|
 Attention
Deficit Disorder in Girls Often Missed
by Kathleen Nelson, Women's E-news, December 13, 2002
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https://www.bridges4kids.org.
The largest
study of preteen girls with Attention-Deficit/Hyperactivity
Disorder indicates that it is more common in girls than
previously thought. When undiagnosed, girls with the disorder
are likely to face academic and social difficulties.
The number of girls with a common disorder that can dramatically
alter academic performance and peer relationships apparently has
been significantly underestimated.
Teachers, parents and medical professionals often associate
Attention-Deficit/Hyperactivity Disorder, known as ADHD, with
hyperactive and impulsive behavior. Girls are more likely,
however, to have a form of the disorder termed inattentive type
ADHD, characterized by distractibility.
Recent research suggests teachers and parents may not recognize
it the disorder in girls. Now, between 1 percent and 2 percent
of girls ages 5 to 18 are thought to have ADHD, at least 30
percent to 40 percent higher than previously believed.
According to the advocacy organization Children and Adults with
Attention-Deficit/Hyperactivity Disorder, ADHD affects 3 percent
to 5 percent of school-age children.
But some, particularly girls, minorities and rural residents,
are under-diagnosed. However, white upper-class boys, who
actually have the illness three times more often than girls, may
be misdiagnosed as having the disorder five to ten times more
often, said Stephen Hinshaw, a child psychologist at the
University of California, Berkeley and author of a surprising
new study appearing in the October issue of Journal of
Consulting and Clinical Psychology.
"Girls with ADHD are impaired across multiple domains," Hinshaw
said. "Their behavior is less controlled. There is clear peer
rejection. They achieve behind grade level academically and
their parents report an uncertainty about how to discipline
their girls."
"This isn't just troublesome girls," Hinshaw added. "It's a real
condition with real consequences."
Adding to the significance of Hinshaw's findings, other
research, announced in this month's British Journal of
Psychiatry, found that although more boys than girls are
diagnosed ADHD, girls with ADHD are twice as likely to be
hospitalized later with mental disorders.
Girls with ADHD were found almost seven times more likely than
ADHD boys to develop schizophrenia as adults, and five times
more likely to develop a mood disorder, such as depression, the
study's authors reported. The ADHD girls were found 18 times
more likely to have a substance use disorder as adults.
"Early intervention . . . in childhood will reduce the risk of a
later psychiatric admission, both in girls and boys," said Dr.
Soren Dalsgaard, the study's lead author.
In the Hinshaw research, researchers coordinated a day camp in
which counselors observed a mixed group of girls ages 6 to 12 as
they interacted in art, drama, classroom and outdoor activities.
Information is Flying Right through Their Brains
"Historically girls have been taught to play the role of
good student, which means looking like you're paying attention,"
says Jerome Schultz, a clinical neuro-psychologist who
specializes in diagnosis of ADHD. "But information is flying
right through their brains and they're catching a small
percentage of what the teacher or other kids are trying to
deliver."
Lori Berry's daughter Shawna participated in the camp. "The
thing I'm upset about is that parents don't know their kids have
ADHD and physicians don't properly diagnose it, so the kids are
ostracized and hammered at for being lazy," Berry said. Shawna
exhibited active and impulsive behavior problems before
kindergarten, but was not diagnosed until age 11.
Schultz doesn't think alternative school placement is necessary
unless the condition is severe, but has two suggestions for
mainstream classrooms: Teachers should be sensitive to the fact
that girls are more likely to exhibit ADHD without hyperactivity
and can look very good in the classroom until exam time; second,
teachers should make girls diagnosed with ADHD aware they have
this condition and empower them to develop individual
strategies.
"Many young girls with ADHD have an outside shell that looks
spacey or winsome and hide their insecurity, but inside they're
ready to fall apart or explode," says Joan Teach, who runs the
Lullwater School, a private school for students with ADHD in
Decatur, Ga. She mentors students in brainstorming, analyzing
tasks and segmenting projects, imparting both academic and life
skills. "The biggest thing I want to teach the girls is
self-advocacy."
ADHD Girls Quickly Become Isolated
Beyond academic success, the ability to make friends is
critical for young girls. Several times during Hinshaw's summer
camp, each girl confidentially nominated three campers she most
liked and disliked, using photographs of her classmates.
"Within a week the girls with ADHD were the most disliked,"
Hinshaw said. "If in elementary school you are consistently
disliked, that is the best predictor of you becoming delinquent,
of not finishing school, and of having mental-health problems in
adulthood," he said. "It predicts devastating outcomes and also
points to the importance of social relationships for later
development."
But it does not have to be this way.
"Most girls with ADHD think they're different or not as good as
everybody else," says Shawna Berry, now 16. A special education
assistant helped her study and pay attention, as well as avoid
confrontation. "I used to stay in a corner and keep to myself in
elementary school," she said, "but I learned that I could be
just as popular as the next person."
Accurate Diagnosis Is Critical
Much of Carol Sadler's time is spent teaching parents to
advocate for their daughters as coordinator of a Children and
Adults with Attention-Deficit/Hyperactivity Disorder chapter in
Atlanta. Managing their child's needs, including meetings with
schools, counselors, doctors, and lawyers, can be overwhelming.
She helps them negotiate federal laws that entitle children with
ADHD to "a free and appropriate public education," which
requires a customized individual education plan and may call for
academic and behavioral tutoring from a classroom aide or
modified instructions in class assignments and testing.
The cause of ADHD isn't well understood, but those with it have
altered brain activity, and there is a proven genetic component
(Sadler and Teach were both diagnosed after their daughters
were, and Berry describes herself as "the most disorganized and
inconsistent person"). Parenting practices don't cause ADHD, but
can exacerbate or improve it.
In order to be accurate, "diagnosis should be confirmed on
multiple, objective measures, rather than potentially biased
parent or teacher reports," said Hinshaw, "and it is important
to study girls on their own terms without an explicit focus on
differences from boys." He is midway through a five-year
continuation study of the summer camp girls.
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