After Carla Ciccone gave birth to her daughter, she spiraled with shame and self-hatred. She felt lost. She felt like a fraud. Part of her had always felt an aching imposter syndrome and a difficulty controlling her emotions.
She knew she needed therapy. What she didn’t expect was an ADHD diagnosis.
She thought back to the boys of her elementary school days, bouncing in their seats and unable to keep still. But that didn’t describe her at all.
Ciccone examined the criticism she faced throughout her life from teachers and family members who told her she was lazy, careless and gave up too easily, she writes in her new book “Nowhere Girl: Life as a Member of ADHD’s Lost Generation” (out now from The Dial Press).
Hyperactive ADHD – the more commonly studied type – is only one part of the story. Inattentive ADHD, on the other hand, is driven by difficulty sustaining attention and focus rather than impulsivity or need for constant movement. Think daydreamers. It’s more common in women than in men.
Ciccone isn’t alone. In 2023, a study published in Epic Research found the number of newly diagnosed women between ages 23-29 and 30-49 nearly doubled from 2020 to 2022. As Ciccone argues in her book, a lack of comprehensive research and attention to ADHD in women and girls has created a “lost generation” she dubs the “Nowhere Girls.”
Meet the ‘big, chaotic sisterhood’ of girls left out of ADHD research
Once diagnosed, Ciccone craved answers. She undertook a personal and academic deep dive to discover why so many women grew up undiagnosed. She interviewed those who had been diagnosed later in life, many only after their children were diagnosed with the genetic disorder. She wanted an explanation for all the times she felt she was doing “life” wrong.
Symptoms of inattentive ADHD include inability to sustain attention during tasks, mind wandering, careless mistakes, losing things, easily distracted by external stimuli or unrelated thoughts and forgetfulness, according to ADHD Magazine ADDitude. People with it can get overstimulated easily and sometimes struggle to control their emotions.
“Although the word inattentive implies a lack of attention, it’s a misnomer,” Ciccone writes. “People with inattentive ADHD can pay attention, and if something is of special interest to us, we display intense focus, but we lack the internal regulation required to make decisions about how and when to deploy our attention.”
While ADHD diagnoses are rising, it’s not just because more people have ADHD. Part of the reason is that professionals are getting better at recognizing symptoms. In the past, the general thinking was that girls couldn’t have ADHD and they were misdiagnosed in adolescence with anxiety or depression. Black women, especially, are under- and misdiagnosed compared to their white male peers, the Washington Post reported in 2021.
Ciccone was frustrated to find research was largely focused on boys. She eventually found Stephen Hinshaw, a professor at UC Berkley and one of the leading researchers on ADHD in women and girls, who is trying to change that.
“Sadly, it’s a common story in the medical field that women and girls get overlooked until it’s too late,” Ciccone tells USA TODAY. “Then they go, ‘Oops, I guess you better study you. I guess your bodies work differently.’”
Gender can play a big role in ADHD diagnosis. “Gendered socialization” – the ways we internalize societal expectations from a young age (like dolls and trucks at playtime) – puts girls with undiagnosed ADHD at a disadvantage. There’s pressure to be a quiet, polite girl. As Ciccone writes in the book, “emotional dysregulation becomes especially tricky because we become more and more beholden to gender expectations that say it’s inappropriate to display intense feelings.” Sometimes, they’re identified as “gifted” kids and are often perfectionists. They may appear to be listening, even if they aren’t. They’re often given more responsibility in the classroom than their male counterparts. They learn to mask.
“In elementary school in the ‘90s, boys were expected to act out to a certain degree and be aggressive and loud and disruptive. And that’s not to say that they had a good experience of that, they still get corrected. But if a girl does it, she gets corrected in a different way, in a way that goes (at) her self-esteem,” Ciccone says. “‘You’re a girl, and you’re supposed to be good.’”
They learn coping mechanisms to skate by schooling “at the cost of a lot of anxiety and a lot of stress,” Hinshaw told Ciccone for “Nowhere Girl.” Those skills (and supportive families, if they have them) can act as scaffolding against exacerbated ADHD symptoms.
Inattentive symptoms typically persist with age, while hyperactive ADHD symptoms often decline, according to the National Institutes of Health. So when that scaffolding falls away – with larger class loads in high school or college, in their first professional job, after having a baby – it all comes crashing down.
Carla Ciccone’s ADHD diagnosis gave her a ‘reason to forgive’ herself
When the pandemic wreaked havoc on the world, “we lost our support,” Ciccone says. “ADHD people, we can be chaotic but we do sort of thrive when we have a routine. And so when we lost that, I think a lot of us were just alone with our brains.”
But the pandemic also opened up different avenues for support, like telehealth. Ciccone found success with online therapy. Once she got her diagnosis, it led to a chapter of reflection and, ultimately, forgiveness.
“The emotional dysregulation that leads to this sense of shame that is really persistent and really, really hard to shake, even when you do know where it’s stemming from … it’s very hard to get away from that,” Ciccone says. Many of the women she spoke with felt overwhelmed, like she had, which led to a feeling of “I can’t handle life the way that other people can and therefore I’m not worthy of my position in the world.’”
Ciccone began to give herself grace for the things she used to hate about herself. She looked at her younger, undiagnosed self with compassion. She started listening to her body and letting herself move when she felt restless. She made slow, gentle changes to her life to accommodate her ADHD.
“It was empowering to know I had a reason to forgive myself,” she says.
Clare Mulroy is USA TODAY’s Books Reporter, where she covers buzzy releases, chats with authors and dives into the culture of reading. Find her on Instagram, subscribe to our weekly Books newsletter or tell her what you’re reading at cmulroy@usatoday.com.