Membership BADDges: Identifying ADHD in Girls with Co-morbid Anxiety

It’s rough being an intelligent girl with ADHD. If such a girl is halfway successful, multiple doctors’ 15-minute default assumptions that she merely has anxiety/depression will too often have been the reason she spent most of her twenties ineffectually medicated with SSRIs – and labeled treatment resistant – instead of receiving the medications that will eventually change her life.

Such a girl has probably railed against the gatekeepers that barred her from having a shot at becoming truly successful – not just halfway – for so many irreplaceable years. She probably has become lost in an RSD spiral at least once after scoring off the charts on her ADHD self-assessment and being shot down anyway because she “did okay in high school.”

Such a girl may even have spent the first year after her formal ADHD diagnosis doubting it. She never forgot the doctor who said her difficulties were due to a lack of skills, not a neurological condition. She may have heard the bully-in-her-brain aping that doctor – telling her that she chose a job she “wasn’t good at” – for quite some time before she learned to trust her lifetime of ADHD experience over an ignorant GP.

If she has learned to trust in diagnostic criteria over doubt, she may become incandescent with rage when she sees other smart girls in Facebook groups and on WordPress being treated the way she once was treated. She may start to write an angry blog post after thinking back on what it was like to be told that she “didn’t need ADHD medications to solve her problems” – she just needed to choose a job within her “realistic personal capabilities.” She may instead realize that diagnostic criteria and angry rants wouldn’t necessarily have helped her in her own diagnosis journey. They wouldn’t necessarily have penetrated the fog of self-flagellation at the time.

She might then wonder what would have helped her feel more confident that she really did have a neurological condition back in her undiagnosed twenties. One thing that would have helped would have been to know that the “ADHD” versus “anxiety/depression” dichotomy is a false one. If a smart girl has ADHD, she most likely has anxiety and/or depression, too. It would have further helped her to have learned how to recognize her ADHD lurking behind her anxiety. It would have helped her to recognize her shibboleths: little traits of hers that stem from the diagnostic criteria for ADHD and aren’t as easily confused with other diagnoses as a non-specific criterion like feeling overwhelmed.  It would have helped to have some way to laugh about just how ADHD she was, not internalize the issues.

The following are some of those shibboleths that one such girl, known as Lavender, shared with another smart girl still in the process of being diagnosed. (She has added a few since that original exchange!) They have no formal diagnostic validity as an ADHD screener, but they probably have a fairly high specificity (though maybe not sensitivity!) To use the guide, assign the female subject +1 points for each item as described below. There is no clear-cut diagnostic threshold for ADHD. As in Improv, everything is made up and the points don’t matter. However, if the girl happens to self-identify with a few of these traits, she is more than welcome to an unofficial Membership BADDge, at least in this girl’s book.

Field Guide to Identifying ADHD in Girls with Co-Existing Anxiety and Other Psychiatric Diagnoses

