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By Joyce Heid

Thought to be more common among boys, ADHD affects an equal number of girls. It just looks different.

Beth Walker knew her daughter had a problem.
“When my daughter was very young—maybe 2 or 3—I knew she was different in temperament and pace. She was a dreamy, gentle child. At the same time, she was very sensitive to loud sounds, bright light. Any significant sensory input was overwhelming,” recalls Walker.
Her behaviors escalated as she grew older.
Walker explains, “Because I knew she was different, I kept a sharp eye on the entire grade school process. She tested into the school’s talented and gifted program at an early age. My daughter coped until about fifth grade, where she went from an A student to a struggling student, crying a lot, and desperately unhappy.”
Dr. Carol Robbins’ daughter Kathryn can sit for hours reading a book. Yet her difficulties began in third grade when, as Robbins describes, “She was beginning to struggle academically. We noticed it earlier, but the academic impact became more noticeable in third grade.”

These two different girls share the same disorder—attention deficit hyperactivity disorder or ADHD. Both of their mothers knew something was different about how their daughters’ minds worked.
The National Institute of Mental Health estimates that between 3 and 5 percent of children have ADHD, or approximately 2 million children in the United States. In a typical classroom of 25 to 30 children, it’s likely that at least one child will have ADHD.
While it is commonly believed that ADHD, which frequently overlaps with a diagnosed learning disability, predominately affects boys, “There really are no statistics to say that it is so,” according to Ben Shifrin, head of the Jemicy School for students with dyslexia in Baltimore.
Historically, it’s just more common for boys to be diagnosed, as their symptoms are typically more overt and disruptive.

In fact, 15 years ago, 80 percent of the students with ADHD at the Jemicy School would have been boys. Today, Shifrin finds a ratio of 50:50.
“Due to education, better teacher training, and increased awareness more girls are [being] diagnosed. Parents and educators are also more aware it is just as much an issue for girls as boys in education.”
Typically, most people think ADHD is the inability to focus.
Shifrin explains, “In reality, ADHD means the child is focusing on everything.”

There’s just too much going on, and the child cannot concentrate on just one stimulus. The child hears the teacher, the traffic outside the window, the students in the hallway, and it just becomes too much.
In response to all this stimuli, Shifrin observes, “A boy with ADHD will start tapping his pencil, kick a chair, while a girl with ADHD just wanders off into space. The same thing is going on, the behaviors are just different. Hyperactivity is just a way to distinguish the inability to focus.”

Frequent daydreaming, difficulty paying attention to detail, forgetfulness, easily losing things, and difficulty following directions are common signs of the inattentive type of ADHD most commonly observed in girls.
Robbins is not only the parent of a son and daughter with ADHD, but also a practicing psychologist in Annapolis specializing in the diagnosis and treatment of ADHD as well as the coordinator of the Anne Arundel County Chapter of CHADD (Children and Adults with Attention Deficit Disorder), and she confirms, “Many girls have the inattentive form of ADHD. It manifests itself differently than in boys. There is no need [for girls] to run around or keep moving.”

While her son with ADHD is stimulated by physical activity, her daughter can be just as easily stimulated by talking or reading.
Because of this, girls with ADHD may not necessarily cause the same disruptions in the classroom. While Robbins’ son could be physically disruptive and entertained the class with paper airplanes before his diagnosis, her daughter displayed behaviors in the classroom typical of many girls.
“She wanted to be a model citizen and do the right thing. Girls are people-pleasers. My son couldn’t care less about pleasing the teacher or being a good classroom citizen. Girls are more motivated by social feedback.”
And like many girls with ADHD, she was disruptive in more subtle ways—talking to classmates during class, passing notes, trying to get the teacher’s attention, and telling others what to do.
Unfortunately, because children with the inattentive form of ADHD often do not disrupt the entire class, their behavior can easily be overlooked or blamed on other disorders.
Walker explains her experience: “When I spoke to them about it, teachers rarely took me and my child’s issues seriously. It was an uphill battle—she felt that she was incompetent and stupid because she just couldn’t do what other children (including her older sister) did with relatively little effort—organize, etc. I know she was diagnosed late because she is a girl, although I think that dreamy boys [as opposed to boys displaying hyperactivity] may also have delayed diagnoses.”

