Understanding Girls with AD/HD: Symptoms and Strategies
By Kristin Stanberry
From SchwabLearning
Girls with AD/HD often suffer in silence — and remain undiagnosed. When their symptoms finally surface, they can be dangerous. Learn what to watch for in your daughter -- and how to help her.
Mrs. Dawson's fourth-grade students assemble in small groups to work on a project. She asks Steven and Julie to join three other students. A mother helping in the classroom notices Steven is better behaved than during her last visit. While he still wriggles in his seat and occasionally interrupts a classmate, he doesn't pound his desk and talk non-stop like he used to. He also smiles now and is more cooperative. Julie is her usual chatty, polite self. She smiles and waves her hands as she talks to the group. Today, though, the other girls in the group seem annoyed with Julie. When the group session is over, Steven sits attentively at his desk in the front of the classroom. Julie's smile has faded and she stares out the window.
What's going on with Steven and Julie? Steven was diagnosed with Attention Deficit/Hyperactivity Disorder (AD/HD) four months ago. His teacher has made classroom accommodations, such as allowing him to sit up front where he'll be less distracted. He's taking medication and being coached on his behavior. His self-esteem grows as he succeeds in his school work and relationships.
What no one knows is that Julie also has AD/HD. She struggles to please others, but they don't seem to understand her friendly overtures. Determined to be a good student, she spends hours on homework because daydreams get in the way. Her self-esteem is sinking as she questions her academic and social abilities. Julie suffers in silence.
Squeaky Wheels Get the Grease
Many people think of AD/HD as a boy's disorder. In fact, some studies estimate at least six times as many boys as girls are referred to clinics for diagnosis. But field studies suggest that, in the general population, the actual ratio of boys to girls with AD/HD is 3:1. To understand why this disparity exists, we must understand how professionals have traditionally defined and diagnosed AD/HD — and how that view is changing.
For many years, hyperactive and impulsive behavior was considered the primary trait of children with AD/HD. Since many more boys than girls fit that description, they've been much easier to diagnose and treat. This also explains why most AD/HD studies have focused on boys. Then in the 1980's, researchers discovered a population of boys who were inattentive but not hyperactive or impulsive. With this discovery, the definition of AD/HD was updated and now includes 3 different types:
- Inattentive
- Hyperactive/impulsive
- Combined type (a combination of the first two types)
The inattentive type of AD/HD is harder to diagnose in both boys and girls since their behavior doesn't "give them away." Bright, inattentive girls often compensate for inattention by becoming super-organized or hyper-focused on school work. Such girls often succeed in school, but their private struggle remains a secret.
Girls who are hyperactive and impulsive are rare. Some hyperactive girls are seen as tomboys and have a better chance of being diagnosed. Other hyperactive girls aren't overactive in a physical sense; they're super-talkative "social butterflies" instead, like Julie whom we described earlier.
Set Up by Social Expectations
Having AD/HD seems to impair girls' social relationships far more than it does for boys. As Janet Giler, Ph.D., points out, "Males and females, in general, operate by different social rules…Female social rules place a greater value on cooperation, listening, care-taking, and relationship maintaining activities …It would make sense that the traits of ADHD might make females seem less cooperative." As a result, girls with AD/HD suffer more peer rejection.
Remember Julie? While friendly and well-meaning, she often gets distracted while a classmate is talking to her. She misses the other person's social cues, and doesn't respond in a desirable manner. Boys tend to be more direct with each other and resolve their conflicts more openly, so a boy with AD/HD doesn't require the same set of social skills. A girl who is both impulsive and inattentive is likely to commit many social blunders.
Mothers often expect their daughters to conform to the standards of society by being especially thoughtful, polite, and compliant. If a girl has AD/HD, this can be a difficult goal to attain.
Brain Differences in Boys and Girls
Researchers have found girls' brains differ from those of boys in several ways, including weight, size, and the relative proportion of certain structures in the brain. This difference may explain why males and females generally display different strengths and weaknesses. It may also account for the different types of AD/HD symptoms they display. Research in this area is ongoing.
When Hormones Wreak Havoc
AD/HD is often hard to detect in girls until they reach puberty and hormone changes can cause dramatic mood swings and disruptive behavior. A girl who has kept her AD/HD hidden until puberty may appear to "erupt" suddenly when female hormones flood her body. Because the current criteria for AD/HD state symptoms must be present before age 7, many doctors dismiss the possibility of AD/HD in girls whose symptoms don't appear until puberty.
By contrast, hyperactive/impulsive boys who've been treated for AD/HD since their early years often calm down when they reach puberty. For them, hyperactivity mellows into restlessness
The Emotional Cost of Under-Diagnosis
Girls whose AD/HD isn't diagnosed and treated by the time they reach puberty are at risk for developing other psychological disorders, such as anxiety and depression. This is understandable, since many girls have spent their lives suffering, struggling, and blaming themselves for poor academic performance and peer rejection. As girls mature, they tend to internalize their feelings, making their struggle less noticeable to adults who might help them. Adolescent girls who don't receive help for AD/HD and co-existing psychological problems are at high risk for addictive behaviors, such as over-eating, smoking, alcohol abuse, and sexual promiscuity.
Help and Hope for Girls with AD/HD
Clearly, better methods for diagnosing and managing AD/HD in girls are needed. Fortunately, many professionals are working toward this goal. They have found, for example, that because a girl's outward behavior can mask her AD/HD, having her answer certain questions (self-reporting) can help make a proper diagnosis.
Professionals have also found some methods that are especially effective for managing AD/HD in girls, including:
- Group counseling with other girls who have AD/HD. This allows girls to support and learn from each other while improving social skills within a peer group.
- Coaching for AD/HD by a trained adult outside the family. Having a mentor provides support beyond what the girl gets at home and can relieve pressure on her family relationships.
- Understanding and support from mothers. Mothers who understand the impact AD/HD has on their daughters may be more effective in steering them, not forcing them, toward success.
As professionals pay more attention to the traits and needs of girls with AD/HD, we can hope for earlier diagnosis and more effective treatment. Parents can help by staying abreast of the research in this area — and by staying in close touch with their daughters.
