by Dr. Robert Myers, Child Psychologist
"I never suspected my nine-year-old daughter's inability to concentrate was due to ADHD," said Diane, the mother of three girls. "She isn't 'hyper' or noisy-in fact, just the opposite. Kayla is the middle child-she's quiet and tends to daydream a lot. We were frustrated because she couldn't ever seem to concentrate or get her schoolwork done...But we were still really surprised when our pediatrician finally diagnosed her with ADHD last year."
When many people hear the term ADHD, the first thing that usually comes to mind is a young, out-of-control boy running all over the place or having a major meltdown at the mall while his frantic parents try to calm him down. Unless you personally know a girl struggling with this disorder, the "wound-up boy" is the image most associated with ADHD. Of course, one reason for this is the fact that boys with the diagnosis outnumber girls by a whopping 3 to 1. Another reason is that ADHD in girls is more often associated with impaired attention and concentration-girls who are labeled as either "dreamy" or "spacey," rather than hyperactive and impulsive.
Unfortunately, research has shown that this stereotype often leads parents, teachers, and health professionals to misdiagnose girls with depression or anxiety. Sometimes the significant difficulties they're experiencing are dismissed altogether. Whether boy or girl, a child who has trouble learning and maintaining healthy peer relationships is more likely to be ignored, while the child exhibiting disruptive behavior is not only more likely to be noticed, but also more likely to be referred for evaluation and treatment. The sad result is that girls are often under-treated, which results in years of suffering in silence, and subsequently leads to self-doubt and low self-esteem. Recent studies have even shown that women with ADHD suffer from depression much more frequently than men with the same disorder.
Slipping Through the Cracks
Here are some signs to look for that may indicate ADHD:
- Gradual or sudden decline in academic achievement
- Forgetting to turn in homework assignments
- Easily frustrated when learning something new
- Always losing personal possessions or leaving things all over the house
- Trouble making friends
- Easily upset over minor incidents
- Overly anxious about trying new things or minor changes in routing or surroundings
What else could be causing these symptoms?
- Sometimes normal child development or a child's temperament
- Undiagnosed learning disabilities
- Adjustment disorder
- Anxiety disorder
As ADHD children get older, boys are more likely to receive additional diagnoses of disruptive or conduct disorders. Boys and girls appear to have an equal opportunity to have co-occurring anxiety and depression. However, ADHD girls seem to be more likely to smoke or drink than ADHD boys during the teen years. Another recent study has shown that they are more likely to have eating disorders.
One answer to the problem of misdiagnosing ADHD is for educational professionals to get additional training to be better able to spot the disorder sooner, as early intervention can prevent more serious symptoms down the road. Mental health professionals also need to develop instruments that may be more sensitive to detecting ADHD in girls. This will require shifting some resources to more in-depth research on the diagnosis and treatment of the disorder in girls.
What You Can Do for Your ADHD Girl Right Now
If you are the parent of a girl with ADHD, you need to work closely with teachers. Don't put off addressing problems related to poor academic achievement or your daughter's difficulty getting along with other kids. Whether the school is concerned or not, you should be an advocate for your child and insist on an evaluation to determine the cause of her difficulties. Whether they are related to ADHD, learning disabilities, anxiety, delayed maturation--or a combination of one or more of these--the sooner the cause is identified and appropriate interventions are initiated, the better for your child.
Another good reason to have ADHD diagnosed early in both girls and boys: Once everything is out in the open, the "blame game" can stop and help can begin. An early diagnosis ensures parents and children that no individual is the cause of the problems. Rather, the child has a brain difference that can be addressed and improved.
You should not be afraid to seek help, thinking that your child will immediately be placed on medication. Depending on the findings of the evaluation, special education and/or psychological treatment may be sufficient to turn things around and keep your child moving in a positive direction.
School is often a source of anxiety for kids with ADHD and for their parents. Perhaps your child's lack of concentration skills and difficulty following through on projects makes it hard for her to feel good about school. The good news is, when a student meets the eligibility criteria for special education services set forth in federal and state guidelines, an Individual Educational Plan (IEP) will be developed and implemented. Even when a student may not meet criteria for special education, they may be eligible for counseling and classroom modifications to help them improve their academic achievement, as well as develop a more positive self-concept and get along better with other kids and adults.
Early Intervention Helps.
Does Your Child Need to be Medicated? Maybe Not... While there is no doubt that there is a group of ADHD kids with moderate to severe symptoms who definitely need to be on medication, there is also a group with only mild to moderate symptoms that will be fine with only psychological treatment. The unanswered question is how to accurately determine to which group your child belongs.
Girls in particular will benefit from interventions that develop improved attention, concentration and memory functions. They also thrive on the techniques that reduce anxiety and increase self-esteem and confidence. Learning to use problem-solving to cope with difficult situations and relaxation to help with frustration is also very helpful. Girls are usually quick learners when it comes to learning and applying specialized training in social skills.
When considering psychological treatment, the key to success is intensive and comprehensive treatment. Parents are often drawn to products that promise a quick and easy fix. Your best bet is to choose a program that provides a psychological treatment that is based on not one, but a combination of research-supported modalities that are sufficiently intense and comprehensive to provide the desired results. The sooner you can get your child the help she needs, the better off she will be in the long run.
Under the Radar: How Girls with ADHD Go Undetected reprinted with permission from Empowering Parents. For more information, visit www.EmpoweringParents.com
Author: Dr Robert Myers is a child psychologist with over 25 years of experience working with children and adolescents with Attention Deficit Hyperactivity Disorder and learning disabilities and is the creator of the Total Focus Program www.trytotalfocus.com. Dr Myers is Associate Clinical Professor of Psychiatry and Human Behavior at UC Irvine School of Medicine. "Dr Bob" has provided practical information for parents as a radio talk show host and as editor of Child Development Institute's website, 4parenting.com which reaches 3 million parents each year. Dr. Myers earned his PhD from the University of Southern California.
Reviewed by athealth on February 8, 2014.