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ADHD: Not Just a Boy's Disorder

"What are little boys made of?
‘Snaps and snails, and puppy-dogs' tails...
What are little girls made of?
‘Sugar and spice, and all that's nice."

Mother Goose Rhyme

Society has always had different images of boys and girls.

From the time he is a toddler a boy is expected to be physically active and to "play until he drops." As parents, we may not be overly concerned if our son has difficulty sitting still in school and in taking time for homework unless symptoms of conduct disorder or failing grades also occur.

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Behavioral expectations for our daughter are different. Even if she is a tomboy or a daydreamer, as long as she gets adequate grades and does not act up in school we will not usually look for emotional or physical problems.

As a result, girls are significantly less likely to be diagnosed with and receive appropriate early treatment for Attention Deficit Hyperactivity Disorder (ADHD).

Ten boys are likely to be referred for ADHD evaluation for every girl considered for this diagnosis. This is despite the fact that this disorder is thought to occur only two to three times more often in boys than girls.

Not only does this failure to appropriately identify ADHD girls affect future school performance, but it compromises development of social skills and substantially increases risk for depression, substance abuse, tobacco use, and sexual acting out.

Lack of Visibility

ADHD is a condition associated with altered brain functioning and characterized by both "noisy" -- hyperactivity and impulsive behavior -- and "quiet" symptoms involving difficulty paying attention.

Girls tend to manifest the quiet symptoms more than their male peers.

A 1999 study showed that among girls diagnosed with ADHD, only 7 percent had the predominately hyperactive and/or impulsive symptoms that characterize many boys with this disorder. Among the other girls, 29 percent had the predominately inattention type, while 59 percent combined inattentiveness with hyperactivity and/or impulsivity symptoms.

In addition, even for those who exhibit the same symptoms of ADHD – restlessness, inability to concentrate, difficulty following directions, fidgeting, or excessive chatting – girls are only half as likely to call attention to themselves by being disruptive in school or at home as their male counterparts.

It is understandable that teachers are often distracted by the noisy symptoms and miss the child who may be daydreaming or who are just very smart and not interested in the subject matter.

And many of these daydreamers and bright underachievers are female. By conservative estimates, at least one million girls and women in the United States have ADHD.

More Than Just Low Grades

School years are about more than developing academic skills. They are a unique opportunity to build self-esteem.

For children who have undiagnosed and untreated obstacles to learning, feeling good about themselves is sometimes impossible. Self-doubt builds as negative feedback from peers, teachers, and parents accumulate. As hard as they try, they cannot change their behavior without help.

And they cannot get help until they are properly diagnosed.

The frustration of having an untreated learning disorder affects all aspects of a young life. The pain of being different can lead to anxiety, depression, and self-medication through early alcohol, tobacco, and other drug use.

Girls with undiagnosed ADHD have difficulty developing basic social skills, including making friends; experience conflict with parents; often will engage in early sexual activities; and are at greater risk for substance abuse and beginning to smoke at an early age than even males with ADHD.

In addition, when girls with ADHD are referred for assessment, they are three times more likely to be diagnosed with and treated for depression than their male peers.

It is important that parents, teachers, doctors, and other adults who see girls in a variety of contexts be alert to the hidden symptoms of ADHD. This may mean engaging the "inattentive" student in a dialog and finding out what the obstacles are to focusing.

Sometimes these difficulties can be alleviated with medicine or behavioral modification. Other times, a change in learning environment may be needed that is more compatible with a student's learning style or interests.

Finally, asking the right questions may reveal distractions that have to do with problems at home with parental unemployment, divorce, physical or mental illness, or substance abuse.

Whatever the effort needed, it is certain that the payoff will be worthwhile.

A Personal Note

ADHD has always held a personal fascination for me. The diagnosis did not exist when I was in school many decades ago and I often wonder how my life would have been different if it had been.

I was one of the quiet inattentive bright kids who mobilized enough focus to "just pass" exams. By the end of junior year in high school I ranked in the bottom quarter of my class and was expert in avoiding being called on by teachers. I couldn't wait until I graduated or was old enough to quit school.

Periodically my advisor would suggest switching to nonacademic courses. I would promise to "do better" because I knew my parents would be both angry and embarrassed if I wasn't college bound. They never checked and I just continued my C and C-minus grades.

My senior year was a dramatic turn around. I earned a 97 average even though I didn't study much harder.

Key was an English teacher who drew me aside and asked me to write for the school yearbook. I started writing every day and she read and fed back her comments and encouragement. I still have those essays. They were full of adolescent angst and pain over being different. What counted for me was that my words were valuable to this woman and that she encouraged me to find my own style.

Somehow her belief in me spilled over into the history, physics, chemistry, and French classes I was taking. Perhaps I was less depressed. Perhaps I was smart enough so that it didn't take much attention to do well in high school.

I went to a small college and had professors who also dealt one-to-one. I went on to become the editor-in-chief of the college newspaper and led the first student rebellion of the 1960s. Later I taught sociology at a major university and became a psychotherapist.

I still have ADHD and can drift into inattention easily. But I know what I am good at and have found ways to generate internal rewards.

It would be helpful to find out how others have coped and are coping with this disorder. If you are a parent or teen with ADHD and would like to share your story, please send it to (fill in the Aspen Publication Address).

Copyright 2002 Judy Shepps Battle

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