Jenna Boyd PSIII Professional Inquiry Project, Spring 2016

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Girls and ADHD
What is ADHD?
ADHD stands for Attention Deficit Hyperactivity Disorder. It is a neurological disorder that affects
executive function. Executive function is a set of mental skills that allow people to do things like
manage time, pay attention, switch focus, plan and organize, remember details, avoid saying or doing
the wrong thing, and apply previous experiences to current tasks. The symptoms of ADHD interfere
with, or reduce the quality of, social, academic, or occupational functioning (American Psychiatric
Association, 2013). There are three presentations of ADHD: primarily Hyperactive/Impulsive (ADHDHI), primarily Inattentive (ADHD-I), and combined (ADHD-C), which is where the criteria for both
Hyperactive/Impulsive and Inattentive are met.
How many girls have ADHD?
ADHD used to be perceived as a disorder that primarily affected boys; and it is still conceptualized as
boys disorder by most people (Littman, 2012). Boys are diagnosed with ADHD between 3 times
(community samples) and 9 times (clinic samples) as often as girls; but according to Biedermen et al.
(2012), ADHD is equally as common among women as it is among men. This means there are a
significant number of girls with ADHD who are not being diagnosed.
Why do girls get missed?
OBrien et al. (2010) found that teachers were more likely to refer a boy over a girl, even if they present
with the same symptoms. But girls do not typically present with the same symptoms as boys because
they display hyperactivity in a different way than boys do. But most girls with ADHD display little to no
hyperactivity at all because they present with the inattentive type (Groenewald et al., 2009, Guendelman
et al., 2016, Littman, 2012, & OBrien et al., 2010), making their symptoms easier to miss. These
children with ADHD-I who do not present with disruptive behaviour are less likely to be referred for
assessment, even though they may have significant difficulties. Though teachers and parents notice
difficulties in girls, they often conceptualize them as something else; usually as simply an attentional
difficulty, or emotional difficulty (Groenewald et al., 2009). The significance of girls attention
difficulties and self-control issues, is frequently underestimated.
Parents and teachers often consider low grades as one of the signs of ADHD; but girls with ADHD show
average to high average intelligence, with many even being gifted (Soffer et al., 2008). This means that
the low marks sometimes indicative of a boy with ADHD, often dont occur in girls with ADHD. These
smart girls with ADHD try very hard to hide their differences, and their good grades conceal the extreme
effort they have put forth to get them. Some of them procrastinate, then work late into the night right
before something needs to be completed. This actually helps them, because procrastinating increases
their stress level, which increases the release of noradrenalin, helping them to focus (Nadeau, 2010). For
some girls, this is the only way they can get work done.
Unfortunately for these smart girls, all of their energy goes into compensating for their cognitive
differences, leaving them drained; and successful compensation hides their ADHD from those who
could help them. These girls frequently dont get diagnosed until late adolescence or adulthood, if they
get diagnosed at all (Littman, 2012).
What does ADHD look like in girls?
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When people think of children with ADHD, they tend to think of boys bouncing off the walls.
However, the inattentive presentation of ADHD looks quite different. Girls with ADHD-I are usually
pretty quiet and well mannered. Their difficulties are attention related. They can appear to be paying
attention, but then after instruction do not know what they are supposed to be doing. They lose things
that they need, like glasses, pencils, agendas and assignments. If they havent lost their assignments,
they may miss details in them, or do them wrong, or just forget to hand them in. It is difficult for them to
pay attention to one thing for an extended period time; or if it is something they are particularly
interested in, they might hyper-focus on it to the point where it becomes difficult to pull their attention
away from it. They start tasks, but dont finish them, because they are too difficult, or because they cant
remember what they were supposed to do, or because they take too much effort to complete to their
satisfaction.
Girls with the combined type of ADHD can show the same signs as the inattentive girls; but also show
signs of hyperactivity and impulsivity. In girls, hyperactivity can take the form of hyper-talking/chatting,
and being emotionally volatile: showing extremes of excitement, anger, happiness and sadness, at times
that seem out of place to others. Impulsiveness can take the form of interrupting, being intrusive, and
being disruptive. They can also be bossy but charismatic, and are less compliant than children without
ADHD.
