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Protecting the Emotional Health of Girls with ADHD

April 4, 2024

“I struggle to fit in. I try so hard to act normal, but I feel like such a fraud.”

“I feel dumb. My brain fails me all the time. It’s no use asking for help.”

“I’m always overwhelmed. If I’m not disciplined, everything becomes chaotic.”

We can’t talk about ADHD in teen girls without digging into emotions. Even before a diagnosis, many teen girls talk about the downstream effects of ADHD on their emotions. They call themselves “stupid.” Their self-esteem drops through the floor. They try so hard to be perfect that they burn or spiral out.

The emotional toll of ADHD on teen girls is profound — especially when it isn’t diagnosed early. And, for naturally cycling teens, we can’t ignore fluctuating hormones, which invariably affect emotions, behaviors, and functioning. Is it any wonder that so many teen girls and young women say that regulating emotions and energy levels are their biggest ADHD-related problems?

Emotional dysregulation is a core feature of ADHD. Understanding this is the first step to safeguarding the emotional health of teen girls with ADHD. To help them develop emotional intelligence and resilience, and to help them pursue healthy lives, follow the steps below.

How to Protect and Empower Teen Girls with ADHD

1. Understand Your ADHD Profile

ADHD is a neurodevelopmental disorder that is highly genetic. It is not a sign of weakness, laziness, or poor motivation. Understanding how the ADHD brain is wired and how it processes information is Step One. Use simple terms and concepts to help your child make sense of their inner world in a non-judgmental way. It’s sometimes difficult to shift out of negative, toxic thoughts because the ADHD brain’s “gearbox” sometimes gets jammed, so be patient and positive.

Also, stress that no two teen girls with ADHD have identical symptoms, feelings, strengths, challenges, and co-occurring conditions. Encourage your child to be curious about their unique ADHD brain and profile.

[Get This Free Download: Learn How Hormones Impact ADHD Symptoms]

2. Understand the ADHD-Hormone Interplay

Through the menstrual cycle, the rise and fall of estrogen may affect your individual child’s symptoms, behaviors, mood, functioning, and even medication efficacy. Arm your teen with this information about herself, so she can independently prepare for her personal highs and lows, without shame.

Don’t assume that hormonal fluctuations affect all naturally cycling teens with ADHD in the same way. During the two weeks prior to menstruation, when estrogen is lowest, symptoms and functioning may worsen for some teens, especially those who experience PMS or premenstrual mood disorder (PMDD). For teens who struggle with impulsivity, high-estrogen states may be the problem, given the increased likelihood of engaging in risky behaviors when estrogen and dopamine are high.1

Help your child track their cycle so they can see how changing hormones interact with their unique ADHD profile. If your child’s ADHD medication appears to lose efficacy at certain times of the month, talk to their doctor (and share any supporting evidence) about cycle dosing, or adjusting a medication’s dosage depending on hormonal status.

3. Sharpen Self-Awareness with Self-Monitoring

When girls and women mask their ADHD or mimic their peers in order to achieve social acceptance, one unfortunate byproduct is underdeveloped self-awareness. As a result of these coping mechanisms, your child may feel overwhelmed by questions like, “What are you feeling?” or, “What do you need?”

[Read: 5 Things Every Doctor (and Parent) Should Know about Girls and ADHD]

Start building self-awareness by helping your child track how lifestyle factors influence mood and everyday functioning. What does your daughter notice about her ability to regulate emotions when she gets eight hours of sleep? Six? Do they feel happier after basketball practice? What does it feel like when the ADHD medication starts to wear off? Have your child track the good and the bad using a journal, an app, or a calendar.

4. Reappraise Situations to Curb Rejection Sensitive Dysphoria (RSD)

RSD — an aspect of ADHD emotional dysregulation that causes painful emotional responses to real or imagined criticism, rejection, or failure — can turn distorted beliefs into self-fulfilling prophecies.