  • (+1) She is unaware of – and unable to modulate – the volume of her voice. People tell her she is yelling one minute and whispering the next. Assign an additional point if she is often thought to be angry or intense when she is really happy or excited: her volume increases in proportion to how ebullient she is at any given moment.
  • (+1) She has characteristic sensory sensations – often sticky or slimy – that she just cannot stand. She may be fine swimming in the ocean, but she can’t take the tepid film of water over a freshwater lake. She may also be miserable in winter because she must choose between dry scratchy skin or the horror of using lotion.
  • (+1) She can’t accurately perceive time. She will say something took place “a week or so ago” – and truly believe it did – when it has been a month or more. Assign an extra point if she can’t recall the details of even her most meaningful autobiographical memories without tangible aids such as photographs or journal entries.
  • (+1) She tries to tell a story with multiple distinct female characters, but she only manages to use the ambiguous pronoun “she” to identify them, utterly losing her audience. Assign an additional point if she vacillates in her story telling between giving too much detail one day – overwhelming her audience – and so little detail that her audience can’t even tell whether the story is about her or someone else the next day.
  • (+1) She has invested real money or unhealthy amounts of time in at least three endeavors (or more!) that should be full-scale, multi-month projects or social commitments in less than half that amount of calendar time. Assign an additional point if she has completed none of these projects to date. Assign another point if she has legitimately forgotten to eat one or more meals because she was in a trance-like fixation (hyperfocus) during one or more of those projects. Assign yet another pee(r)-less point if she got so lost in hyperfocus she nearly forgot other bodily needs that are typically much more urgent.
  • (+1) She has driven on an expired car registration for 3+ months, but not because she didn’t have the money. She only managed to remember that she needed to take care of her registration after normal DMV business hours. By the next morning, these best-laid plans were erased from her brain. Assign an additional oh-yes-she-did point if she has also lost her credit card, driver’s license, birth certificate, wedding ring or some other “how could she possibly lose that” item critical to daily living at least once this year. Assign an additional Easter-Egg point if she can deliberately hide money in her “safe places,” knowing her ability to lose it there will prevent her from impulsively spending it.
  • (+1) She has flipped at least one pen clip across the room during a business meeting at work. Assign an additional point if she managed to hit her boss in the process. Assign an additional see-me-in-my-office-later point if the pen that hit her boss somehow managed to be her boss’s own pen that that she had accidentally filched from him during the meeting.
  • (+1) She has had to be yanked back from walking into traffic. Assign an additional point if she didn’t notice. Assign an additional but-don’t-think-saving-her-exempts-you-from-listening-to-her-story point if she continued to talk the entire time this was happening without hitch.
  • (+1) She has hyperfocused through a fire alarm, tornado siren or other warning of impending natural disaster. Add an additional this-is-not-a-drill point if she also hyperfocused through the actual fire/tornado or other natural disaster hitting nearby. Add an I-bow-before-my-queen point if she also hyperfocused through the tornado coming down on top of the house. (The author of this guide has the first two points, but not the last one, so far!)
  • (+1) She has wasted more of the coffee/tea in the package than she has drunk by setting it down for “a minute” to “wait for it to cool down.” Add an additional point if there are more than two half-full glasses of any drink within three feet of her right now because she forgot she had already grabbed a cup/opened a can/obtained the liquid before. Add an additional bonus point if she has had to carry around multiple water bottles in her purse because she forgot she already put one in. (Add a dysautonomia-diva point if she happens to have a chronic illness wherein carrying a water bottle is critical for disorder management, yet the only way she can follow doctor’s orders is to buy five separate water bottles and leave one in each place she frequents.)
  • (+1) She has at least four reminder alarms set on her phone each day. Add additional points if she a) has that many alarms just for waking up and b) at least one of those alarms is labelled with curse words and an injunction to “get your forgetful/lazy/procrastinating @$$ going, girl.”
  • (+1) Any password strong enough to keep a thief out keeps her out, too. She must request three-step verification and set up a new password each time she logs on to her online banking account. Assign an additional point if she has legitimately forgotten her own ATM pin. Assign an ADDulting-is-hard point if she has managed to forget her ATM pin at the same time she has also lost her debit card and/or driver’s license, and she, thus, has no way to convince the teller that she is the person she claims to be while she attempts to retrieve it.
  • (+1) She must carry around an ideas notebook to have any hope of remembering her inspired flashes (or basic project instructions.) Assign an additional point if the notes in her notebook are unable to be interpreted by anyone except her. Assign an additional point if her handwriting is so bad her notes are also unable to be interpreted by her. Assign an on-IRS-list-somewhere-I’m-sure additional point if she has a job wherein precisely documenting her work for others to review (for audits, lab notebooks for study replication, billable hours submission, etc.) is in the job description, yet she still can’t manage to keep records that can be verified by anyone else. Assign a but-at-least-she-noticed-the-text-that-time-so-don’t-press-your-luck point if anyone has ever had to send her scanned pages from her old notebooks three years later – while the auditor was in the room – going “what the heck does this mean?” Assign a to-hell-with-anyone-who-says-women-with-ADHD-aren’t-smart point if she was then able to a) re-derive the entire results of the old project on the fly (after she couldn’t read the notebook either) and b) the auditor gave full marks for record keeping as a result.
  • (+1) She has more time management apps on her phone than there are hours in the work day. Assign an additional point if, despite all those apps, she still relies on some form of a paper planner/bullet journal anyway. Assign an additional bonus point if, among all those apps, she refuses to download Slack, even though it is the office standard. Assign a Silicon-Valley-doesn’t-understand-the-ADHD-they-idolize point if she detoured from this assessment for a minimum of ten minutes while she read a dozen articles to figure out what Slack is – and why it’s so horrible for folks with ADHD. Assign another Slacker – um, ADHD – point if she uses Slack regularly, but she still detoured from the assessment to read about how awful it is, anyway!
  • (+1) She intellectually understands that post offices exist (and that people send things like birthday cards and thank you notes at them, roughly 1-2 weeks before/after major events), but she can only manage e-cards. Assign an additional maternal-guilt-trip point if she can’t even manage e-cards. Assign an additional no-really-maternal-guilt-is-the gift-that-just-keeps-on-giving point if she has planned to set up automatic e-cards multiple times, but she still can’t remember to be on time with her automation intentions.