How does ADHD affect girls socially?
Children with ADHD have difficulty reading social cues. When they are in a situation where they are
unsure of a persons intentions, due to an inability to read their facial expression, vocal tone, or body
language, children with ADHD tend to assume that the person has a hostile intent (Sciberras et al.,
2012). This results in reactively aggressive behavior, which is inappropriate for the intimate social
networks and social gender expectations of girls peers (Sciberras et al., 2012).
Children with ADHD are easily distracted, so even when they appear to be listening, they often are not.
They then appear uninterested in their peers, because they dont remember what friends say, or dont
respond appropriately in conversation. When trying to show interest in a conversation, the child with
ADHD may interrupt with a story about a similar experience they had, or with a story about how that
topic affects them personally; which peers see as selfish or self- centred (Giler, 2000). They appear
oblivious to others feelings, and dont recognize the impact of things that they say or do. Instead of
building rapport, AD/HD girls often alienate others. (Giler, 2000).
What happens if AHDH goes undiagnosed?
Girls with undiagnosed ADHD are frequently criticized by the adults in their life for their lack of
attention, for not listening, for failing to follow through with things, for being messy and disorganized,
for not finishing the things they start, and for forgetting important things. Accused of being lazy, selfish,
flaky, irresponsible or worse, these girls internalize that criticism, leading to feelings of shame and a
strong sense of self-blame; which can lead to permanent low self-esteem and under-functioning (Quinn
& Nadeau, 2013).
According to Sciberras et al. (2012), girls with ADHD report particularly high rates of peer
victimization, like getting bullied or excluded. They also experience high levels of peer rejection and
poor friendship stability, even as adults.

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The DSM-V, the leading authority on diagnosing ADHD, says that adults with ADHD have a harder
time getting and keeping a job than their equally qualified peers; so they have a higher rate of
unemployment (American Psychiatric Association, 2013) than adults without ADHD.
Depression frequently appears comorbid with ADHD; the most common diagnosis women have, prior to
being diagnosed with ADHD, is depression (Quinn & Nadeau, 2013). Treating the depression does not
offer much improvement if the underlying ADHD is missed.
Adult and adolescent females with undiagnosed ADHD-C are at a greater risk for antisocial, addictive,
mood, anxiety, and eating disorders (Biederman et al., 2012). They also have a high occurrence of
suicide attempts and self-harm (Hinshaw et al., 2012).
Dont kids eventually outgrow ADHD?
ADHD used to be perceived as something that boys would eventually outgrow (Guendelman et al.,
2016), because as they got older, they were less hyperactive and appeared less impulsive. However, the
symptoms of ADHD persist into adulthood for the majority of those diagnosed. For girls, symptoms
actually increase as they get older, because symptoms increase with estrogen levels (Littman, 2012). In
fact, because their symptoms went unrecognized, or were conceptualized as something else by the adults
in their lives, many people who were not diagnosed as children, are diagnosed with ADHD as adults.
Symptoms of ADHD just look different in adults. Impulsivity may manifest as interrupting people,
aggressive driving, or having addictive tendencies. Hyperactivity may manifest as constant fidgeting,
talking excessively, or getting bored quickly. Inattention may manifest as chronic lateness, constantly
misplacing phone/keys/wallet, or forgetting to pay bills or forgetting appointments. An adolescent or
adult who no longer appears hyperactive, has not necessarily outgrown the disorder.
What can we do?
More often than not, adults suspect ADHD, but decide that the child is not having enough trouble to
refer them for assessment. They wait until the child displays academic or severe social problems before
seeking out a diagnosis, but this is a mistake according to Littman (2012). Girls mature faster
neurobiologically, than boys do, so they dont need to perform as poorly as boys of the same age, in
order to be deficient enough to need help (OBrien et al., 2010).
