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Girls And ADD
Following is an article that appeared in several
community newspapers. It focuses on ADD in girls, which is an important topic that is not
discussed enough. I think you will find it of interest.
November 18, 2002
Girls and ADD: Attention Deficit Disorder is often undiagnosed in females
By Mary Beth Faller
Staff Writer, The Advocate
Slowly, parents and professionals are starting to realize that just as many girls as
boys have Attention Deficit Di sorder, but because their symptoms are so different, girls
often are not diagnosed and continue to struggle without the help they need.
ADD, sometimes called Attention Deficit/Hyperactivity Disorder, is a brain condition
that exists from birth. It has many symptoms, including a short attention span, easy
distractibility, a low frustration tolerance, impulsive behavior, hyperactivity,
disorganization and immaturity, says Simon Epstein, a Stamford psychiatrist who
specializes in treating ADD. Many people with ADD also have a learning disability, but not
all.
"In my experience, it's pretty even between boys and girls," he says. Epstein
and other experts say that girls with ADD are much less likely to be hyperactive and
aggressive. And that's the problem.
"If you're hyperactive, the kindergarten teacher knows and you're off to the
social worker for help right away," Epstein says. "But if you're inattentive and
nice and looking out the window, you're not a problem child. You drift along, never doing
well, never reaching your potential. You never make the waves that bring you to someone's
attention."
But early diagnosis is important because another difference is that boys with ADD tend
to do better once they hit puberty, but girls tend to get worse.
Kathleen G. Nadeau, co-author of "Understanding Girls with AD/HD" (Advantage
Books, 1999, $19.95), says her book is still one of the few to address the specific
differences and needs of girls with the disorder.
"AD/HD is the most highly researched childhood psychiatric condition, there are
literally thousands of published academic articles," says Nadeau, a Maryland
psychologist who is a founder of the Center for Gender Issues and ADHD. "Yet less
than one-half of 1 percent have anything to do with girls."
Decades ago, AD/HD was called "hyperactivity," and was thought to afflict
only boys, and that they were defiant, aggressive and difficult.
Twenty years ago, when schools were told to provide accommodations for kids with
learning problems, psychologists were flooded with calls from pediatricians and parents.
"If you got this magic diagnosis, you could get special help for your kid," she
says. "We were doing evaluations morning, noon and night."
She noticed that often, the boys' parents also showed signs of ADD - mothers as well as
fathers.
But the American Psychiatric Association based the diagnostic criteria on those
hyperactive boys. For a diagnosis, a child must have six or more hyperactive or
inattentive symptoms in early childhood for more than six months, and they must cause
significant dysfunction in two or more settings.
"Girls are much more likely to have the inattentive type of ADD," says
Epstein. They will exert extra effort in the classroom, getting decent grades.
"If a girl has all the symptoms, but is doing reasonably well, she won't get the
diagnosis," Nadeau says. "Studies show elementary school girls are more
motivated to do well, and they're being punished for that by not meeting the criteria.
"But they have school anxiety, thinking, 'The teacher will call on me and I won't
know what page we're on.'"
In fact, Nadeau says that studies show that girls with ADD are often diagnosed as being
depressed or anxious, which they might be, as a result of the brain disorder. These girls
can be shy and have difficulty in social situations.
Nadeau's daughter had AD/HD, but was one of the rare girls who was also hyperactive.
"She was an easy one to diagnose," she says of the daughter now in her 30s.
"In those days, there were no school accommodations. The only way to 'treat' her
was to hand-pick her teacher. That's all I had at my disposal."
Eventually, her daughter was helped with medication, but that treatment is a
complicated issue, she says, because hormonal cycles can exacerbate ADD symptoms in girls,
and stimulants used to treat the disorder, such as Ritalin, can worsen anxiety.
Middle school is especially difficult academically, Epstein says.
"When they get to seventh and eighth grade, things get much worse for them, with
the requirements of attention, focus and homework and changing from class to class. Their
grades may plunge," he says.
Epstein stops short of blaming teachers for overlooking girls with ADD. "Teachers
get blamed for everything, and they're already overburdened," he says.
Nadeau agrees, citing studies that show pediatricians are reluctant to diagnose girls
with ADD.
"But when a child is not doing what they seem capable of doing and seem to be
drifting and not quite focused - things that ring a bell - it should be considered a
possible attention problem," he says.
Parents won't see their daughter daydreaming in the classroom, but they will notice
difficulties when it's time for homework.
"They'll see a child who is otherwise motivated but doesn't do well with sitting
down and finishing a task such as homework or is up and around doing a dozen other things
other than the homework," he says.
Most kids dislike homework, so how does a parent know if there's truly a problem?
Nadeau's book has several pages of specific questions to distinguish girls' ADD symptoms
from normal childhood behavior. For example, two of the 37 questions for pre-school girls
are: "Does she not show appropriate fear?" and "Does she talk very little
in public?" For middle schoolers: "Does she tend to interrupt
conversations?" and "Does she seem to overreact?"
Once diagnosed, treatment for boys and girls is the same, Epstein says: family
understanding, counseling for the child, and, if needed, medication.
"ADD is not just an individual patient," he says. "It's important that
the family understand what ADD is and what the symptoms are in that particular child.
There could be problems with homework, trouble sitting still or problems with getting
frustrated easily. Some have a temper, some are more aggressive, some love to punch their
siblings."
Counseling helps the child with organizational skills, peer relationships and
difficulty in dealing with frustration.
Beryl Kaufman, executive director of the Connecticut Association for Children and
Adults with Learning Disabilities, based in Norwalk, says she has seen an increase in
requests for information not only for girls, but also for women with ADD.
"We're having more and more women call," she says, and the organization is
working on getting a support group together.
Nadeau says women with ADD face many of the same issues as girls: lack of diagnosis and
misdiagnosis as depression. "They get on the anti-depressants and they feel better
but they're still unable to function," she says.
Nadeau says recent studies of brain scans show distinct differences in activity in the
brains of people with ADD, which could eventually lead to more concrete criteria.
"I'm really almost holding my breath waiting for the day when there's a medical
diagnosis for AD/HD," she says.
For more information: Call CACLD at 203-838-5010, or visit www.cacld.org, www.simonepstein.org
or www.addvance.com, the Web site for the Center for
Gender Issues and ADHD.
© 2002 Southern Connecticut Newspapers, Inc.
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