New Research Shows Neurodivergent Girls Really Do Have More Intense Pain. Here Is Why And What To Do.

New Research shows girls with ADHD and Autism really do sense more pain.

Let’s face it, whiny kids can give anyone a headache. And girls with ADHD and Autism can seem whiny, overly dramatic, or attention-seeking when they are in pain.  Many adults and kids don’t believe them, leading girls to consider themselves to be wimps. But, while it may not look like it, that teensy cut she is wailing about or those period cramps that have her doubled over do produce the experience of more pain in girls with ADHD compared to their neurotypical peers.

These girls are coming to you for solace and to learn to manage the more intense pain they experience.  So, here is how to help your daughter develop the nerve to take good care of herself. Even when others don’t believe her. It begins with knowing that she is braver than she believes. Than any of us have believed.

How Do We Know Their Pain Is More Intense?

There are many studies that indicate that girls (and women) with ADHD and Autism experience more pain than their neurotypical peers.(1) From how long she can hold her hand in ice water (2) to the significant percentage (76%) who report chronic back pain, (3) studies are finding that neurodivergent girls not only experience more intense pain, but also have more incidence of chronic pain than neurotypicals.(4)  And, period cramps are more severe, as well.(5)

Why Do They Have More Intense Pain?

So far, we only know that there is a significant correlation between ADHD and pain, meaning there is a relationship between them. But, we don’t yet know if one causes the other.  And we don’t know exactly how they are related. There is continued research about the role of dopamine (6) as well as inflammation of the central nervous system.(7) In the meantime, here is what we do know that will already help parents better understand their daughters.

1. Dopamine Deficiency → Higher Pain Perception

Girls with ADHD have lower levels of the neurotransmitter dopamine than their peers.  Dopamine deficiency is implicated in the challenges we often think of with ADHD, like motivation, task initiation, and focus.  But, dopamine does more than that. It suppresses and regulates pain. It has an analgesic effect that dulls the perception of pain.(8) This makes pain more bearable for those who have sufficient levels of dopamine. But, it also means those who have less dopamine, like girls with ADHD, also experience more pain.

And, even though everyone gets a dopamine surge with acute pain as our body’s way of reducing our perception of pain, everyone with ADHD already has less from the start. This is likely one way girls with ADHD are experiencing more pain than their peers.

2. Pain Disrupts Sleep → Poor Sleep → Reduces Dopamine → Increases Pain

Pain impairs sleep quality for everyone.  Many studies have shown that pain disrupts the normal sleep cycle by shortening time in restorative deep and REM sleep.(9) But, in a vicious cycle, low quality sleep then reduces the production of dopamine for everyone, and thereby deprives one of natural pain relief.(10)  This makes it more likely that the next night, lacking sufficient dopamine to numb the pain, one will sleep poorly again. And, this noxious loop cycles for all neurotypes.  As girls with ADHD already have lower dopamine levels and often struggle with sleep, girls with ADHD are much more vulnerable to the deteriorating effects of the sleep pain cycle and are suffering more than most of us have believed.

3. Emotional Dysregulation → More Pain → Weakened Emotional Regulation

The sleep and pain loop is not the only viscous cycle girls with ADHD experience.  Emotional Regulation and pain also loop around in a cycle.  And while very many girls with ADHD struggle from emotional dysregulation before they even have any pain, pain itself is, in turn, emotionally dysregulating for most people.  Here is how it works.

Emotional regulation is that part of executive functioning that allows us to control our thoughts and emotional responses (fear) to pain.  Strong emotional regulation allows us to focus our brains on things other than the pain, like the TV, thereby reducing our perceived pain.(11)  Emotional regulation also allows us to control our emotions and use positive self talk to keep calm, which then reduces our perception of pain. This lowered level of pain, in turn, allows us to have higher levels of emotional regulation.

But, since ADHD girls struggle to redirect their focus away from the high stimulation of pain, the perception of pain remains high.  And, as girls with ADHD struggle to have flexible thinking and are more likely to be overwhelmed by anxious and even catastrophizing thougths, they are again less able to use emotional regulation to reduce pain.(12)   

How To Help If She Is Caught In A Cycle of Pain?

1. Validate Her Pain

Since pain is subjective, others often believe girls with ADHD are exaggerating.  And, invalidation of pain may then cause her to hide the intensity of her pain for fear of seeming weak. She may also feel shame, believing herself flawed because she repeatedly is unable to cope with what everyone else deems trivial pain. This shame itself is dysregulating and further increases pain perception.  So fight the shame, to ease the pain. Here is how.

Teach her that her strong body is extra sensitive and that others have a natural medicine that numbs pain. At a time when she is not in pain, have a short talk and let her know that all bodies are different and that her body does not have as much of this natural medicine as most other bodies do. So others may not understand how much pain she feels because their own pain is numbed.

