Labels like drama queen or airhead tend to follow girls with ADHD. The reality of the disorder isn’t nearly as cute as those names might suggest.
Dr. Anatoly Belilovsky, a New York pediatrician, thinks Alexander the Great could be the poster boy for ADHD (Attention Deficit Hyperactivity Disorder). Alexander was peripatetic to a fault (to put it politely), rangy, difficult, known to have poor interpersonal relationships and poor conflict resolution (again putting it politely). He was also very successful, hence the “Great,” within a field of work that was visual, stimulating, and which didn’t require a lot of listening.
But possibly the main reason Alexander seems to fit the bill as an ADHD poster boy is that, simply, he was a boy. ADHD has long been seen as primarily a male disorder. You don’t have to go back very far in the literature to read statements suggesting that it affects males three or four times as often as females, and those claims persist today. New research, though, shows that in fact that simply isn’t the case. Girls not only have ADHD, they have it just as much as boys, and they may suffer its effects longer and more deeply than boys. If there seems to be a three-to-one boys-to-girls ratio, it’s not a ratio of occurrence, but rather a reflection of our ability to pick up on the symptoms. When it comes to girls, we’ve been dismally missing, or misreading, the signs.
What is ADHD?
We used to call it ADD, Attention Deficit Disorder, though now we call it ADHD, the H standing for Hyperactivity. It’s one name, but it can be made up of various degrees of inattention, hyperactivity, and impulsivity. It’s genetic, and is known to be 80 percent heritable, which is about the same rate that height is heritable from parent to child.
ADHD is a developmental disorder, so symptoms begin in childhood and carry over into adulthood. “The core issue of a diagnosis of ADHD is the fact that it causes impairment in social, academic, emotional, and psychological functioning,” says Dr. Kenny Handelman, an Oakville, Ont., psychiatrist. If a child’s quality of life is suffering, that’s when it’s a good time to consider a medical assessment.
Medication may be considered once a diagnosis is made, though Dr. Handelman is quick to say that “pills don’t teach skills. We need to give people the ability to improve their functioning through skills they learn and use” in consort with any medications.
Girls and ADHD
“I’m not as hyperactive as he is though I show more of the inattentive and impulsivity than he does,” says Laura Valta, a mother of one in Aurora, Ont. Both Laura and her son, Matthew, have been diagnosed with ADHD, though both behaved very differently from one another. Matthew, for his part, is the classic boy with ADHD. From infancy, “he was like a little vibrating toy,” says Laura. She describes him as very physical, energetic, taking lots of risks, and requiring lots and lots of stimulation. He is the kind of child that can really get your attention, whether you like it or not.
Laura was in many ways an example of what we are coming to know as the classic girl with ADHD. In school she was “distractible, daydreamy and moody, more than the average hormonal girl,” she says. She was easily frustrated, and very emotional. High school was a long haul and full of drama. “I became withdrawn, shy, had very bad grades, didn’t have very good relationships, and had low self-esteem. All of those things you can tie to being a normal teenage girl,” she says. “But in me, it was to the point where I really got into trouble. And I mean big trouble. I did some really stupid things.”
Missing the diagnosis
Those core differences that Laura sees between her and her son may be the reasons why it is so commonly missed, or misdiagnosed, in girls. “Girls are more likely to be the inattentive type of ADHD,” says Dr. Kenny Handelman, a child and adolescent psychiatrist in Oakville, Ont. “They are quiet daydreamers rather than hyperactive.”
And while the boys get noticed, the girls don’t. “We diagnose three or four boys for every girl we pick up. But if you look at the newer research in the adult ADHD the ratio is one-to-one, male-to-female. ADHD is a developmental disorder, so starts in childhood. It’s not that women are getting it in their 20s and 30s, we just missed a lot of the girls.”
It doesn’t help that the disorder is often masked by other things. “With ADHD it is common to have a second disorder with it. With boys it’s much more common to have a behaviour disorder with it. With girls, it’s more common to have learning or emotional issues with it … a girl tends to be a daydreamer who may get a little emotional and, well, people say ‘not everyone is an A student,’ and maybe ‘Sally is a bit of a drama queen’ or something. But they don’t consider it ADHD.”
Labels like ‘drama queen’ or ‘social butterfly’ are ones that often follow girls with ADHD just as readily as comments like ‘boys will be boys’ follow the guys. Laura notes that she was very much the ‘distractible daisy’ or a candidate for ‘president of the air-heads club.’ The reality of the disorder, however, isn’t nearly as cute as those names might suggest. “In a way I’d like to say I’m multitasking, but really, I just can’t sit still.” Laura compares the experience of having ADHD to “walking into a busy mall at Christmas time. You don’t have a clue where you are or what you’re going to get, you’re wearing a blindfold … and you don’t know what to do about it.”
The dangers, too, are very real. Girls with ADHD are more prone to anxiety and depression, and low self-esteem. Dr. Handelman finds that many of the teenage girls he diagnoses with ADHD are first referred to him due to depression and esteem issues. Worse, what he’s found in his practice is that girls with undiagnosed ADHD are more likely to develop depression or anxiety in their later years.
For Dr. Laura Gerber, a pediatrician in Burlington, Ont., anxiety is often the primary reason to pursue treatment for ADHD. She says that girls with ADHD are prone to “internalize the idea that they are not smart when in fact it’s their untreated ADHD that is preventing them from showing their true colours.” It isn’t about intelligence, it’s about their inability to perform effectively. “Not only are they going to be unable to reach their full potential, but if they have to spend 10 times longer to get that information, the other areas of their lives are going to suffer,” she says.
Laura Valta was quick to advocate for Matthew because of her own experience with ADHD. Sadly, for girls out there with ADHD, only one out of every three can count themselves as lucky.
Reading between the lines
of the symptoms may be right there, in writing, in your daughter’s
report cards. Watch for these kinds of comments that Dr. Handelman and
Dr. Gerber note can be red flags for ADHD:
“needs to pay closer attention to detail”
“needs to make sure she has understood the instructions”
“needs to socialize less during class time”
“needs to listen attentively”
“does really well when she concentrates”
“doesn’t apply herself”
“capable of so much more”
“could do much better if she only applied herself consistently”
Glen Herbert is a father of three and a frequent contributor to ParentsCanada.
Published in November 2010.