Scotty’s parents and teachers could see symptoms of his ADHD as early as the first grade. The 6-year-old constantly chattered and asked questions. He couldn’t seem to stay in one place. And his play with other children was often too intense for them. He was, said one teacher, a “handful.” Scotty’s 10-year-old sister Jane, however, seemed to be the perfect child and student. She was quiet, respectful, and never caused a problem. But suddenly, in the fifth grade, Jane began to have problems. She seemed to have trouble concentrating. She didn’t finish simple assignments. And her teachers said that she always appeared to be daydreaming.
How Girls Get Missed
That is exactly the problem, says Michael Reiff, M.D., FAAP, pediatrician and editor-in-chief of the parents’ handbook, ADHD: A Complete and Authoritative Guide. “People notice boys’ behavior because it disrupts classes, but girls exhibit [ADHD as] inattention that goes undetected,” he says.
ADHD is the most commonly diagnosed behavioral condition in children, affecting 6 to 9 percent of school-age youngsters, according to Dr. Reiff. But diagnosing ADHD is neither simple nor always the same.
“Boys’ ADHD behavior typically begins to be observed in kindergarten and the first two grades, when they are learning to read,” he says. “For girls, however, ADHD inattention is more observable when they have to begin to get content out of books and are reading to learn. That means that girls are less likely to be referred for evaluation and to receive the treatment they need until later.”
Even with correct diagnosis and treatment, girls with ADHD are at a further disadvantage because most ADHD research to date has focused on boys. Little is known about potential differences between boys and girls in ADHD development and treatment.
As noted in ADHD: A Complete and Authoritative Guide, girls with ADHD have been found to have:
- Problems in academic achievement and grade retention
- An increased incidence of special-education placement
- Significant rejection by their fellow students
- A tendency for their parents to adopt authoritarian discipline styles
Help for Your ADHD Daughter
For parents, it is important not to discount the prospect of ADHD just because their child is a girl. Be aware of these factors that may make it harder to notice symptoms, say the experts:
- Some general myths about girls — that they tend to daydream, that they just are not interested in school work — may mask a real problem in a girl’s ability to function.
- Teachers tend not to refer girls for evaluation as often as boys, even when girls’ symptoms are the same as boys’.
- Girls are less likely than boys to receive enough treatment once they have been diagnosed.
If your daughter is diagnosed with ADHD, ask your pediatrician to keep you updated on research about the development of ADHD in girls, as well as the challenges girls with ADHD may confront and the different ways they may respond to treatment.
For more information, talk to your pediatrician, visit the AAP Web site (www.aap.org), and consult ADHD: A Complete and Authoritative Guide (Michael I. Reiff, M.D., FAAP, Editor-in-Chief, with Sherill Tippins, American Academy of Pediatrics)
Treating ADHD—It Takes a Team
Parents, you are not alone. When it comes to effectively treating boys and girls with ADHD, it’s important for parents to know that they are part of a team approach — parents, pediatrician, and teachers. “Pediatricians don’t usually spot ADHD behavior in children during office checkups,” says pediatrician Michael Reiff , M.D., of the University of Minnesota School of Medicine. “We first hear about ADHD from parents who may have observed the behavior or may have heard it from teachers. Pediatricians are, however, very conscious that ADHD is a widespread problem and, once alerted, can ask the right questions and work with parents and teachers to treat it successfully.” Here are some of the questions that your child’s pediatrician may ask you to help diagnose ADHD:
- How is your child doing in school?
- Are there any problems with learning that you or the teachers have seen? Is your child happy in school?
- Are you concerned with any behavioral problems in school, at home, or when your child is playing with friends?
- Is your child having problems completing classroom work or homework?
Evaluating and treating ADHD is not an automatic or one-size-fits-all process. But when parents, pediatricians, and teachers work together, the likelihood for a healthy outcome is greatly improved.
Six ADHD Myths and Misconceptions
There is a considerable amount of misinformation about ADHD, ranging from its causes and diagnosis to long-term treatment. ADHD expert Reiff and his colleagues note that some of the most prevalent misconceptions are these:
- “He’s just lazy and unmotivated.” A child who finds it almost impossible to stay focused at school or complete long tasks may try to “save face” by acting as if he or she doesn’t care or doesn’t want to do the task. That is masking a serious difficulty in his ability to function.
- “He’s a handful (or “She’s a daydreamer…”) but that’s normal. They just don’t let kids be kids.” All children are impulsive, active, and inattentive at times. But a child with ADHD has a serious problem fitting into family routines, keeping friends, avoiding injuries, and following rules.
- “Treatment for ADHD will cure it. The goal is to get off medication as soon as possible.” ADHD is a chronic condition. It does not just go away. From childhood to adolescence to adulthood, ADHD evolves and treatment may need to evolve with it. Getting off ADHD medications is not the goal; dealing with the problem effectively is.
- “He focuses on his video games for hours. He can’t have ADHD.” A child with ADHD may stay focused on the stimulating visuals, sounds, and physical activity of video games, but have real problems dealing with situations where his senses aren’t as stimulated. These can include sitting for long periods in a classroom, organizing complex projects over a long time, and dealing with people in ways that require frequent and subtle changes.
- “ADHD is caused by poor parental discipline.” Poor parenting does not cause ADHD. But it can be made worse by inconsistent limits and other lapses that can confuse the child. There are proven techniques that parents can use to help their ADHD children. Your pediatrician can help you understand these.
- “If a child doesn’t receive the ADHD diagnosis after being examined, she doesn’t need help.” A child may not meet the clinical requirements for an ADHD diagnosis, but still need help through counseling and extra help with her behavior. Remember, too, that ADHD can manifest itself in different ways over many years. The key is to continue helping your child learn to function better at every age.
For a complete exploration of ADHD myths and realities, see ADHD: What Every Parent Needs to Know, edited by Dr. Michael Reiff.
This article was featured in Healthy Children Magazine. To view the full issue, click here.