Articles of Interest:
An AD/HD Mother's Resolutions
Attention Deficit Disorder in Girls Often Missed
by Kathleen Nelson, Women's E-news, December 13, 2002
The largest study of preteen girls with Attention-Deficit/Hyperactivity Disorder indicates that it is more common in girls than previously thought. When undiagnosed, girls with the disorder are likely to face academic and social difficulties.
The number of girls with a common disorder that can dramatically alter academic performance and peer relationships apparently has been significantly underestimated.
Teachers, parents and medical professionals often associate Attention-Deficit/Hyperactivity Disorder, known as ADHD, with hyperactive and impulsive behavior. Girls are more likely, however, to have a form of the disorder termed inattentive type ADHD, characterized by distractibility.
Recent research suggests teachers and parents may not recognize it the disorder in girls. Now, between 1 percent and 2 percent of girls ages 5 to 18 are thought to have ADHD, at least 30 percent to 40 percent higher than previously believed.
According to the advocacy organization Children and Adults with Attention-Deficit/Hyperactivity Disorder, ADHD affects 3 percent to 5 percent of school-age children.
But some, particularly girls, minorities and rural residents, are under-diagnosed. However, white upper-class boys, who actually have the illness three times more often than girls, may be misdiagnosed as having the disorder five to ten times more often, said Stephen Hinshaw, a child psychologist at the University of California, Berkeley and author of a surprising new study appearing in the October issue of Journal of Consulting and Clinical Psychology.
"Girls with ADHD are impaired across multiple domains," Hinshaw said. "Their behavior is less controlled. There is clear peer rejection. They achieve behind grade level academically and their parents report an uncertainty about how to discipline their girls."
"This isn't just troublesome girls," Hinshaw added. "It's a real condition with real consequences."
Adding to the significance of Hinshaw's findings, other research, announced in this month's British Journal of Psychiatry, found that although more boys than girls are diagnosed ADHD, girls with ADHD are twice as likely to be hospitalized later with mental disorders.
Girls with ADHD were found almost seven times more likely than ADHD boys to develop schizophrenia as adults, and five times more likely to develop a mood disorder, such as depression, the study's authors reported. The ADHD girls were found 18 times more likely to have a substance use disorder as adults.
"Early intervention . . . in childhood will reduce the risk of a later psychiatric admission, both in girls and boys," said Dr. Soren Dalsgaard, the study's lead author.
In the Hinshaw research, researchers coordinated a day camp in which counselors observed a mixed group of girls ages 6 to 12 as they interacted in art, drama, classroom and outdoor activities.
Information is Flying Right through Their Brains
"Historically girls have been taught to play the role of good student, which means looking like you're paying attention," says Jerome Schultz, a clinical neuro-psychologist who specializes in diagnosis of ADHD. "But information is flying right through their brains and they're catching a small percentage of what the teacher or other kids are trying to deliver."
Lori Berry's daughter Shawna participated in the camp. "The thing I'm upset about is that parents don't know their kids have ADHD and physicians don't properly diagnose it, so the kids are ostracized and hammered at for being lazy," Berry said. Shawna exhibited active and impulsive behavior problems before kindergarten, but was not diagnosed until age 11.
Schultz doesn't think alternative school placement is necessary unless the condition is severe, but has two suggestions for mainstream classrooms: Teachers should be sensitive to the fact that girls are more likely to exhibit ADHD without hyperactivity and can look very good in the classroom until exam time; second, teachers should make girls diagnosed with ADHD aware they have this condition and empower them to develop individual strategies.
"Many young girls with ADHD have an outside shell that looks spacey or winsome and hide their insecurity, but inside they're ready to fall apart or explode," says Joan Teach, who runs the Lullwater School, a private school for students with ADHD in Decatur, Ga. She mentors students in brainstorming, analyzing tasks and segmenting projects, imparting both academic and life skills. "The biggest thing I want to teach the girls is self-advocacy."
ADHD Girls Quickly Become Isolated
Beyond academic success, the ability to make friends is critical for young girls. Several times during Hinshaw's summer camp, each girl confidentially nominated three campers she most liked and disliked, using photographs of her classmates.
"Within a week the girls with ADHD were the most disliked," Hinshaw said. "If in elementary school you are consistently disliked, that is the best predictor of you becoming delinquent, of not finishing school, and of having mental-health problems in adulthood," he said. "It predicts devastating outcomes and also points to the importance of social relationships for later development."
But it does not have to be this way.
"Most girls with ADHD think they're different or not as good as everybody else," says Shawna Berry, now 16. A special education assistant helped her study and pay attention, as well as avoid confrontation. "I used to stay in a corner and keep to myself in elementary school," she said, "but I learned that I could be just as popular as the next person."
Accurate Diagnosis Is Critical
Much of Carol Sadler's time is spent teaching parents to advocate for their daughters as coordinator of a Children and Adults with Attention-Deficit/Hyperactivity Disorder chapter in Atlanta. Managing their child's needs, including meetings with schools, counselors, doctors, and lawyers, can be overwhelming. She helps them negotiate federal laws that entitle children with ADHD to "a free and appropriate public education," which requires a customized individual education plan and may call for academic and behavioral tutoring from a classroom aide or modified instructions in class assignments and testing.
The cause of ADHD isn't well understood, but those with it have altered brain activity, and there is a proven genetic component (Sadler and Teach were both diagnosed after their daughters were, and Berry describes herself as "the most disorganized and inconsistent person"). Parenting practices don't cause ADHD, but can exacerbate or improve it.
In order to be accurate, "diagnosis should be confirmed on multiple, objective measures, rather than potentially biased parent or teacher reports," said Hinshaw, "and it is important to study girls on their own terms without an explicit focus on differences from boys." He is midway through a five-year continuation study of the summer camp girls.
For more articles like this visit http://www.bridges4kids.org.
For more information:
Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD): http://www.chadd.org
National Institutes of Mental Health--"Attention Deficit Hyperactivity Disorder" http://www.nimh.nih.gov/publicat/adhdmenu.cfm
Mental Health: A Report of the Surgeon General--"Attention-Deficit/Hyperactivity Disorder: http://www.surgeongeneral.gov/Library/MentalHealth/chapter3/sec4.html
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