Hyperactivity Symptoms in Women and Girls with ADHD: Children and Adults

Like most people with an ADHD diagnosis, I discovered my condition in the context of failing to meet school-related expectations. In third grade, I was lucky enough to have a teacher suggest that my regular inattentiveness might be related to attention deficit hyperactivity disorder (ADHD or ADD). This was shocking and perplexing and life-changing because, at that time, most educators only thought to attribute the condition to disruptive and hyperactive children — not well-behaved, quiet daydreamers like me. I was never oppositional, defiant, or difficult. In fact, I was overly cautious and obsessed with following the rules.

One time, I was very mildly punished because I accidentally stayed outside after recess had ended. Instead of acting out because small infractions like these felt beyond my control, I apologized profusely, cried, and was thoroughly embarrassed. I held my struggles close to my heart and kept them secret. I never told my parents about instances like these, or that I constantly failed to keep myself from blurting out in English in a Spanish-immersion school where that was forbidden.

Regardless, my parents and teachers noticed that I lost everything, daydreamed constantly, and was thoroughly unmotivated to do my homework. I was initially diagnosed with primarily inattentive ADHD. Though I accepted the diagnosis and felt some relief, it did not help explain the struggles I felt outside of the classroom. No one connected the dots from my ADHD to my chronic lethargy, sleeplessness, ruminating thoughts, or emotional irregularities. My diagnosis explained a lot, but it did not explain the constant hyperactivity I held within myself.

That hyperactivity manifested in quiet ways when I was a child. I chewed on the ends of pencils, bit my sleeves, chewed my hair, ate paper, tapped my foot, felt mildly anxious, picked my scabs, and felt a strange overwhelming need to blow out candles at restaurants. Beginning in middle school, I became increasingly self-conscious of these habits. My hyperactivity became more and more tortuous as I bottled it up inside.

I became extremely socially anxious, couldn’t sleep at night, developed certain obsessions, had periodic panic attacks, and became deeply sad. I eventually started taking SSRIs for generalized anxiety disorder in high school. I could no longer hide the fact that I hadn’t slept for three days straight, or that once or twice I called my parents in tears when seized by the terror that I was being targeted by malevolent insects. I developed certain obsessions — like the possibility that my family would die, or that I had done something awful but forgotten about it.

[Self-Test: Symptoms of ADHD in Women]

I also became secretly obsessed with discovering what was wrong with me. Did I have obsessive compulsive disorder? Did I have a personality or a mood disorder? Or maybe I was just sad and anxious? I kept ADHD at the back of my mind, but I didn’t even begin to relate it to my ongoing struggles.

I never considered talking to my doctor about experimenting with different ADHD medications or dosages, though I always suspected that my medication had little to no effect on me. Medical professionals suggested that I required a very low dosage, since my lack behavioral problems was equated with having ADHD of lesser severity. What’s more, I had outgrown my previous academic struggles in elementary school — at least outwardly. Though I procrastinated constantly, couldn’t bring myself to study for exams, and often skipped boring classes, I got mostly As. I quickly gave up on reading Shakespeare when my attention wandered, but I used sparknotes and was a strong writer. I loved more ADHD-friendly literature and was obsessed with mathematics, therefore had no issues excelling in those areas. Since I no longer performed poorly in school, everyone considered my ADHD treated. For the longest time, I thought that ADHD was a learning disability, not a mental illness. Therefore, I vaguely suspected the diagnosis was a mistake all along, or that I had simply outgrown it.

When my brain wouldn’t give me a break, I felt terminally broken, confused, and sick. I constantly searched for answers but couldn’t find them. Why did I exhibit strong OCD symptoms, but then seemingly move on from them for months at a time? Why was I selectively misophonic — driven to rage or anxiety by certain noises, but only if I was already uneasy or trying to focus on something? Why was getting out of bed in the morning so hard? Why was I so avoidant and afraid of failing?

I swallowed these questions whole because I was still foolishly ambitious and felt optimistic about college. I grossly overestimated what I was capable of handling in college. I enrolled in the honors college at my university and tried double majoring in English and Physics — all while pursuing my somewhat promising dream of being a successful musician. I had also entirely underestimated the role my family played in keeping me on track in high school. Left to my own devices, I floundered miserably. As I tried to keep my head above water, I quickly realized that I had to drop the honors college and only pursue one degree if I was going to survive.

