When you think about Attention Deficit Hyperactivity Disorder (ADHD), do you have an image of a hyperactive boy who can’t sit still in class? Do you ever think about the girls and women who struggle with ADHD? The quiet daydreamers who struggle with organization, the perfectionists who mask their symptoms, or the social butterflies whose impulsivity is dismissed as simply being “talkative”?
In Richmond, Virginia, a growing movement of educators, healthcare providers, and parents is working to change the narrative around ADHD in girls and women—a condition that often goes undiagnosed until adolescence or adulthood, leaving many struggling in silence.
Why is it so Hard to Diagnose?
“Girls with ADHD become very good at hiding their struggles,” says Amanda Sovik-Johnston, Ph.D., of Active and Connected Family Therapy in Richmond, VA. “They’ve learned to blend in and even excel, but hide the anxiety and work they put in in order to do well. By the time they reach my office, many are dealing with anxiety, depression, and plummeting self-esteem because they’ve spent years wondering why it’s so hard.”
The statistics are telling: while official numbers suggest ADHD affects about 4.2% of women, boys are nearly three times more likely to be diagnosed than girls. Research suggests the actual prevalence may be much closer to equal—representing thousands of girls and women in the Richmond area who may be struggling without support.
A Different Presentation: How ADHD Looks in Girls and Women
ADHD in girls and women often manifests differently than in boys and men. While some females do exhibit hyperactivity, many instead show symptoms that are easily overlooked:
- Internalizing behaviors: Daydreaming and internal distraction rather than physical hyperactivity
- Social difficulties: Missing social cues, interrupting conversations, overcommitting, or consistently running late
- Organizational challenges: Struggling with daily tasks like cleaning, answering emails, or completing routine responsibilities
- Hyperfocus: Intense concentration on engaging tasks while neglecting others
- Difficulty with transitions: Trouble shifting between activities or contexts
- Compensatory behaviors: Developing coping mechanisms like intense exercise, perfectionism, or anxiety-driven discipline
Caroline Megargel, LCSW, of Active and Connected Family Therapy in Richmond, VA, emphasizes these differences create barriers to identification. “Teachers and parents don’t realize the inattention is actually symptomatic of ADHD,” she explains. “Meanwhile, the girl who’s quietly struggling to keep up with assignments, who’s constantly forgetting things despite being bright, who’s overwhelmed by everyday tasks—she’s flying under the radar.”
The Adult Diagnosis Experience
“Many women I work with have similar stories,” notes Dr. Sovik-Johnston. “In school, they were often talkative or daydreamers. They’d find creative ways to complete work—writing essays under their desks during other classes. Many were entrepreneurial and full of ideas, which are actually common ADHD traits. But it wasn’t until adulthood, when their compensatory mechanisms couldn’t keep up with mounting responsibilities, that they sought diagnosis.”
This pattern is common. Many women like, Dr. Sovik-Johnston herself, discover their ADHD only after decades of struggling:
- High achievement in youth through anxiety-driven discipline or hyperfocus
- Increasing difficulties when faced with the multiple demands of career and family
- Challenges with maintaining social relationships due to missed cues or commitments
- The gradual breakdown of compensatory mechanisms built during childhood
ADHD vs. Anxiety: A Complicated Relationship
One factor complicating diagnosis for Richmond women is the overlap between ADHD and anxiety symptoms.
“Many of my clients come in thinking they have anxiety,” Dr. Sovik-Johnston notes. “And often they do—but it’s secondary to undiagnosed ADHD. They’ve developed anxiety from years of trying to keep up, feeling overwhelmed, and not understanding why everyday tasks feel so difficult.”
Key distinctions include:
- ADHD typically involves difficulty focusing and organizing even when motivation is high
- Anxiety may lead to avoidance behaviors but can sometimes improve focus
- Professional evaluation is crucial to distinguishing between the two
- Many women experience both conditions simultaneously
Academic and Social Impact Throughout Life
For Richmond girls with undiagnosed ADHD, challenges often intensify during educational transitions:
- Elementary school may be manageable with external structure and parental support
- Middle and high school bring increased demands for organization and long-term planning
- College can be particularly difficult due to decreased structure
- Graduate studies may become easier if the subject is engaging enough for hyperfocus
Socially, the impact can be significant. “I’ve worked with countless women who experienced social fallout due to ADHD,” Megargel shares. “Consistently running late, forgetting commitments, interrupting conversations—these behaviors can strain friendships, despite the best intentions.”
Richmond Resources Making a Difference
Richmond families seeking support for girls with ADHD, and adult women exploring diagnosis, have several excellent resources:
- VCU’s Neurodevelopmental Assessment Clinic offers comprehensive evaluations specifically designed to identify ADHD in females across the lifespan.
- Richmond ADHD Collaborative provides education workshops addressing gender differences in ADHD presentation.
- Active and Connected Family Therapy provides therapy for children, women, and families of individuals struggling with ADHD.
Diagnosis and Treatment: A Thoughtful Approach
“Diagnosis is about more than checking symptoms off a list,” Dr. Sovik-Johnston emphasizes. “It requires professional evaluation considering family history, environmental factors, and ruling out other conditions—particularly trauma, which can present similarly to ADHD.”
Treatment options in Richmond have expanded beyond medication alone:
- Behavioral interventions and skill-building techniques
- Executive function coaching
- Mindfulness and meditation practices
- Medication when appropriate
- Support groups for shared experiences and strategies
“What works is highly individual,” Megargel notes. “Some women find medication life-changing; others prefer non-medication approaches. The key is personalized support that recognizes ADHD as a different brain wiring—with challenges but also potential strengths.”
The Path Forward
“Early identification changes everything,” Dr. Sovik-Johnston emphasizes. “When we can name what’s happening, provide appropriate accommodations, and teach girls and women strategies that work with their unique brain wiring rather than against it, we see remarkable transformations. They go from feeling ‘broken’ to understanding they simply have a different type of mind with its own strengths and challenges.”
Megargel agrees, adding: “Our ultimate goal is to create a Richmond where neurodiversity is recognized and celebrated, where females with ADHD don’t have to wait until they’re failing or in crisis to get help. We want to catch these bright, creative minds early and give them the tools they need to thrive.”
For Richmond parents who suspect their daughter might have ADHD, or women questioning their own experiences, experts recommend:
- Keeping detailed notes about behavioral patterns
- Consulting with professionals familiar with how ADHD presents in females
- Seeking evaluation from specialists using gender-sensitive assessment tools
- Connecting with support groups where both parents and women can share experiences
The journey to understanding and supporting girls and women with ADHD in Richmond continues to evolve. With increased awareness, improved identification practices, and expanding resources, there’s hope that the next generation won’t have to wait decades for answers and support.
As Dr. Sovik-Johnston puts it, “Every girl and woman deserves to be seen, understood, and empowered—exactly as she is.”
If you’re concerned about possible ADHD in yourself or your daughter, contact your healthcare provider or Active and Connected Family Therapy to learn more.