Girls with ADHD

Much has been documented about boys with Attention Deficit Disorder, (ADD), and Hyperactivity Disorder, (HD), however, as a parent or educator would you be able to recognize a female student with this same diagnosis?  It would be easy to miss because the symptoms do not exhibit itself in the same way that it does with boys.

With the media focus primarily on the impulsivity of male students, girls are often left behind when it comes to recognition of special needs and programs. Why? Because most teachers are familiar with external characteristics, such as unruly behavior, and the less obvious characteristics, like daydreaming or being ‘scatterbrained’, that may be exhibited by female students.   Unfortunately, undiagnosed AD/HD can lead to consequences for the female student that can affect her far into her future.

In her research with girls with AD/HD, Anita Gurian, PhD, clinical assistant professor of Child and Adolescent Psychiatry at the NYU School of Medicine, believes that girls are often around 12 before they are diagnosed, while their male counterparts are typically a much younger age.  Because of the overt characteristics that a boy displays in his behavior, it is more readily observed compared to the subtle, less obtrusive signs a girl shows.

Here is a list of some of the common characteristics that girls may display:

Poor grades despite a high IQ and / or creativity

Low self-esteem

Inability to organize

Poor social skills

Appearing messy or showing a chronically messy workspace

Shyness

Difficulty falling or staying asleep

School avoidance or phobia

Withdrawal within the classroom

Forgetfulness-appearing unfocused

Inability to follow through or complete projects

Distractibility

Test anxiety

Incompletion or missing assignments

Feeling like they don’t fit in

Girls who have an undiagnosed AD/HD suffer from social stigmas more than their male classmates do. While a boy who is disruptive within the classroom can be annoying, culturally we expect boys, especially at the elementary age, to exhibit bursts of impulsive energy, noise and rambunctiousness.

Not so, however, when a female student interrupts with excessive chatter, intrusiveness from maintaining poor boundaries, or is plagued with periods of unexplained and uncontrolled physical outbursts. Besides being misunderstood by their teacher, these girls are often shunned by their peers.

The stigma of being different can result in various issues: Feeling like she does not fit in like other girls; experiencing loneliness, depression and anxiety resulting in school avoidance or phobias; engaging in risky behavior such as smoking, drinking, illicit drugs or promiscuity to ‘prove’ her popularity.

Impulsivity is just one manifestation of the disorder of AD/HD. The other side is the attention deficit. This shows itself as difficulty concentrating on school work; excessive day dreaming; inability to follow through with completing projects; indecisiveness; easy distractibility; organizational problems; forgetfulness; incomplete assignments; and frustration or anxiety in attempts to meet expectations of parents and teachers.

In our competitive society comparison to other classmates is an unfortunate byproduct. Girls who recognize that they are having difficulty with tasks that their peers are achieving experience negative self-judgment and criticism. If not addressed during the developmental growth period these girls may struggle with this for their entire lives never reaching their potential.

Additionally, parents, particularly mothers, may find it difficult to accept that their daughter is different from other girls, adding rejection from one who could act as an advocate.

 It is important for a parent to be aware of how your child is interacting with other children as early as possible.  When there is suspicion that ‘something’ is not right, following up with a competent physician may increase your child’s opportunity for early intervention.  But, this may not happen until the child has started school. There, within the larger environment of the classroom, a teacher may add information that is imperative to build a larger picture of the problem. 

Finding a competent physician may be an overwhelming task.  Referrals by trusted friends and family may be helpful.  Although a generalist may be the most convenient resource it is important for parents to realize that a family physician may not be the best choice when it comes to matters of mental health.  A pediatric psychiatrist is schooled in the latest treatment and can work with the parents to devise the most accurate plan of care that will serve to turn the disorder into a manageable challenge.

In addition, a therapist will may work in conjunction with a psychiatrist, for emotional support surrounding issues of low self esteem, adjustment to social awkwardness and behavioral problems. 

Giving children medication for AD/HD has frequently been problematic for conscientious parents.  Diminished appetite resulting in a loss of weight is a common side effect of most stimulants.  Ritalin, Dexedrine, and Adderall are three frequently used stimulant medications.  There are, however, others such as Strattera and Focalin which have had less of an effect on the appetite.  With a good working relationship between parent and doctor finding the right medication is possible.  

The purpose of medicating the child with AD/HD is to bring their physiological chemistry to a level of functioning to enable them to be successful in the classroom and at home; with their peers, socially, and their alone time; focusing on completing tasks and meeting goals.

Helping your child succeed requires a special effort on all family members and teachers. It is important to remember that most schools offer special programs for children with AD/HD.

In the home environment it is best to establish a routine and stick with it as closely as possible.

There are special tools that are helpful. Some of these can be found in ‘teacher’ stores. For example: a clock that can be set with 15 minute increments keeps a child on task.

Breaking down large chores into smaller, more manageable tasks aids in organization skills.

If there is a sleep problem talk to her physician-she may need a medication adjustment. Don’t let her become over stimulated with activities before bedtime, but doing something she enjoys that is a quiet, relaxing activity may help her to ease into the bedtime routine.

Keep the distractions to a minimum by having an area for study that is not in the middle of family activity. Set a time limit and offer a reward when she accomplishes her goals.

Serve food that is appealing and nutritious without being overwhelming. Keeping high protein snacks available is also useful if she is on a stimulant that accelerates her metabolism.

By staying open, positive, and accepting of your daughter’s disorder you can build a relationship with her that shows her you are her advocate. Encourage her to come to you to discuss her feelings, tell of her school experiences, and offer a computer blog or journal to write her feelings down.

Low self esteem is frequently a problem. Encourage her to join an activity she is interested in and help her build friendships with girls who may experience this disorder.