If this assessment is being completed in a clinical setting, additionally include the indicator below:

(+1) Her psychiatrist has dropped her as a patient for repeatedly running more than the allowed 15 minutes late to appointments. Assign an additional why-are-we-even-doubting-she-has-ADHD point if she arrives late even though she regularly leaves with “enough time” to get to appointments and/or her stories about why she was late could put sitcom writers out of business.

Assign an I-guess-this-turned-into-an-angry-rant-after-all point if multiple doctors have observed this behavior at appointments, yet none of them ever stopped to ponder whether her willingness to face the embarrassment of being multiple hours late to an appointment, yet keep begging for something to help her get control of the chaos, just might be a sign she has a certain diagnosis with four letters…

Need a recap of anything I’m talking about in any post? Check out the Glossary of Terms.


38 thoughts on “Membership BADDges: Identifying ADHD in Girls with Co-morbid Anxiety

  1. This was fascinating! Thanks for sharing. I don’t know that much about ADHD, but a lot of what you wrote reminded me of the difficulties experienced by women seeking an Asperger’s diagnosis. So often they have learnt and implemented coping skills that are so effective they “present” well in the public eye, which makes others (including healthcare professionals) doubt their diagnosis.

    Liked by 2 people

    1. ADHD is strongly correlated with intelligence. When I can manage to not collapse and self-destruct on IQ tests – which admittedly is not often or my K-12 experience might have been a lot happier – I score gifted. I managed a PhD self-medicating with coffee, caffeine pills, and eventually a third-line ADHD (tricyclic antidepressant) that I took for migraines but helps a bit with ADHD. Yet, the first doctor I asked about formal diagnosis told me I was too smart to have ADHD, but maybe not quite smart enough to be in STEM, when I struggled handily in my first very structured job post PhD. My therapist in grad school, who later provided documentation for the clinical interview, ended up apologizing to me because “the ADHD signs were right in front of me, but I only could see anxiety because you were doing such academic work.” I don’t know if you have ADHD, but intelligence neither makes it more or less likely. Unfortunately, it does makes it so a smart girl is even LESS likely to correctly diagnosed. 😦

      Liked by 1 person

  2. Yessss! Took me forever to get the right diagnosis. Just this week… or 3 weeks ago? I drove around with an expired license without noticing until I went to a bar, also lost my phone in my dresser drawer for 3 hours today.

