She may have undiagnosed Attention Deficit Hyperactivity Disorder

Most parents today have heard a great deal about Attention Deficit Disorder. When they hear that term, it’s likely that a hyperactive little boy comes to mind. Boys with ADHD, are easy to spot in the classroom, and are much more likely to be referred for an evaluation. Most questionnaires used to screen children for ADHD emphasize items that describe these boys, items about hyperactivity, impulsivity and defiant behavior. Only those few girls who are like these boys with ADHD are sent for assessment. The ratio of children referred to clinics for ADHD evaluations continues to be about four or five boys for each girl.

What we are beginning to realize is that there are many girls left undiagnosed because their symptoms look different. One big difference is that girls are less rebellious, less defiant, generally less “difficult” than boys. Sadly, they lose out due to their good behavior. It’s the squeaky wheel that gets oiled. When a boy is causing frequent discipline problems, either at home or in the classroom, he will quickly be referred for treatment. Parents and teachers alike want quick relief from their constant challenges. Girls are more compliant, and are not as easy to spot. Often they are left to drift along from one school year to the next, never working up to their potential. Girls with ADHD are not all alike. As we mentioned earlier, there are a few girls whose behavior closely resembles the behavior of boys with ADHD. But what about those who don’t?

“Tomboys” with ADHD

Hyperactive girls are often “tomboys.” They are physically active, drawn to more risk-taking activities such as tree climbing, exploring and playing with their brothers or other boys in the neighborhood. They may like soccer, swimming or horseback riding, but are less attracted to more girlish activities. But unlike many boys with ADHD, these girls are often more cooperative at home, and may work harder to please their teacher at school. Their handwriting may be messy, they are often disorganized, and they may rush out the door for their next activity leaving their room a huge mess. Rather than suspecting ADHD, parents and teachers of these girls may see them as undisciplined and just not academically inclined.

“Daydreamers” with ADHD

Girls of the inattentive variety are often shy daydreamers. Their inattention in class may be overlooked because they try hard not to draw attention to themselves. Many quiet girls with ADHD seem to be listening to their teachers, while their minds are a thousand miles away. These girls often seem anxious about school. They are forgetful and disorganized in completing their school work and become very worried as assignments come due. When sent to their room to complete homework they may quietly daydream at their desk unless they are kept on track by a parent sitting beside them. They may seem easily overwhelmed and operate at a slower pace than other girls. Some of these girls are anxious or depressed, and are often mistakenly seen as less bright than they actually are.

“Chatty Kathy” with ADHD

A third type of girl with ADHD is a combination of hyperactive and inattentive. While they have a much higher activity level than the daydreamers, they are not necessarily “tomboys.” Often these girls are hyper-talkative rather than hyperactive. They are “silly”, excitable and overemotional. They chatter constantly in class and have trouble staying quiet even when they are disciplined for talking. They interrupt others frequently and jump from topic to topic in conversation. These girls may have trouble explaining a story line or movie plot — frequently interrupting themselves to say “wait a minute, I forgot to tell you…” Or they tell the story in a very confused manner because they have trouble organizing their thoughts before they start talking. These girls may be social leaders. They are active, talkative and are exciting to be around. Their friendships may be more dramatic, filled with overreactions and arguments. These girls may adopt a “silly” personality to mask their disorganization and forgetfulness. During their teen years these girls may compensate for poor academics by becoming hyper-social and taking risks such as smoking, drinking and becoming sexually active at an early age.

Gifted girls with ADHD

Highly intelligent girls with ADHD can be the most difficult to spot. The brighter your daughter with ADHD is, the later her school problems tend to emerge. Many girls with above average IQ can keep it together academically until they hit middle school, or even high school. As their school life becomes more demanding and complicated in the upper grades, their problems with concentration, organization and follow-through are more likely to reveal themselves.

The high cost of going undiagnosed

Girls with undiagnosed ADHD often pay the price of being seen as ditzy, spacey or nonacademic. Due to internal disorganization and distractibility many of these girls pick up, but soon drop many hobbies and interests. Activities such as learning to play a musical instrument, which require discipline and perseverance, are rarely continued. Not only do they fall behind academically, but they also come to think of themselves as “quitters” with few talents. Parents and teachers may dismiss these girls as undisciplined, and sadly, they come to deny their own abilities. The social cost of undiagnosed ADHD is high as well. Studies show that social problems begin as early as preschool and tend to become worse as girls with untreated ADHD go through elementary school into their teen years. Having few friends or feeling left out takes a toll on self-esteem that continues into adulthood.