[Self-Test: Obsessive-Compulsive Disorder in Adults]

I began seeing a therapist to address my disturbing obsessive thoughts and deep sadness. My therapist reasonably posited that I may be dealing with untreated OCD and suggested that I talk to my doctor while she helped offer strategies to deal with my obsessions. I readily accepted her prognosis and became optimistic again. I ignored the suspicion that the new diagnosis didn’t account for the fact that my obsessions tend to inexplicably fade away for long periods of time before materializing once again. Or that, though they kept me up at night, the obsessions didn’t seem to be the root of my issues during the day. Still, it was easier to believe OCD had been the root of my problems; it was, at least, an answer that validated the pain I felt.

I also re-evaluated my medication, and with a doctor’s approval, started taking ​bupropion as a substitute for my ADHD medication and SSRIs. Bupropion is a norepinephrine-dopamine reuptake inhibitor (NDRI), which can sometimes help treat ADHD as well as mood disorders. I didn’t believe my ADHD was very severe at all, so I figured that forgoing stimulants would be a non-issue. The doctor I spoke to briefly on the phone enthusiastically agreed.

I didn’t feel any better, but I kept faith in bupropion and kept upping my dose until I wasn’t allowed to increase it any further. I then lied to myself and my doctors, and told them I was seeing an improvement in my symptoms. Meanwhile, I lost my previous ability to precariously balance my academic responsibilities. I managed to maintain allowable grades, but I was at the brink of hurting myself. I continued to spiral downward, while frantically protecting the facade that I was doing well.

I was late to work and class every day, and sometimes completely forgot to go. I quit my job because I suspected that I was about to be fired, and I lied to my professors about struggling with migraines when they expressed concern over my absences and apparent sudden disengagement in class discussions. I felt overwhelmingly ashamed, guilty, and lost as I tried to reconcile the high expectations I’ve always had for myself with my helpless lack of motivation.

The end of my freshman year came to a boiling point when I found myself having to write 10 pages of a 12-page research paper the night before it was due. I created an extremely dangerous strategy to kick my dopamine-starved brain into action; the night before an essay was due, I would sacrifice sleep, drink about seven cups of coffee, and tell myself that I only had two options: finishing the assignment or ending my life. I made it to the end of the year, but confessed to my parents that I wasn’t sure I could handle going back, which took them by complete surprise. My parents found me a therapist, while strongly advising me to create a resume and find a job to keep myself active. Without the school-related anxiety, I couldn’t even bring myself to write a resume during those three whole months, let alone get a job. My self-esteem was at an all-time low and I felt like a huge disappointment.

That summer, I rummaged through my parents file cabinet and, in a desperate search to discover what on earth was wrong with me, reconnected with old documents related to my ADHD diagnosis. I read school reports dating all the way back to preschool in which teachers expressed that I was well-behaved but did not grasp material as quickly as expected and was always staring out the window. I then went through a psychoeducational evaluation that documented clear inconsistencies and divergences in the way my brain operates. Although my visual sequencing skills were reported above the 99th percentile, my visual memory was reported in the 0.4th percentile as a result of my inability to concentrate. I have clear strengths, but I struggle to efficiently utilize them with my serious deficiencies.

I felt a sudden wave of cathartic relief and frustration. I don’t just have ADHD, I have REALLY bad ADHD! No wonder life is hard for me. I’m living with what I’ve learned to accept as a beautiful and unique but hilariously inefficient brain. I did further research into the condition I almost thought had fallen upon me by accident or mistake. The explanation for my difficulties that I so desperately yearned for had been there in plain sight since I was 9 years old.

No one had told me that my ADHD accounted for my hypersensitivities, obsessions, lack of motivation, and sleeplessness. No one told me that visible hyperactivity only manifests in 25% of children and 5% of adults with the condition. I never yelled, rebelled or distracted others, but I internalized the whirring in my brain, kept it from interfering with others, and came dangerously close to hurting myself as a result. I became deeply frustrated by the fact that many people (including educators and medical professionals) still believe that hyperactivity from ADHD is only a problem when it’s socially disruptive.

At the same time, I found peace with myself, stopped searching for answers, and started accepting my endlessly annoying brain with loving compassion. My sophomore year, I started taking Adderall in conjunction with SNRIs for generalized anxiety and mood disorder. Adderall almost immediately helped me see the forest through the trees and envision a non-disastrous outcome for my life. I remember calling my dad to tell him that I finally felt healthy, engaged, and optimistic again. I no longer felt like I was constantly driving a car that was leaking steering fluid and had no brakes. When I hung up the phone, I burst into actual tears of joy. I was so relieved to finally believe it when I told my parents that I felt happy, and that they don’t have to worry about me.

I still struggle daily with my ADHD, but I also recognize the color it adds to my life — the unique and valuable way it makes me approach problems; the resilience it forces; and the passion and focus it reserves for the things I care about.

[Self-Test: Generalized Anxiety Disorder in Adults]

Updated on September 3, 2019