    Liked by 2 people

  3. This sounds like my daughter, always late, looses her debit card at least once a month. Forgets to pay credit cards. Erratic behaviour mood swings, lost her latest well paid job due to poor timekeeping. I also think she has co existing conditions like anxiety and paranoia. Won’t accept that anything is unusual in this. Wish I could get her addicted to coffee that might help…

    Liked by 2 people

    1. It’s sad she can’t see she has challenges, but it might stem from shame. After awhile, you get so used to being told what’s wrong with you that you instinctively react poorly to someone – even your mom – trying to help if it means hearing you “failed” again. It might an immense relief to your daughter to know her challenges could have a biological base, respond to treatment and don’t have to mean she’s “lazy, crazy, or stupud.” Just approach her knowing that low self-esteem and rejection sensitivity are the norm in ADHD. I get it. Heck, show her this post – these are all true stories! – but then tell her to read the side links about the rejection sensitivity, hyperactive and intense emotions and chronic shame, too, so she knows I laugh with her/me, not at her. 🙂 Also, yeah, I self medicated with coffee for years before figuring out I had ADHD. It has nothing on the real meds, so diagnosis is worth it. Coffee ain’t bad though 🙂

      Liked by 1 person

    1. ADHD can be genetic. I’m full scale hyperactive ADHD, but there is an inattentive flavor that “they say” is more common in women. Check it out if your daughter fits many of these, but you see bits and pieces in yoyrself, too. 🙂

      Liked by 1 person

  4. Thank you. I related to every single point and I keep doubting myself and my constant failures because my psychiatrist always says my inability to focus, remember, finish things, pay attention, show up on time is because of depression and never wants to take the discussion further. I’m going to try and be more assertive at my next appointment now.

    Liked by 2 people

    1. When I moved last, it took awhile to get insurance at my job. When I FINALLY got in to a new psychiatrist, the guy – despite having my records showing I’d been diagnosed/medicated for years – told me I was “laying it on a bit thick” with the way I was “pretending” to show the symptoms of ADHD to get drugs. Umm, no, I wasn’t pretending. Just out of meds! I have lost pretty much all belief that doctors actually want to help over the years. I’ve never been wrong on a diagnosis for myself or another family member. I do my homework, with good journal access. Yet, they always fight first and delay the right treatment. Keep fighting. The ADHD nervous system really is different from the neurotypical one, and the right meds are a godsend, even if they can’t totally be a cure. The best ever treatment for my anxiety was just treating the ADHD that underpinned It!

      Do you have a partner or parent or someone else close to you who can attest in a diagnostic interview that you show these types of symptoms in multiple contexts, even when you show no other signs of “depression” being active? It sounds awful – like a savvy businesswoman having to bring her husband to the used car dealer so the ahole will negotiate with “him” at all – but bringing someone else who can speak to your symptoms often helps with getting psychiatrists to take you seriously.


      1. I get exactly what you mean. I just had my appointment and it actually went well. I didn’t have anyone to come with me so I did the closest thing I could by saying my mom and niece have ADD and ADHD respectively, that my dad always thought that I also had it, and then I pulled up this post and noted all the things I relate to. I also really reiterated that my depression is doing well and that this is not the same as the problems I had with that. So THANK YOU you helped tremendously. I’ve been trying to get someone to listen for 15 years.

        One infuriating thing, in case anyone else works in a creative field… he implied he’d already thought of me as ADD but he wanted to deal with the depression first (fine) and didn’t want to prescribe me anything because I’m “creative.” ???? I mean… As if suddenly I’ll be out of control making art all over the place?

        Once I pointed out I haven’t been able to draw in 5 years and I never do anything that’s not a job because I can’t actualize my ideas he gave me an Rx to try.

        Liked by 1 person

  5. Kindred spirit here! My car registration has been out since February, and really that’s not too bad for me. You have a great way of capturing the inner workings of your mind in a way that others can identify with. Thank you.

