From the NYU Child Study Center: Ask the Expert
Why are Girls with ADHD Overlooked, Underdiagnosed, and Underserved?
By Glenn S. Hirsch, M.D.
Boys with ADHD are usually easy to spot because of their behavior—they
are more likely than girls to have the combined type of ADHD: hyperactive,
impulsive, and inattentive behaviors. On the other hand, girls are more likely
to have the attentional type of ADHD, which leads to difficulty in attending
and focusing rather than disruptive behavior.
Because they don’t disturb the rest of the class, it often takes longer for
girls to get a diagnosis of ADHD and to get the help they need. Boys are three
times more likely to be diagnosed with ADHD than girls; as many as 50 to 75% of
girls with ADHD are missed. On average girls are diagnosed with ADHD five years
later than boys (boys are generally diagnosed at age 7 and girls at age 12).
Here’s the good news: educators, mental health researchers, and parents are now
becoming aware of the unique needs of girls with ADHD.
Many girls with ADHD can slip by without notice in the early school years, but
they’re likely to run into trouble in the middle and high school years. When
they have to deal with increased demands in organization, planning, memory, and
independent study, their psychological problems may become more apparent. In
fact, older adolescent girls with ADHD have been found to have more depression
and anxiety than girls without ADHD. Adolescence brings challenges for all
girls; and even well-adjusted, non-ADHD teenage girls report more stressors in
life than boys. Thus, teenage girls with ADHD have a double risk for
psychological problems since they have to deal with both social and academic
pressures.
Teachers should be alert to the specific symptoms of ADHD in girls, such as
poor concentration, easy distractibility, difficulty focusing, disorganization
(i.e., messy backpack and loss of schedules or homework), and forgetfulness
(i.e., forgetting to hand in papers or take assignments home). Other possible
clues include nonstop talking, bossiness, interrupting others, slow to pick up
social cues, and difficulty paying attention to multi-step directions.
Teachers can use strategies such as seating the student in front of the room to
make sure her attention is not drifting; giving her a task to help her refocus;
having her buddy share; and teaching social conventions explicitly (i.e., how to
join a group or give a compliment). To help her organize, provide her with
folders and notebooks; break down work into simpler component tasks; assign
classroom responsibilities to make her feel important; and teach calming techniques,
such as deep breathing and visualization, when she is overstimulated.
Parents can help by making sure their daughter is correctly and promptly
diagnosed and that she gets the most effective treatment. According to experts,
treatment should combine stimulant medications with behavioral therapy that provides
structure, teaches organizational skills, and rewards desired actions.
Treatment for girls should be designed to target their particular
vulnerabilities and may also include individual, group, and/or family therapy
and school support.
As identification and treatment strategies specifically tailored to the needs
of girls with ADHD are developed, more girls with ADHD can look forward to
healthy and productive lives.
This monthly column provides educators, parents and families with important
information about child and adolescent mental health issues. Please submit
questions for ASK THE EXPERT to Glenn S. Hirsch, M.D., Medical Director at the
NYU Child Study Center at glenn.hirsch@med.nyu.edu.
To subscribe to the ASK THE EXPERT Newsletter or for more information about the
NYU Child Study Center, visit www.AboutOurKids.org or call 212-263-6622.#
