We asked Chartered Coaching Psychologist and ADHD specialist Pippa Simou for her advice.

Hello. If you're reading this, I'm guessing you've got a daughter with ADHD who is either heading towards puberty, slap bang in the middle of it, or has just slammed her bedroom door so hard the pictures on the landing are wonky...

This stage is TOUGH. The research increasingly describes puberty as a real turning point for girls with ADHD, not just something that happens quietly in the background. It's one of the biggest transitions our girls will face. But to be clear: tough is not the same as hopeless. With some understanding, consistency (I know, I know), and genuine belief that things can change, we can get them through this (and ourselves too!)..

Why does it all seem to hit at once?

• Her hormones start doing a full-on rollercoaster.
• Schoolwork suddenly gets harder and there's far more of it.
• The cosy structure of primary school disappears, replaced by a timetable, six different teachers, in different rooms and a bag she must remember to pack herself each day.
• Friendships get complicated, and then there are the inevitable crushes...
• Social media invades her consciousness.
• Sleep goes out of the window.

Add the executive function difficulties that come with ADHD (planning, organising, remembering, switching between tasks) and it's no wonder so many of our girls start to wobble. This is often the point when struggles that she managed to hide, or mask, suddenly become visible. Sadly, it's also when the risks of anxiety, depression, self-harm and disordered eating start to climb steeply. I'm not saying that to frighten you, but to raise your awareness to the vulnerabilities she faces, so you know what to keep an eye on and protect against.

The 'triple bind'

Professor Stephen Hinshaw, who led a long-term study of girls with ADHD at the University of California, Berkeley, identified ‘the triple bind’. It describes the impossible set of expectations society places on teenage girls. They're expected to be:

1. Nurturing and compliant, the 'good girl' traits girls have been expected to show throughout history.

2. Highly competitive and successful, academically and in sport, now that girls (rightly!) have equal opportunities.

AND to maintain all of that while being:

3. Effortlessly attractive and ‘sexy’, in a world that hypersexualises girls from a frighteningly young age.

Honestly? It's an impossible ask for a teenage girl (or anyone!), and the cost can show up as low self-esteem, a sense of failure and sheer exhaustion. Now imagine trying to juggle this, when your regulation skills and your emotional and social development is running a few years behind your actual age. That's what our girls are dealing with. It's a lot.

Why so many of our girls aren't spotted until now

If your daughter was only diagnosed recently, or you're still fighting for an assessment, you are very much not alone. Lots of girls with ADHD reach their teens undiagnosed.

Part of the reason is that girls more often have the inattentive type of ADHD: the daydreaming, the disorganisation, the drifting off halfway through a task. That doesn't disrupt a classroom, so it's easy to miss. And when girls are hyperactive, it tends to look like chattiness or fidgeting rather than climbing the curtains.

Studies looking back at clinical records show that girls are typically older than boys when they're first referred and diagnosed. They're more often referred for emotional problems, and are more likely to have been given other medication, or even hospital care, before anyone identifies the ADHD. Put simply, it's often the anxiety, low mood or self-harm in early adolescence that finally gets a girl through the door, and even then the ADHD underneath can be missed.

An expert group led by Professor Susan Young concluded that the gap between diagnosis in boys compared to girls is at least partly down to girls being overlooked. It seems girls need to show more ‘serious’, obvious, disruptive problems than boys before they're taken seriously. If you've ever felt you had to shout twice as loud to be heard, there's your answer. It's not you.

Hormones, periods and ADHD: what's actually going on

This is the bit I really wish someone had explained to me sooner.

Oestrogen matters. The best current evidence suggests that ADHD symptoms in girls and women can go up and down with their oestrogen levels. Oestradiol (the main form of oestrogen) supports the brain's dopamine and noradrenaline systems, which are the ones that help with attention and self-control. They're the very same systems involved in ADHD and targeted by stimulant medication. In women without ADHD, higher oestradiol and progesterone have generally been linked with better attention and executive function. So, when oestrogen drops immediately before her period, a girl with ADHD may find it harder to concentrate, regulate her emotions or manage impulsive behaviour. These hormonal fluctuations may help explain why ADHD symptoms can vary across the menstrual cycle.

Researchers think this might mean more impulsive, risk-taking behaviour around ovulation, and more inattention and low mood in the run-up to a period, all turned up by the social pressures of being a teenager. If you've noticed your daughter seems like a different girl at certain times of the month, you are onto something!

Her emotional wellbeing and mental health

This is where the evidence is strongest and most consistent, so I'll be straight with you. Girls with ADHD are at much higher risk of depression, anxiety, self-harm and eating difficulties, and those risks build through adolescence into early adulthood.

Those pre-period lows. In a Dutch clinic study of 209 women with ADHD, 45% reported symptoms suggesting premenstrual dysphoric disorder (PMDD), a severe form of PMS. That's far higher than in the general population. These were adult women describing their own symptoms, but it's a very good reason to gently ask your daughter how she feels before her period, and to get her support if she needs it.

Big feelings and rejection sensitivity. Intense emotions that change in a flash are really common with ADHD, and they collide head-on with the social drama of adolescence. That crushing sense that a friend's offhand comment means she's hated by everyone? The ‘double whammy’ idea suggests puberty may amplify this for girls.

