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ADHD and girls: It’s not what you expect

Let’s distract ourselves for a moment with a quick thought experiment.

Picture for yourself…the typical kid with ADHD.

Got him?

I write “him” because chances are you pictured a snot-nosed boy in a preschool or kindergarten classroom, wriggling and giggling and fidgeting and misbehaving, and generally working everyone’s last nerve.

ADHD has been thought of as a disorder for males since the diagnosis was invented, but that stereotype is inaccurate. And it is changing, according to the results of a very large, population-based study of children aged 5-17 years old, in which parents surveyed from 2003 to 2011 reported a much greater rise in ADHD diagnoses among their daughters than among their sons. Specifically, reported diagnoses increased 55 percent for girls compared to 40 percent for boys according to the study, published last month in the Journal of Clinical Psychiatry.

This is big news, because females with ADHD have historically been an unseen and underdiagnosed population, with boys receiving the diagnosis two to nine times more frequently than girls.

The reasons for this are partly due to the different ways ADHD manifests itself in boys versus girls. Boys with ADHD show more obvious hyperactivity, defiance, and (sometimes dangerous) impulsivity – just the sort of behaviors that drive teachers and parents crazy and quickly result in referrals for further evaluation and treatment.

By contrast, girls with ADHD are usually less obviously hyper and loud, and show their ADHD via disorganization, careless mistakes, inattentiveness, difficulties making and keeping friends, and daydreaming.

Hence girls with ADHD can fly under the radar in a busy classroom, mislabeled as mere “underachievers” or “anxious and out-of-it.”

And the consequences to girls with ADHD who are not identified in childhood are dire. Girls with untreated ADHD are prone in adolescence and young adulthood to have combative relationships with parents, continued academic difficulties, social problems, and anxiety and depression. They are also more likely to experience the demoralizing experience of chronically failing live up to cultural expectations of women as overachievers who can juggle the multiple demands of running a household, raising children, and holding down a job.

But given that the first long-term follow-up study of teenage and young adult outcomes for girls diagnosed with ADHD in childhood was not published until 2011, many people are not surprisingly unaware of how devastating the effects of the disorder can be for young women, including those young women themselves – who enter adulthood with a battered self-esteem and only a vague sense that “there’s something wrong with me” rather than the self-knowledge of having a neurological difference for which good treatments are available.

Indeed, research indicates that medications and behavioral treatments work just as well for girls with ADHD as for boys, but these treatments won’t work for girls if they aren’t referred in the first place.

Hence mental health professionals are increasingly calling for universal screening for ADHD for both genders. This can be accomplished relatively easily in classrooms and pediatricians’ offices via brief teacher or parent questionnaires. The benefit to this is that scientifically sound questionnaires allow for comparison of a girl’s score to that of a population of other girls – rather than that of boys – and hence their more quiet ADHD symptoms can be detected.

Once identified, girls with mild attentional difficulties can receive some accommodations in the classroom, such as more check-ins with the teacher and additional help in organizing themselves. Girls who score in the moderate or severe range on such ADHD questionnaires can in turn be referred for more comprehensive evaluations and the effective treatments we already have for the disorder.


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