Detection of ADHD in girls lags frighteningly

The diagnoses and treatment of medical conditions seem always to be growing by leaps and bounds. But the understanding of girls and Attention Deficit Disorder (ADD) – now more commonly known as Attention Deficit Hyperactivity Disorder (ADHD or AD/HD) – appears to be lagging.

According to 2008 Centers for Disease Control and Prevention statistics, there are 5 million children in America ages 3-17 living with the psychological condition.

ADHD is characterized by difficulties with focus/inattention, impulse control and hyperactivity that often carry into adulthood.

While 11 percent of boys are diagnosed as having the condition, that number is less than half for girls, at 4.8 percent.

Why the disparity between boys and girls?

“Because they don’t get noticed. ADHD girls aren’t necessarily disruptive,” says Spokane pediatric psychiatrist Dr. Sandra Dexter of Inland Psychiatry and Psychology. “Girls are usually the quiet ones.”

ADHD boys are more inclined to be diagnosed with the hyperactive type of the condition, while ADHD girls tend to fall into a category known as “predominantly inattentive type.”

While the difficulty with focus and attention, especially with “hard” or “boring” things, is common to both genders in ADHD, girls experience other things as well, Dexter says.

“They’ll often feel that they are ‘dumb,’ ” she says. “They get depressed, feel like something is wrong, and can be hypercritical of themselves.

“Girls with ADHD are often the quiet daydreamers,” adds Dexter, who specializes in ADHD, depression, anxiety and developmental delays.

Daydreaming, along with talking loud and fast, being especially “boy-crazy,” feeling anxious and hyper-focusing to compensate for a lack of attentiveness, are other common signs of ADHD in girls.

These symptoms and others are listed on a parental checklist in ADDitude, a magazine created by doctors and ADHD specialists.

What’s the difference between ADHD and “normal” versions of these symptoms, and when may it be appropriate to seek treatment?

“When it’s interfering with daily life,” Dexter says.

According to a 2000 study published in Harvard University’s Neuroscience Biobehavior Journal, the neurotransmitter dopamine plays a role in gender and ADHD.

Dopamine is a brain chemical that affects attention. The study says that differing amounts of dopamine receptor sites in boys and girls contribute to their different ADHD symptoms.

Dr. Patricia Quinn, a developmental pediatrician in Washington, D.C., and longtime ADHD expert, has released a passage from a new book she has coming out this fall, “One Hundred Questions and Answers About ADHD in Women and Girls,” that underscores the gender gap in diagnosis and treatment and what contributes to it.

Quinn says girls continue to be seen in significantly fewer numbers than boys, most likely because they are dependent on teachers and parents for referrals.

“Studies have demonstrated a significant bias against the referral of girls by teachers and parents for evaluation of ADHD symptoms,” she reports.

Quinn points to a recent study in which a researcher presented identical vignettes for review by teachers and parents of children with high symptoms. Half of the participants read scenarios with boys’ names and half read the same vignette but with a girl’s name.

“After reading the vignette, parents and teachers rated their likelihood of referring the child for services and how much benefit they expected from three types of services,” Quinn writes.

“Parents and teachers were both less likely to refer girls for services, not because they were less disruptive, but because they believed that services were less effective for girls.”

Concludes Quinn: “In general, for girls that are referred, it is more likely that they demonstrate more severe symptoms and that these girls are not representative of the larger sample of girls in the general population who continue to ‘suffer silently’ without a diagnosis.”

On his website, ADHD specialist Dr. David Rabiner, a senior research scientist at Duke University and child psychologist, calls for more studies that take in gender differences.

Most studies have been conducted only on boys, or have included very few girls in the sample, Rabiner says.

“As a result, the scientific literature on ADHD/ADD is almost exclusively based on male subjects,” he says.

According to a 2004 Medscape study, “Perceptions of Girls and ADHD: Results From a National Survey,” 58 percent of the general public and 82 percent of teachers think ADHD is more prevalent in boys.

The study found that four out of 10 teachers report more difficulty in recognizing ADHD symptoms in girls.

It concluded: “An overwhelming majority of teachers (85 percent) and more than half of the public (57 percent) and parents (54 percent) think girls with ADHD are more likely to remain undiagnosed. ADHD was reported to have a negative effect on self-esteem, more so in girls.”

Dexter says that she first sees many ADHD girls for depression and anxiety, but sometimes, in treating other issues, they are able to see the ADHD symptoms more clearly.

With diagnosis and treatment – typically medication, but sometimes such approaches as cognitive behavior therapy or biofeedback – girls with ADHD “can begin to look at themselves in a more realistic manner rather than so critically,” she says.

What’s the end goal for them? Says Dexter: “That they feel and know they are competent.”