<img src="" align="left" /> AD/HD in smart girls may go unnoticed and untreated.
Girls who are diagnosed with AD/HD when they are older have higher verbal IQ scores and show symptoms of depression and anxiety compared to girls who are diagnosed with AD/HD when they are younger. These girls may have not been diagnosed at an earlier age because their higher IQs may have helped them "get by" and/or their symptoms of depression and anxiety finally led to enough concern that they were finally brought to a clinic for an evaluation. It is also possible that their AD/HD symptoms may not have been present when they were younger. These are the conclusions of researchers from the Stanford University School of Medicine and the Children's Health Council in Palo Alto, California. <table align="right" width="30%">
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"Diagnosing AD/HD in females may be difficult because our knowledge of AD/HD symptoms in females is based on a few studies that use a narrow definition of the disorder," says Pamela M. Kato, Ph.D., lead author of the study. "AD/HD in females may need to be examined with a broader definition that reflects the disorder along a continuum." The Stanford research is based on reviews of the medical records of seventy-five girls between the ages of 4 and 19 who had been diagnosed with AD/HD.
Why Are We Missing The Girls?
Males with AD/HD usually exhibit disruptive behaviors that are consistent with hyperactivity and impulsivity. These boys draw attention to themselves and to their possible need for treatment. Girls typically do not exhibit these behaviors. Instead, their problems are generally associated with the inattentive subtype of AD/HD. Thus, girls with AD/HD often go unnoticed and untreated. When they are diagnosed, it is usually at a later age.
In the Kato study, despite differences found between younger and older girls diagnosed with AD/HD, both age groups performed similarly on a continuous performance test of attention and parent and teacher reports of attention difficulties. Thus, the girls who were older with higher verbal IQ scores and symptoms of depression and anxiety exhibited the same symptoms of inattention as the younger girls who were more likely to have lower verbal IQ scores and few, if any, symptoms of depression or anxiety. The clinician on the study, Mary Nichols, Ph.D., surmised that these older girls used their superior verbal skills to compensate for their attention difficulties when they were younger. Unfortunately, this ability to compensate diminished with age when school environments require them to work more independently and plan their own activities such as homework.
"Critical biological, social, and academic changes occur around 9 years of age," notes Kato. "The diagnosis of AD/HD in older females (age 9 and above) also may be difficult to make because it co-exists with other disorders that can emerge in females of this age," she said. For example, girls experience more anxiety and depression than do their male peers. These problems may lead a clinician to see attention problems as a symptom of depression or anxiety and therefore miss diagnosing the problems as being AD/HD. On the other hand, it may be that the girls' symptoms of depression and anxiety brought older girls with AD/HD in to a clinic for an evaluation that eventually resulted in a diagnosis of AD/HD.
Rather than allowing these factors to obscure the AD/HD diagnosis, Kato suggests that clinicians should take a closer look at difficulties with attention among older girls who have problems with mood disorders and have strong verbal skills. Also, parents should know that even though their daughter is "smart," her difficulties paying attention should still be taken seriously. "Diagnosing clinicians should consider that verbal IQ scores in the average and higher ranges may be particularly characteristic of girls with AD/HD," says Kato. "Future research should determine the extent to which girls, especially those who are younger, with higher IQs and AD/HD are misdiagnosed or unidentified during the diagnostic process."