    Liked by 2 people

  6. Holy crap, this would be crazy-making! Just reading this list, my eyes are like O.O

    My hat is off to anyone who lives like this and can function (with much, MUCH compensation, it sounds like!) on a daily basis with this kind of interference. This is a really comprehensive and clear list of the daily agony of going through life with ADD/ADHD, but with none of the support or assistance that would make life bearable. In a way, I can sympathize. I don’t have ADD, but I do have Complex PTSD, chronic pain (severe scoliosis), and depression that stems from prolonged emotional flashbacks…and I am unmedicated. Doctors continually think I’m drug-seeking, and I hold down a job, raise a child (singlehandedly), and have a clean record. So I must be lying or exaggerating, right? [insert eye-roll here]

    So I completely sympathize with the frustration and aggravation. Stay strong, all my unmedicated, desperately frustrated, and compensating-like-a-boss-lady sisters! ❤

    Liked by 2 people

  7. I lost track somewhere around 21 because wow counting is realllllly not a strong suit over here, but I’m pretty sure I nodded start to finish reading this and had a Job Bluth “SAME” moment at “she has had to be yanked back from walking into traffic. Assign an additional point if she didn’t notice. Assign an additional but-don’t-think-saving-her-exempts-you-from-listening-to-her-story point if she continued to talk the entire time this was happening without hitch” because this is one of the most relatable things I’ve ever read.

    Awesome post!!

    Liked by 2 people

  8. I just found this through you liking a post on my blog and I am SO glad. I identified really, really strongly with what you wrote as another smart girl with ADHD, PTSD, anxiety, depression, migraines, and a fun little chronic pain pal called NDPH. I even have IBS too.

    Your writing is fantastic and brave and wry and funny and so insanely relatable that I was actually saying “Yes!!!” and such out loud to myself as I read it, just in the middle of a bit of a messy patch of, well, messy stuff and needing very badly to feel like others might know about that painful place of mind and emotion and maybe be there too sometimes– and get out other times.

    Weird comment by very awkward person saying you seem fantastic from all the posts I have read and kudos and thank you.

    Liked by 1 person

  9. Loved this! It so often happens that labels constrict us and keep us from becoming who we really are. Strangely enough I also love that you used the word shibboleth. Such a great word. Not many people know that word. it’s origin is interesting also.

    n. late 14c., the Hebrew word shibboleth, meaning “flood, stream,” also “ear of corn;” in Judges xii:4-6. It was the password used by the Gileadites to distinguish their own men from fleeing Ephraimites, because Ephraimites could not pronounce the -sh- sound.

    Liked by 2 people

  10. Ok. I have spent a lot of time reading posts and going through links, ALL of it fascinating. You have assembled an amazing resource here and you can be QUITE PROUD of yourself. WELL DONE!!

    I read so many outside links I am not sure I’m keeping them all straight. And so I hope I am responding to the right blog post and not one I read an hour ago.

    Also, a trigger warning before you read further as I will be detailing some abuse that may be a bit hard to read for some.

    As the last comment said, I also picked up on shibboleth. I am impressed by your use of that word, and the manner in which it was used here in this post.

    My own shibboleth is abuse, abuse, abuse (trauma). I witnessed bloody fighting episodes between adult relatives and witnessed a child relative nearly dying by the hand of an adult relative- all before I began kindergarten; in addition to several molestations that happened in preschool years. So for me I just tend to see everything patterning back to trauma. But I don’t disagree with anything you wrote or linked here, I share many of the RSD and ADHD and PTSD and spoonie symptoms. And believe me you have my empathy and support. I ‘get’ it. Been there, and in many ways I still am going through a lot of it.

    So, I hope this isn’t offensive in any way. It’s just my story and so I recognize and own that I have a pretty strong bias toward it.

    In my own case: I have substantial proof I was sexually abused as an infant by a relative–who, also, ironically, used old Hebrew words like shibboleth to ‘show off’ to me during the frequent, arduous, spiritually and emotionally abusive phone calls he would make to me (he was/is a pastor). Anyway, that relative frequently ‘confessed’ the abuse he did to me as an infant, through a twisted form of teasing. He frequently brought up an incident from my babyhood–even mentioning it in front of my grown children a few years back. He never once mentioned it in front of my husband who would have quickly picked up that it was abuse- as it is clearly a violation; to those who didn’t have such things ‘normalized’ as I had.