A checklist if you think your daughter may have ADHD

Ask your daughter to answer the following questions. Note that they are self-report questions. This is important. Most ADHD questionnaires are completed by parents and/or teachers. Because many girls work hard to hide their difficulties, teachers are often unaware of the extent of their struggles. Studies show that parents seem to be more aware of their daughter’s ADHD issues than her teachers are, but most important, your daughter knows what’s going on inside no matter how she “looks” on the outside.

• I have trouble finishing my assignments in class.
• I daydream in class.
• Even when I try to listen, my thoughts wander.
• I forget to bring papers and permission slips from home.
• I have trouble following the teacher’s directions.
• My mind wanders when I read.
• Projects and papers are hard for me to finish.
• I often do my work at the last minute and turn things in late.
• I forget to bring the right books home from school.
• I get upset more easily than my friends.
• Sometimes it feels like I’m not good at anything.
• I am frequently late.
• It’s hard for me to concentrate when there are people around me.
• My parents and teachers tell me I don’t try hard enough.
• Other kids tease me about being spacey.
• I feel different from other girls.
• I lose track of time.
• I have a messy book bag.My room at home is a disaster.

If you suspect that your daughter may have ADHD…

Look carefully in your community for professionals who have experience in diagnosing and treating girls.

CH.A.D.D. (Children and Adults with Attention Deficit Disorder) is a national organization with local chapters in many cities and towns across the country. You can contact the CH.A.D.D. national office to find the CH.A.D.D. chapter nearest you. ((301) 306-7070). Monthly CH.A.D.D. meetings are free and are a good place to network with other parents to find the best professionals in your area.

If you feel that your daughter is not working up to her potential, or if she seems to fit some of the patterns described here, trust your instincts and seek an evaluation.

Your daughter’s teacher may disagree with an ADHD diagnosis because he or she is only trained to recognize male-pattern ADHD behaviors. Teacher education is badly needed to help them recognize the different ADHD patterns seen in girls.

The sooner that your daughter is diagnosed, treated, supported and encouraged the better off she will be. Make sure that your daughter has a chance to develop her potential, to recognize her talents, and to feel good about herself. We’ve let far too many girls grow up, never taken seriously. Don’t let your daughter be one of them!

Ways to Help Your Daughter with ADHD

Help her to establish a “quiet zone” in her life

Whether shy and withdrawn, or hyper and impulsive, girls with ADHD often feel emotionally overwhelmed. Help your daughter to learn stress management techniques, and to understand that she may need emotional “time out” to regroup after an upset.

Try to minimize corrections and criticism

Too often parents, with the best of intentions, shower ADHD girls with corrections and criticisms. “Don’t let them hurt your feelings like that.” ‘You’d forget your head if it wasn’t attached to your shoulders.” “How do you expect to go to college with grades like that?”

These girls, whether loud and rebellious, or shy and retiring, typically suffer from low self-esteem. Of course, negative behaviors need to be dealt with, but parents should be conscious of balancing the negative with affection, encouragement and time spent enjoyably together.

Make your home a “safety net” for your daughter.

Home is an important place to refuel, and to rebuild the confidence that is so frequently eroded during the day at school. Work to make your home a place where she feels supported and understood, a place where she can talk about the challenges of her day, a place where she can relax and unwind.

Help her look for ways to excel

Many girls with ADHD feel that they are “not good at anything.” Their distractibility, impulsivity and disorganization often results in mediocre grades. Likewise, they often don’t have the stick-to-itiveness to develop skills and talents like many of their friends.

Help your daughter identify a skill or ability. Praise and recognition for developing skills can give a girl with ADHD a terrific, positive boost. Finding an activity to feel good about is often a positive turning point in the life of a teenage girl with ADHD.

Resources for girls with ADHD and their parents

Understanding Girls with AD/HD by Kathleen Nadeau, Ph.D., Ellen Littman, Ph.D., and Patricia Quinn, M.D.

The Adventures of Phoebe Flower by Barbara Roberts. A charming series for kids ages 8-10 featuring Phoebe, a delightful, spunky girl with ADHD. This series presents ADHD in a positive, but realistic manner. Phoebe will provide a great role model for your daughter as she learns about her ADHD.