Relationships, sex and staying safe

I know. This is the section that makes us want to lock them in their rooms until they're 30. But knowledge is power, so here's what the research tells us:

• Earlier sexual activity. Teenage girls with ADHD, especially the combined type, were more likely to become sexually active younger and to have more partners.
• Unplanned pregnancy. 42.6% of women who had ADHD as children reported an unplanned pregnancy by young adulthood, compared with 10.6% of women without ADHD.
• The pill and mood. A huge Swedish study of around 30,000 girls and young women with ADHD (aged 15 to 24) and 763,000 without found that those with ADHD had about three times the risk of depression overall. Those taking the contraceptive pill had about five times the risk compared with women without ADHD who weren't on the pill. Non-oral methods, like the implant or hormonal coil, showed no extra risk linked to ADHD.
• Unhealthy relationships. By the ages of 17 to 24, 30.7% of the young women with childhood ADHD had experienced physical violence from a partner, rising to 37.3% for those whose ADHD continued into adulthood. Lower school achievement in adolescence partly explained the link.

Reading those numbers took my breath away the first time. Impulsivity, executive function difficulties, low self-esteem after years of being told off, and being rejected by peers all seem to play a part. Please remember: none of this is about blame, hers or yours. It's about knowing where she needs extra support, and making sure she gets it.

Medication and treatment through puberty

At the moment there's no official guidance telling doctors to adjust ADHD treatment around the menstrual cycle, and most of the evidence comes from adult women. But there are some really useful questions you can take to your next appointment:

• Does her medication seem to work differently at different times of the month? There's some evidence that stimulants may feel stronger when oestrogen is high and progesterone is low (the first half of the cycle). One day, dose or timing might be
  tailored to the cycle.
• What about contraception? Given the Swedish findings, it's very reasonable to ask for her mood to be monitored if she starts the pill, and to talk about non-oral options. Bonus: they also take away the need to remember a daily tablet, which, let's face it, is a big win for an ADHD brain.
• Is she being treated as a whole person? NICE guidance (NG87) recommends a holistic plan covering psychological, behavioural and educational needs, regular reviews, and awareness that ADHD is under-recognised in girls, who are more likely to be misdiagnosed. If your daughter is showing anxiety, low mood or self-harm in early adolescence, it's absolutely fair to ask whether ADHD might be sitting underneath.

Top tip: track it. For three months, jot down her focus, mood, sleep and how well her medication seems to work, alongside her period dates. An app or a notebook is fine (the one you'll actually remember to use is the best one!). It gives the doctor something concrete to work with, and it helps your daughter start to understand her own patterns, which is a gift in itself.

So, what actually happens?

The message from the research is this: look for ADHD in girls who are struggling emotionally at puberty, ask about hormonal patterns, and get support in place before things escalate. Early recognition, open conversations about hormones, and proactive support for her mental and sexual health make a real difference.

For us parents and carers, that means talking early and openly about periods and how they impact her focus and mood. Track her symptoms alongside her cycle. Keep a gentle eye out for low mood, self-harm, changes in eating, and relationships that worry you, and ask for help early, rather than waiting.

If you're hoping to make some changes that'll make family life a bit calmer, the research suggests you've got the best chance if you stick to these core principles:

• Get to really know ADHD. Learn what it is and what it actually feels like to live with it. (If you have ADHD yourself, you've got a head start!)
• Find regular, positive time together. Join her in something she loves when things are calm and low-key, and just chat. Car journeys, baking, watching her favourite show. No agenda.
• Be specific. When you notice her behaviour, and your own reactions, try to be objective. Keep a note of what happened and what was actually said, not just how it felt in the moment.
• Take small steps. Break big goals into little ones. Start slowly and only move on once a step feels secure.
• Use the ‘ABC’ approach. Look at the Antecedents (the situations, expectations and requests that set things off), the Behaviour itself (described specifically), and the Consequences that follow, which make it more or less likely to happen again. It helps you encourage the good stuff and respond sensibly to the tricky stuff.
• Build in rewards. Recognise her effort, not just results. Charts or visuals that show the skills she's working on help her see her progress. Mix up the rewards to keep it interesting (ADHD brains love novelty!).
• Be clear about consequences. When behaviour crosses the line, follow through with a brief, immediate consequence. Agree these calmly and clearly ahead of time, so there's no room for bickering in the heat of the moment. Deliver them calmly and matter-of-factly.
• Reward yourself too. Seriously. Pick one or two goals for yourself at a time. You are only human, and parenting ADHD can feel incredibly heavy, especially if you're juggling your own ADHD at the same time. Notice your own progress and celebrate it.

One last thing, ‘mum to mum’

Puberty is a genuinely vulnerable time for our girls with ADHD. They need targeted support from us, from their teachers and from the professionals around them if they're going to come out the other side thriving. It's hard work, and some days it will feel like you're getting nowhere. But it really does pay off.

You're clearly someone who cares enough to read all the way to the end of this (and I know how hard that can be with an ADHD brain!). That tells me your daughter is lucky to have you in her corner. Be kind to yourself. You've got this, and you're not doing it alone.

You can find out more about the work Pippa does via her website or follow her on social media.