New York Times Syndicate
Saturday, October 5, 2002
October 01, 2002 It's a label that is usually applied to fidgety, overly aggressive little boys who can't sit still in class or follow directions
But attention deficit hyperactivity disorder (ADHD) may be much more prevalent in little girls than many parents and teachers recognize, a new study says. Girls with the disorder are just as likely to develop profound academic and social problems.
``Girls don't have (just) a pale copy of ADHD,'' said UC Berkeley psychology professor Stephen Hinshaw, lead author of the study, published today in the Journal of Consulting and Clinical Psychology. ``They have significant deficits (from it). But they may suffer in silence.''
Girls with ADHD had more trouble focusing and were more likely to tease peers and act aggressively than other girls, the study found. And many of them - more than their male counterparts - were socially isolated and found it hard to make friends.
The study, one of the largest and longest of preadolescent girls with ADHD, looked at 228 Bay Area girls, ages 6 to 12, who were recruited to attend a six-week summer camp for three consecutive years. Unlike most previous studies, it looked at girls who weren't on medication.
ADHD is probably the most-studied childhood psychiatric disorder, but the vast majority of studies have focused on boys, who are more likely to have it by a ratio of 3 to 1.
While ``hyper-boys'' usually draw more attention, girls usually have what's called an ``inattentive'' type, characterized by disorganization and unfocused behavior, rather than impulsive outbursts. That makes it harder to spot in a classroom.
But girls with ADHD are just as likely to have problems with tasks like organizing, planning and setting goals - all of which lead to trouble with schoolwork and social relationships, Hinshaw said.
That's what happened to Lori Berry's daughter, who saw at least three specialists before anyone figured out why she couldn't concentrate at school. Now 15, she's learned strategies to help her stay organized, but she still struggles.
Berry, who lives in the East Bay, said she first noticed something was wrong when her daughter was in day care. She never stuck with any activity very long and seemed to be in perpetual motion.
In elementary school, her daughter's grades slipped to D's and F's. She fidgeted at her seat, talked during class and couldn't focus, but she didn't get in trouble or act out. She wasn't ostracized by other kids, but she felt she was somehow different. Berry knew her daughter was bright, but no one could explain the behavior.
``Rather than figuring something was neurologically wrong, the teachers put it down to behavior,'' Berry said. ``They would say she's not attending to task, she's not being responsible or organized. They weren't thinking that maybe she can't settle down, that she doesn't know how to.''
Since the sixth grade, when she was diagnosed after being referred to the study, Berry's daughter has been treated with behavioral modification, which she's found most useful, and medication.
``I wish she'd gotten help earlier,'' Berry said. ``We wouldn't have done all the shouting, had all the conflict. We just weren't understanding what was going on.''
Dr. Patricia Quinn, who co-founded an advocacy group called the National Center for Gender Issues and ADHD, said the study confirms what doctors have been finding clinically - that girls with the disorder get overlooked.
``People think if you're sitting there quietly that you couldn't possibly have it,'' said Quinn, a developmental pediatrician in Washington, D.C., who specializes in treating girls and women with ADHD. ``Girls try to compensate. They sit there and look at the teacher. They try very hard to please and do well.''
As a result, she said, girls tend to get diagnosed two to four years later than boys. Studies have shown that women with ADHD develop a sense of helplessness and have self-esteem problems, Quinn said. Many are diagnosed with depression.
Teachers, doctors and psychologists need more training to identify girls with the disorder, she said. Often they don't know the signs - girls who are hyper-talkative and emotionally hyper-reactive without being rough and aggressive.
And the general public knows even less, Quinn said. In one recent survey, 97 percent of those who responded said they knew a male with ADHD. Only half knew of a woman who had it. Fifty percent also said they didn't know it even existed in girls.
Hinshaw, who conducted the study with four other researchers from Kaiser Permanente Medical Group, Minnesota Department of Mental Health and UC Berkeley, said that both boys and girls with ADHD respond well to treatment. Without it, they're at higher risk of dropping out of school, substance abuse and delinquent behavior, he said. Researchers will continue to study the girls to see what happens as they mature.
``The main message is that whatever ADHD is in girls, it's darn impairing,'' Hinshaw said. ``It's causing life problems that seem to predict difficult problems later in life.''
(The San Francisco Chronicle Web site is at http://www.sfgate.com/chronicle )
c.2002 San Francisco Chronicle