Girls with ADHD: A Different Kind of Deficit

When many people think about somebody with ADHD, they picture an extremely active little boy who has trouble sitting still in school and disrupts his class. In fact, statistics seem to point to the idea that boys make up the overwhelming majority of kids with ADHD, with maybe the occasional tomboyish girl thrown into the mix. However, it's becoming clear in recent years that ADHD occurs in girls just as much as in boys, but may manifest itself in different ways. Girls with ADHD come with their own set of challenges, and without help and guidance, they are likely to experience many failures and disappointments as they grow older. Teachers can make themselves aware of how ADHD affects girls, so that they can help the girls in their classrooms to succeed.

The statistics about the ratio of boys versus girls with ADHD vary greatly, with studies showing that boys are anywhere from three to nine times more likely to have the disorder. (Staller, 2006.) But studies also show that by adulthood the ratios equal out, with equal numbers of men and women being treated for ADHD. (Adams, 2007.) What happens to that ratio, between childhood and adulthood?

One reason may be that most studies on the numbers of children with ADHD are done by counting clients at psychiatric clinics. (Staller, 2006.) Only the children whose behaviors are the most disruptive end up being referred to these clinics, and these children tend to be boys. A sampling of the general community might show a more equal number of boys and girls with ADHD.

Another factor is that girls with ADHD are vastly underdiagnosed. Girls with ADHD are diagnosed an average of five years later than boys, with the average age of diagnosis being seven for boys and twelve for girls. (Adams, 2007.) And fifty to seventy-five percent of girls who have ADHD never get diagnosed at all.

Why do girls with ADHD get overlooked so often? The main reason is that ADHD manifests itself differently in girls than it does in boys. However, because there is no biological test for ADHD in existence, ADHD is diagnosed via a list of criteria. (Staller, 2006.) And the criterion is derived from the male symptoms of ADHD. The basic criteria for a diagnosis of ADHD are hyperactivity, impulsivity, and inattentiveness. Girls with ADHD have these symptoms, but often on a less intense level. When compared to girls without ADHD, girls with ADHD have the symptoms more severely... but when compared to boys with ADHD, girls' ADHD may not measure up.

Boys with hyperactivity tend to fidget a lot, have trouble playing quietly, leave their seat often, and act impulsively. In girls with ADHD, hyperactivity and impulsivity may show up in the form of a girl who talks nonstop, even when asked to be quiet during class; who interrupts often or blurts out answers; or who has trouble controlling her emotions. (Adams, 2007.) These behaviors may be disruptive, but often are not disruptive enough to cause a teacher to suspect ADHD.

On the other hand, girls with ADHD are more than twice as likely as boys with ADHD to have the inattentive type. A child with the inattentive type of ADHD has an unusual level of trouble with sustaining attention, following multi-step directions, or focusing on a lecture that goes on for more than a few minutes. (Adams, 2007.) Inattentiveness also may show up in the form of careless work, disorganization, distractibility, forgetfulness, and avoidance of unpleasant and boring tasks. (Staller, 2006.) These symptoms can impair any child's ability to learn.

However, it is important to note that girls tend to be people-pleasers... even those with ADHD. (Quinn, 2005.) Girls with ADHD often work extra hard in order to compensate for or hide their symptoms, because they strongly wish to please their parents and teachers. This isn't too difficult for girls in younger grades. But as they get older, and the expectations and demands increase, girls have a harder time coping on their own. Impaired academic function can begin to show itself in a girl with ADHD. (Staller, 2006.) But even if teachers do notice that girls are lacking behind, they often give girls the benefit of the doubt, assuming that the girls' deficits are caused by immaturity or lack of academic ability. (Adams, 2007.)

If, and when, a girl's inattentiveness symptoms do come to light, it may be too late for the girl to get a diagnosis of ADHD. The diagnostic criteria for the inattentive type of ADHD requires that the symptoms appeared before age seven. (Staller, 2006.) So, the longer a girl has been able to cope with and compensate for her inattentiveness, the more difficult it will be for her to get a diagnosis.

Why is it so important for girls to be diagnosed, anyway? When children get diagnosed with ADHD, they are able to get the extra help they need to succeed in school and life. Different teaching styles, behavior plans, and medications can help kids with ADHD. But those who remain undiagnosed, trying to deal with their symptoms and challenges completely on their own, will have a harder time in life.

Girls with ADHD are more likely than other girls to have problems with anxiety, depression, and withdrawal. (Quinn, 2005.) In fact, as they grow older, they may be diagnosed with dysthymia, depression, bipolar disorder, etc. Women with ADHD who do not get diagnosed until adulthood have more problems with depression, stress, anxiety, low self-esteem, etc, than girls diagnosed with ADHD as children or males diagnosed at any point.

Girls with ADHD also have more social problems than boys with ADHD. (Staller, 2005.) Girls with the combined type of ADHD are often rejected by their peers, possibly because they can be bossy, interrupt a lot, and have trouble picking up social cues. On the other hand, girls with the inattentive type tend to be socially isolated. They may not be teased or blatantly rejected by their peers, but they may not be noticed, either.

In fact, for girls with ADHD, social problems can outweigh school behavior problems. Boys with ADHD have trouble following normal classroom procedures. But on the playground, their social rules are less strict and their games are more physical. Girls with ADHD have a more complicated social world to navigate, and their social problems may follow them as they get older.

Whether or not a girl is actually diagnosed with ADHD, teachers can be on the lookout for girls with symptoms such as nonstop talking, friendship trouble, inattentiveness, extreme messiness or disorganization, unfinished work, and emotionality. (Adams, 2007.) Here are some tips for helping girls with ADHD do their best.

Build "buddy-sharing" and other opportunities for interaction into the lesson, to give kids an acceptable outlet for talking during class.

Encourage the entire class to be patient and generous with other people's differences.

Teach social skills, such as how to join a group and how to give compliments.

If a child is inattentive during a lesson, give her a job to focus on, such as having her pass out or collect papers.

Consider shortening lectures.

Teach the whole class what paying attention looks like, and practice together.

Use a secret word or signal to draw a child back in when she starts to drift off and daydream.

Reduce the paper flow in the classroom, giving kids less to keep track of.

Post homework assignments, and other information, online.

For children who have trouble with neatness in their handwriting or projects, let them show what they know with alternative assignments that don't necessarily require neatness.

Break down schoolwork into smaller, more manageable tasks, and give them one at a time.

Reduce the number of problems in assignments, for kids who have trouble finishing their work.

Help everyone, including girls with ADHD, to feel included in the class. Make your classroom a safe place.

Teach calming techniques and ways to control emotions.

Teach the entire class to be sensitive and respectful to others' feelings. For instance, calling someone a crybaby... even if that person cries at the drop of a hat... should be unacceptable.

Girls with ADHD experience it differently than boys do, but that doesn't mean they don't have special needs. By recognizing the different symptoms and challenges for girls with ADHD, teachers can help everyone to do their best.

Sources

Adams, C. (March 1, 2007). Girls And ADHD. Instructor, 116(6), 31-35.

Quinn, P. O. (February 18, 2005). Treating Adolescent Girls and Women With ADHD: Gender Specific Issues. Journal of Clinical Psychology, 61(5), 579-587.

Staller, J., et al. (November 2, 2006). Attention-Deficit Hyperactivity Disorder in Girls: Epidemiology and Management. CNS Drugs, 20(2), 107-123.