However, if behaviors are ignored it can mean trouble beyond the classroom. A 1999 study funded by the National Institute of Mental Health (NIMH) compared 140 ADHD girls with 122 control girls. The study found those with ADHD displayed higher levels of mood and anxiety disorders consistent with those seen in boys with ADHD than in children without ADHD. The ADHD with ADHD were also at higher risk of increased alcohol and drug usage, including smoking.
A study by Harris Interactive released in August 2002 concurs with the NIMH results. This study explored gender differences in ADHD. Researchers interviewed 3000 people—parents of children with ADHD, adolescents ages 12 to 17 with ADHD, teachers, and the general public—to detail perceptions about the disorder. The findings suggest that, compared to boys with ADHD, girls with ADHD have more trouble making friends, getting along with parents, and feeling good about themselves. It also reported that 55 percent of parents of girls believe that ADHD affects their daughter’s self-esteem a great deal, as compared with 46 percent of parents of boys. In addition, the survey found that girls with ADHD are three times more likely to be treated for depression than boys with ADHD.
The results also revealed that parents of girls were more willing to seek medical assistance for their child’s symptoms than were the parents of boys. In fact, 92 percent of parents of girls were “very willing” to seek help, while only 73 percent of boys’ parents were willing to do so.
And is there a role for medication? Studies show that medication can be effective for boys and girls.
However, Shifrin points out, “All medications do is allow the student to focus on the teacher—you still need a good teacher.”

And medications can have side effects.
Shifrin cautions, “A child can become lethargic, have decreased appetite, be less inclined to do athletics—you have to weigh the side effects.”
He stresses the importance of having a teacher who understands how to connect with a student with ADHD. “If you have a classroom with a teacher who is speaking Chinese,” he notes, “the students will become bored.”
That is how a student with ADHD feels, he explains, like the teacher is speaking a foreign language and he or she just doesn’t understand what is being said. Once bored, the student is overcome with the other stimuli in the room.
Both of Robbins’ children take stimulant medication, but she too believes in the importance of a good teacher. “It is a matter of finding what stimulates them and keeps them calmer,” she says. “Their minds have to be engaged.”
However, in contrast to Shifrin’s viewpoint of the impact of medications on a child’s athletics, Robbins describes, “I have found personally and professionally, that stimulants actually enhance athletic performance for kids—more focus, less ‘picking daisies in the outfield,’ and they can remember more plays [such as in football].” BC

Do You Suspect Its ADHD?
Understanding that ADHD can be present without hyperactive and impulsive behaviors is a critical first step in making early effective diagnosis and treatment possible.
If your child is having problems paying attention at school, seems forgetful and is easily distracted, you may want to consider having her evaluated for ADHD. Start with your pediatrician. The doctor may do the assessment, or he or she may refer you to an appropriate mental health specialist.
And, if your daughter is diagnosed with ADHD, tell her she is not alone! Many women, including Whoopi Goldberg, Cher, and Agatha Christie, share her diagnosis and have obviously found ways to move forward and be successful. As the authors of Delivered From Distraction: Getting The Most Out Of Life With Attention Deficit Disorder and several other books on ADHD, Dr. John J. Ratey and Dr. Edward Hallowell, so perfectly stated, “attention deficit disorder is a highly misleading description of an intriguing kind of mind.”

Find Out More about ADHD
CHADD (Children and Adults with Attention Deficit Disorder). Local support groups offer information and support, including monthly meetings and speakers. Members may borrow books, audiocassettes, and video tapes from their chapter library. 301-306-7070, 800-233-4050,
Individual Differences in Learning Association. This group provides information and support for the parents and teachers of highly able children with learning disabilities including ADHD.

For More Reading
Beth Walker was so motivated by her daughter’s experience that she wrote a book for girls and their families about ADHD. The Girl’s Guide to AD/HD: Don’t Lose This Book! (Woodbine House, 2004) provides comfort for girls with ADHD and works as a valuable tool for parents and educators.
Another recommended book is by Kathleen Nadeau, Ellen Littman and Patricia Quinn, Understanding Girls with AD/HD (Advantage Books, 2000).

© Baltimore’s Child Inc. September 2008

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