Showing these girls that someone cares, and pointing out their academic successes, can help protect
them from some of the more significant risk factors. In fact, one of the most powerful interventions that
parents [and teachers] can offer is a consistent sense of hope (Littman, 2012). However, early
identification and intervention is key to help lessen the impact ADHD has on the lives of those who have
the disorder, their families, their peers, and their teachers.

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References
American Psychiatric Association. (2013). Neurodevelopmental Disorders. In Diagnostic and statistical
manual of mental disorders (5th ed.). Washington, DC: Author. doi:
10.1176/appi.books.9780890425596.dsm01
Biederman, J., Petty, C. R., OConnor, K. B., Hyder, L. L., Faraone, S. V. (2012). Predictors of
persistence in girls with attention-deficit/hyperactivity disorder: Results from an 11-year
controlled follow-up study. Acta Psychiatrica Scandinavica, 125, 147156.
doi:10.1111/j.16000447.2011.01797.x
Giler, J. Z., (2000). Are Girls with AD/HD Socially Adept? Retrieved from
http://www.chadd.org/LinkClick.aspx?fileticket=rDK3seKyzkc%3D
Groenewald, C., Emond, A., Sayal, K. (2009). Recognition and referral of girls with Attention Deficit
Hyperactivity Disorder: case vignette study. Child: care, health and development, 35, 6, 767
772. doi:10.1111/j.1365-2214.2009.00984.x
Guendelman, M. D., Owens, E. B., Galn, C., Gard, A., Hinshaw, S. P. (2016). Early-adult correlates of
maltreatment in girls with attention-deficit/hyperactivity disorder: Increased risk for internalizing
symptoms and suicidality. Development and Psychopathology, 28, 114.
doi:10.1017/s0954579414001485
Hinshaw, S. P., Owens, E. B., Zalecki, C., Huggins, S. P., Montenegro-Nevado, A. J., Schrodek, E., et al.
(2012). Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early
adulthood: Continuing impairment includes elevated risk for suicide attempts and self-injury.
Journal of Consulting and Clinical Psychology, 80, 10411051. doi:10.1037/a0029451
Littman, E. (2012). The Secret Lives of Girls With ADHD. Attention, 1520. Retrieved from
http://drellenlittman.com/secret_life_of_girls_with_adhd.pdf
Nadeau, K. (2010). Raising Girls with ADHD. Attention, 1012. Retrieved from
http://www.chadd.org/AttentionPDFs/ATTN_8_10_ATE_Raising_Girls_Nadeau.pdf
OBrien, J. W., Dowell, L. R., Mostofsky, S. H., Denckla, M. B., Mahone, E. M. (2010).
Neuropsychological Profile of Executive Function in Girls with Attention-Deficit/Hyperactivity
Disorder. Archives of Clinical Neuropsychology, 25, 656670. doi:10.1093/arclin/acq050
Sciberras, E., Ohan, J., Anderson, V. (2012). Bullying and Peer Victimisation in Adolescent Girls with
Attention-Deficit/Hyperactivity Disorder. Child Psychology Hum Dev, 43, 254270.
doi:10.1007/s10578-011-0264-z
Soffer, S. L., Mautone, J. A., & Power, T. J. (2008). Understanding girls with attentiondeficit/hyperactivity disorder (ADHD): applying research to clinical practice. The International
Journal of Behavioral Consultation and Therapy, 4(1), 14+. Retrieved from
http://go.galegroup.com/ps/i.do?id=GALE
%7CA214102573&sid=summon&v=2.1&u=leth89164&it=r&p=HRCA&sw=w&asid=85b5710
6b0a4cfa9bd01d4dfed801d29
Quinn, P. O., Nadeau, K. G. (2013). Understanding Girls with AD/HD Part I: Improving the
Identification of Girls with AD/HD. National Center for Gender Issues and AD/HD, Monograph
Series. Retrieved from https://roots2learning.files.wordpress.com/2013/11/girls-with-adhd.pdf
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