Let her know that you are just learning this new information. Apologize if you have not believed her pain in the past. Apologizing never makes you weaker as a parent, but much stronger, because it builds trust with her and models how to handle mistakes without severity. If she needs, let her talk about her frustration of particular times that she may still feel shame about when you have not believed her in the past or abandoned when you did not help when she needed it. If she needs to list the times, let her list them. If she needs to list them in writing to make it more real, go with the flow of healing that is coming out of her. She needs to get the hurt and shame exposed, healed, and reframed to disarm future shame. And, promise to her that you will believe her going forward because you always want to help her when she needs support.

Then, let her know you see and believe her pain when she is ever hurting. Let her know, too, that it is okay for her to be herself in pain around you. She needs to know you won’t be angry or reject her.  She needs a safe space to be in pain to calm down to alleviate it. 

Even if others don’t believe her, she needs to internalize that you do believe her so she can disarm shame. Remind her that she is braver than she believes, than anyone believes. The more often you remind her of this when she is in pain, the more likely these will be the thoughts about herself that pop into her head when she is in pain in the future. You are retraining her brain not to go the route of shame. Because the world will not understand her pain and they will shame her. So, she needs to learn how to disarm the shame now.

Then praise, praise, praise her for her trying hard to manage. No matter how she is handling it, say something like: “Look how you are dealing with something so hard!  You can manage hard things. Little by little, you are managing it. You are brave.”

Finally, normalize pain as part of life. Her pain may be more intense, but she is not the only one who ever has pain and she will have much more of it in life, especially monthly as a girl. And she needs to learn how to go on with life giving herself permission to take good care of herself, knowing of her own bravery, but not expecting everyone to bend backwards every time she is in pain.

Also, sometimes neurodivergent girls can be more alarmed by the shock of an accidental fall than by the pain.  So calmly give a minute and ask if her reaction is more from pain or from shock.  This will teach her to discern the difference over time as well.  Eventually, then when she says she is in pain, you will know she is.

2. Be Her Emotional Regulation For Her

Whether its a skinned knee or a heavy headache, she needs you to be her emotional regulation for her.  Her capacity for this will develop more over time, but she needs to learn from you how to help herself.  And, she needs to keep rehearsing it with you until it becomes a bit more automatic for her to use her thoughts to help herself.

Calm the anxious thoughts that are creating fear, but don’t trivialize her fear or dismiss it by telling her she should not be afraid. This only creates shame that she is wrongly responding to pain. Instead, we want her to trust her own emotions. Fear is a normal emotional response to pain. So, let her know that pain can feel scary and that is normal, that you are doing things to make it better, and that she will be okay.  Remind her that this is hard, but she has done many hard things before and she will get through this, too.

Also, try to redirect her natural ADHD hyper focus away from the highly stimulating pain to something else very interesting or stimulating. Again, this is very hard for the ADHD brain. This may mean a few minutes on a video game or watching an especially funny Youtube video. Explain that by focusing on something else she is dulling her own perception of pain so she learns this experience for herself. Neurodivergent girls often learn and remember better when they experience it. Let her experience herself taking good care of herself with your support.

Finally, neurodivergent girls need to know that they are not the wimps other may be calling them. Instead, they face more intense pain than their peers and they are doing well trying to manage it.

3. Tend to the Pain In An Explicit Act To Make Her Feel In Control

A girl with ADHD in a family with whom I have been working needed a Band-aid no matter how invisible the scrape. She even wanted them for bellyaches.  She needed an action, some physical way to tend to the hurt to make her feel more in control. Neurodivergent girls feel safest, and therefore, less pain, when in control. 

So, think about explicit ways to tend the pain to give them a sense that they are controlling their own healing: heating pad, ice, cup of cocoa or a band aid across the bellyache.  It may seem a silly waste of good bandaids (buy some cheap ones), but these gestures are ways to calm her nervous system, which in turn calms her pain.  And these gestures are also teaching her how to get control of herself when you can’t be there.

And keep a stash of children’s pain medications on hand and consider giving them especially near bed time.  Remember that reducing the initial pain can prevent the poor sleep cycle from spinning out of control.

Conclusion

Neurodivergent girls are often more sensitive than their peers. This sensitivity is both physical and emotional.  And, it causes them really to experience more intense pain than most of us understood. But, by believing them, serving as their emotional regulation, and offering them ways to feel in control while in pain, parents give them the nerve to take care of themselves. And, it is this sense of being able to help oneself rather than feeling helpless that will make her strong and competent in the face of pain in the future. She is much braver than she believes, than most people may ever believe of her. And, your guidance teaching her to manage the pain and reframe that shame is what will make her thrive.

References

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9. Jain, S. Vl, Panjeton, G. D., Martins, Y. C. (2024). Relationship between sleep disturbances and chronic pain: A narrative review. Clinics and Practice 14, 2650–2660. https://www.mdpi.com/2039-7283/14/6/209#:~:text=An increased prevalence of sleep,, and fibromyalgia [25].

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