    So, I know from reading research that a developing brain exposed to early forms of trauma ‘learns differently’ and ‘develops differently’ than brains not exposed to trauma. And I know that I was already being traumatized in my crib, which is very ‘early’ in terms of development.

    I also believe, and this is the controversial part, perhaps, but I do believe and have hope that a lot of that early brain damage I suffered can still be reversed. BUT, I am afraid that reversing it is SOOOO extremely difficult and requires the kind of resources (financial and other) which most of us, especially those already kicked in the backside by genetics and family dynamics, LACK. Combine that with our current healthcare system, a hostile sexist political and work and school environment, churches that by and large harbor abusers and tells victims to ‘just forgive and be healed’ — well I don’t know how people are supposed to find any support to enter the long and arduous healing process that such early trauma exposures need.

    I chose a course of treatment that used a ‘shibboleth’ of ‘hyper stimulation’ to describe what was happening to the central nervous system (causing my reactive fear responses). And so, according to that model of healing, before we could begin any CBT or Trauma work in therapy, we had to first wait until I came down out of hyper-stimulation or the belief was that I would just keep spiraling with stimulation upon stimulation and never really heal let lone be able to adequately address the difficult ‘roots’ underlying the flared central nervous system. And I was averse to using any medication whatsoever as I react badly to even OTC medicines, and I can’t handle ANY caffeine whatsoever either. This meant, for me, that in order to reduce my stress enough to ‘feel’ myself coming down– I could no longer work full time. I had to learn how to take naps. I bought even more expensive foods than I was already eating. I completely avoided reading stimulating ‘self help’ materials or survivor stories and just focused on containing all troubling thoughts and learning how to be in the moment instead. At first it was entirely self-care only; until I no longer woke up with panic feelings.

    And so I dropped out of nearly ‘everything’, started shutting my phone and computer off at five every night, and cut about twenty some relatives completely out of my life. We took lots of weekend retreat trips and beach vacations, too. I sat on my butt ‘relaxing’ (outwardly, inwardly I was often still buzzing) for a few years, literally. If we hadn’t had the financial resources we did/do, I couldn’t have even started this kind of process. Had my children still been at home, I couldn’t have done it either.

    Anyway, so it took me about twice as long as it takes some who use this approach to heal an anxiety disorder, and for me it was well over a year, to see any measurable decrease in anxiety or brain fog or any of it. I almost gave up multiple times. But once I did see some progress and feel that my brain was not so fuzzy anymore and I wasn’t terrified all the time; we slowly began CBT and trauma work. Then the REAL hell began. I still sit and ‘shake’ a couple times a week, as trauma releases itself. But I’m not panicked about it anymore. The grief and sadness is ongoing, though, and more painful than I anticipated. Unleashing all the repressed emotions, which come in waves now, is hard work but it is good work, if that makes sense. And I find myself often dialing it back again when it gets to be too much. I know it’s become too much as my old anxiety symptoms will flare, as will the body pain, etc. And then I do self-care for a week or so before I get back into ‘feeling my emotions’ again.

    One thing my therapist suggested was that when I take self-assessment tests, which (I think) you linked here, to number it 1-10 rather than ‘yes’ or ‘no’, and then go back later and track progress. So when I took the one linked here, and when I read through your descriptions of ADHD, I realized that I would have scored very high on these things at one time–literally had a ‘ten’ score on every single one of them! But also that SOME of it no longer applies to me at all now. Others went from a ten to a two. While one or two are still as high as ever.

    I don’t know what that means, exactly. But this one thing seems quite clear: I think doing too much traditional CBT work in a trauma victim can do more harm than good if the anxiety disorder and/or the ADHD and/or the hyper-stimulation and/or the PTSD (or whatever) isn’t first managed well. That’s the ‘big’ overall take away I am getting from your work here. And, admittedly, trauma is where I tend to ‘go’, it’s ‘my’ bias. Another take away is that a supportive spouse (or family) is absolutely crucial to anyone with any of these diagnoses. I hope and pray that everyone who suffers from them can find that support.

    Liked by 1 person

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