts. But it turns out they were only experts in one way ADHD can present. And as far as the red flags being lower for Alexis, that's common, too. Many of the women I know whose siblings were diagnosed in childhood were older sisters and took on the oldest sibling role. But even those who weren't older sisters often saw themselves as the peacekeepers of the family.

While the household was steeped in the chaos of everyday life with an ADHD child, this daughter strived to be the reliable, parent-pleasing, nurturing sibling. This actually falls in line with what many of us with ADHD experience. In moments of chaos, we can be the calm in the storm. We can feel and act more clear and centered when we're dealt with a higher stimulation level of being in a frantic, loud, emotionally intense environment. Since that's what other people can observe, it might not seem like we have the racing thoughts, hyperactivity, impulsivity, etcetera.

Meanwhile, when we are alone or in more calm environments, our struggles can become much more intense. All of these reasons point to why late ADHD diagnoses can bring up a wide range of emotions. It can feel like relief, like hope for the future, like a validating experience. It can also bring up negative emotions, mourning a childhood we never had, where we are understood, supported, and appreciated for who we are.

It can lead to a lot of the "what ifs," like what Alexis mentioned. What if she was diagnosed in childhood and was able to focus, finish what she started, and power through the hard or boring parts? Would she have been able to pursue a career that gave her more financial stability?

If I, Jaye, was diagnosed in childhood, would I have been able to continue studying math and science, both subjects I loved as a child, but decided I was bad at, after feeling deep shame when I fell behind in schoolwork? Could I have become a doctor or an engineer? What my dad always wanted me to be. Could I have maintained more healthy, romantic relationships long-term? Could I've lived up to the potential people always said I had when I was growing up? What if?

Instead of saying "what if," I like to say, as I do in every episode, what can we do? What can we if we feel that grief, that mourning of a life that could have been, that mourning over wasted potential? First, I'd like to that this grief is valid, just like all the other emotions we feel. We can't change the past and it's OK to allow ourselves to sit with those feelings for a little bit.

I recommend talking through this with a mental health professional because it can allow more productive, safe ways for us to feel those hard emotions. We can then choose to reframe the situation. While we can't change the past, with an ADHD diagnosis and awareness, we can change the path for our future. With ADHD treatment, including healing the wounds created from emotional dysregulation and the painful moments of our past, the future is now wide open.

I used to have a big negative reaction every time I heard the word potential. It was something that made me feel ashamed and hopeless whenever I heard it because it reminded me that I failed to live up to mine. It could have been so much, but you know what? I'm still alive. How could I fail at reaching my potential if it's something that's ongoing?

So, I wasn't able to get into a top tier college for engineering when I was 17 years old, not by a long shot. But after all the work I've done after my ADHD diagnosis, I'm actually pretty confident that if I wanted to be an engineer or a doctor, I could be. It might be harder to juggle school, work, and other obligations at this point in my life, but I'm very confident that I could pull it off. I've been through hard things before.

The past few years have shown me that after unraveling all my tangled emotional hangups about how I feel about myself, I can be quite powerful and adaptable. I can pick up new skills and knowledge quickly, something that is common for many of us with ADHD. As it turns out, once I stopped feeling shame for not being good enough to be an engineer or doctor and saw those careers as real possibilities, I realized I didn't actually wanna go into those fields.

So, I wasn't able to have healthy romantic relationships long-term in the past. I'm pretty sure I can now. The limitations I felt before my diagnosis that restricted what I felt I could or couldn't do have been lifted. And while, of course, I would have preferred not to have had all those painful moments in my past and all that shame I felt, even as a child, those experiences have allowed me to appreciate my life and what I've been able to do the past few years.

For Alexis, going into acting and the arts may have been something that was done out of necessity because it was harder for her to maintain interest and motivation in other career fields. But she was able to carve a place for herself in an area she feels passionate about and really dedicate herself to her craft. And if she wants to pivot into a more financially stable field at this point, she totally can. She is more in control of her future now than she has ever been before. The same goes for all of you.

ADHD has long been overlooked in girls, which has recently led to a boom in adult ADHD diagnoses in women. Women are statistically more likely to have internalized, primarily inattentive ADHD symptoms, which may be biological, or maybe because of societal expectations that have been drilled into girls from a young age. It's harder for other people to notice internalized symptoms of ADHD.

But also, when those ADHD symptoms trickle out, they can be viewed as intentional actions and not ADHD challenges. ADHD can even be missed in girls who have siblings with childhood ADHD diagnoses because their ADHD can present differently with fewer red flags, and parents can sometimes consider themselves experts in what ADHD looks like when they're only familiar with what ADHD looks like in their more disruptive child.

All of this can lead late-diagnosed women to experience grief and "what ifs," mourning a childhood where they could have been understood and lived up to their potential. But while we can't change the past, with ADHD diagnoses and treatments, we can change the path of our future. Whatever limitations we have placed on ourselves can be lifted in time as we grow, and we can now have a stronger say in the direction of our destiny.

You've been listening to "Tips from an ADHD Coach" on the Understood Podcast Network. If you have a challenge you're facing, we'd love to hear about it. Send us an email or voice memo at ADHDcoachtips@understood.org. You can also check out the show notes to find links to anything mentioned in the show and more resources.

This show is brought to you by Understood.org. Understood is a non-profit organization dedicated to empowering people with learning and thinking differences like ADHD and dyslexia. If you wanna help us continue this work, donate at Understood.org/give.

"Tips from an ADHD Coach" is produced and edited by Jessamine Molli and Margie DeSantis. Video is produced by Calvin Knie. Our theme music was written by Justin D. Wright, who also mixes the show. Samiah Adams is our supervising producer, Briana Berry is our production director, and Neil Drumming is our editorial director. For Understood.org, our executive directors are Laura Key, Scott Cocchiere, and Seth Melnick. And I'm your host, Jaye Lin. Thanks for listening.