Your child may desperately want to make new friends, but RSD may cause her to misconstrue a classmate’s response to her question as annoyance, when the classmate is really just shy or tired. Still, your child thinks, “Everyone finds me annoying. Why do I even try?”

There is power in teaching your child to reappraise situations, especially with ADHD emotional dysregulation in mind. Encourage your child to pause, consider alternative explanations, and refrain from acting until they feel emotionally anchored.

5. Raise Self-Esteem with Self-Compassion

Peer inside the mind of a teen girl with ADHD, and you’re bound to find a harsh, negative choir of voices signing a tune of self-doubt, imposter syndrome, perfectionism, shame, and inadequacy. (The longer it takes to get diagnosed, the louder the chorus.)

Self-compassion transforms the vicious choir into a kinder one and heals a degraded self-image. To develop self-compassion, try developing a gratitude practice together. On the drive to school or at the dinner table each day, share three things about yourselves for which you are grateful.

6. Buy Time with Mindfulness

Emotional dysregulation and impulsivity sometimes lead to poor choices. Mindfulness can help your child buy time to reflect, recognize that emotions will pass, and respond to situations in healthy ways. From breathing exercises to progressive muscle relaxation, mindfulness is a habit that, practiced alongside distress-tolerance skills, can teach your child to withstand difficult emotions without resorting to unhealthy coping measures.

7. Set and Respect Empathetic Boundaries

Protect emotional health by setting empathetic boundaries — like asking for a timeout during a heated discussion before it turns into conflict. This discipline will take practice, but the results are worth it. Your child will demonstrate that they can stay in control and take responsibility for their emotions, which improves self-esteem and promotes healthy relationships.

8. Beware Bad Advice

In a world designed for neurotypical people, beware of useless or even harmful advice for neurodivergent brains. Teen girls with ADHD who struggle with emotional dysregulation, social struggles, and RSD do not need to hear, “If you’re angry, stand up for yourself and say what’s on your mind!”

Another terrible suggestion? “Live a little” or “take the edge off” with a drink. Given high rates of addiction in ADHD2, older teens and young women with ADHD must understand the risks associated with drinking and taking other substances.

9. Establish Healthy, Fulfilling Lifestyle Habits

Healthy habits ranging from nutrition and movement to sleep, routines, and friendships can help your child cope with symptoms, big emotions, stressful times, and life’s demands over the long haul. Find safe, inclusive communities where your child can participate in sports, hobbies, and activities of interest. Help your child find environments and scenarios where they know their contributions are meaningful.

10. Parents: Learn to Listen Better

Emotional intelligence is built in interaction with others who respect us and make us feel safe. Practice active, reflective, and non-judgmental listening when your child speaks to you. Don’t rush to solutions and suggestions; try to simply reflect back what your child is telling you. To be heard and listened to builds emotional self-efficacy and is extraordinarily empowering.

Emotional Health of Teen Girls with ADHD: Next Steps

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “The Emotional Lives of Girls with ADHD” [Video Replay & Podcast #488] with Lotta Borg Skoglund, M.D., Ph.D., which was broadcast on January 23, 2024.

ADDitude readers: Sign up to access LetterLife, an app co-founded by Dr. Lotta Borg Skoglund that provides users with personalized insights — on hormonal cycles, ADHD symptoms, and lifestyle factors — to better manage ADHD.

Use the discount code ADDWEB20 to get 20% off Dr. Skoglund’s book, ADHD Girls to Women, when purchased via uk.jkp.com.

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Sources

1Roberts, B., Eisenlohr-Moul, T., & Martel, M. M. (2018). Reproductive steroids and ADHD symptoms across the menstrual cycle. Psychoneuroendocrinology, 88, 105–114. https://doi.org/10.1016/j.psyneuen.2017.11.015

2Wilens, T. E., & Morrison, N. R. (2011). The intersection of attention-deficit/hyperactivity disorder and substance abuse. Current opinion in psychiatry, 24(4), 280–285. https://doi.org/10.1097/YCO.0b013e328345c956

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