Twenty-year-old Andrea Burns fits the profile of ADD women and girls perfectly. She wasn’t officially diagnosed with attention deficit disorder (ADD ADHD) until her freshman year at Indiana University in Bloomington, even though she showed obvious signs of ADHD in middle school.
After an academic advisor had her undergo a LASSI (Learning and Studies Strategy Inventory) screening to evaluate learning behaviors and academic achievement, the results indicated what she and her family had long suspected.
Things had to get really bad — Burns was close to failing out — before she was even tested. “In high school, I had a tutor to help me with different subjects, but once I got to college, I was expected to do it all by myself. I was studying all of the time, but doing poorly on tests because I’d freeze up,” says Burns. “And I’d try to listen in class, but I had a hard time concentrating and focusing on what the teacher was saying. I’d take lots of notes, but when I reviewed them, I couldn’t make sense of what I wrote,” says the communications major, now entering her junior year.
After a diagnosis of Inattentive Sub-type ADHD, Burns was prescribed medication. She saw almost immediate results: “I was finally able to focus during a lecture and take good notes, which helped improve my grades. For the first time I felt in control in the classroom.”
Burns is relieved to have identified the cause of her poor school performance, and happy she’s able to treat it. But it’s unfair that she, like so many other girls, suffered a decade or more with an untreated condition that can impact life negatively in so many ways. Why are girls being diagnosed so much later than boys, if at all? And what do teachers, pediatricians, and parents need to do to bring about a change?
One of the key reasons girls are so often overlooked is that they exhibit hyperactivity differently than boys, according to Patricia Quinn, M.D., director of the National Center for Gender Issues and ADHD in Washington, D.C. “In a classroom setting, a boy might continually blurt out answers or repeatedly tap his foot, whereas a girl might demonstrate hyperactivity by talking incessantly,” she says. A girl who talks all the time is often viewed by the teacher as chatty, not hyper or problematic — and thus is less likely to be recommended for an evaluation.
Another reason that ADHD is often missed in girls is that they’re more likely than boys to suffer from inattentive ADHD. The symptoms of this sub-type (which include poor attention to detail, limited attention span, forgetfulness, distractibility, and failure to finish assigned activities) tend to be less disruptive and obvious than those of hyperactive ADHD. Put simply, a (hyperactive) boy who repeatedly bangs on his desk will be noticed before the (inattentive) girl who twirls her hair while staring out the window. “I believe I was overlooked for so long because I didn’t show hyperactivity the way my two brothers with ADHD have,” says Burns.
It comes as no surprise that a recent national online Harris Interactive poll reaffirms that, with respect to ADHD, girls have gone largely unnoticed. Dr. Quinn and Sharon Wigal, Ph.D., associate clinical professor of pediatrics at the University of California at Irvine, surveyed 3,234 people, including members of the general public (adults without ADHD whose children don’t have the condition), parents of children with the condition, teachers, and children with ADHD, ages 12 to 17. Among those polled, 85% of the teachers and more than half of the parents and the general public believe that girls with ADHD are more likely to go undiagnosed. They said that girls are more likely to “suffer silently” or show fewer symptoms. And four out of 10 teachers report more difficulty in recognizing ADHD symptoms in girls than in boys.
Polled parents and teachers also said that, among children with ADHD, boys are more likely than girls to exhibit behavioral problems, while girls are more often inattentive or depressed. Drs. Quinn and Wigal said these differences cause some girls with ADHD to slip through the cracks. “The failure to recognize ADHD symptoms in girls probably results in significant undertreatment,” they wrote. “...it is not a trivial disorder for them, and they are equally in need of professional care.”
The Price Girls Pay
Another revelation from the Harris poll: Females may suffer more negative effects from their ADHD than their male counterparts. The survey showed that girls are more likely than boys to be asked to repeat a grade due to poor school performance. When a boy struggles, he’s more likely to be evaluated for ADHD or LD (and then diagnosed) than held back. But a teacher who observes a disorganized female student — one who can’t plan ahead, meet project deadlines, and so on — believes that she’ll benefit by being held back a year. “A year later, the girl is no better off because she still hasn’t figured out the source of her problems,” says Dr. Quinn.
The self-esteem of girls with ADHD also appears to be more impaired than that of boys with ADHD (which may explain why the survey found that girls were three times more likely to report taking antidepressants prior to being diagnosed). It’s not surprising, then, that the condition can take a toll on a female’s emotional health and general well-being. According to Dr. Quinn, girls with ADHD tend to have more mood disorders, anxiety, and self-esteem problems than non-ADHD girls. “They might get an A on a report, but because they had to work three times as hard to get it, they see themselves as not being as smart as other people,” she says.