Under the Radar: How Girls with ADHD Go Undetected And Why the Correct Diagnosis is Important for Girls and Boys Alike

by Dr. Robert Myers, Child Psychologist
Under the Radar: How Girls with ADHD Go Undetected And Why the Correct Diagnosis is Important for Girls and Boys Alike

  “I never suspected my nine-year-old daughter’s inability to concentrate was due to ADHD,” said Diane, the mother of three girls. “She isn’t ‘hyper’ or noisy—in fact, just the opposite. Kayla is the middle child—she’s quiet and tends to daydream a lot. We were frustrated because she couldn’t ever seem to concentrate or get her schoolwork done...But we were still really surprised when our pediatrician finally diagnosed her with ADHD last year.”

“Girls are often under-treated, which results in years of suffering in silence, and subsequently leads to self-doubt and low self-esteem.” —Dr. Bob Myers

When many people hear the term ADHD, the first thing that usually comes to mind is a young, out-of-control boy running all over the place or having a major meltdown at the mall while his frantic parents try to calm him down. Unless you personally know a girl struggling with this disorder, the “wound-up boy” is the image most associated with ADHD. Of course, one reason for this is the fact that boys with the diagnosis outnumber girls by a whopping 3 to 1. Another reason is that ADHD in girls is more often associated with impaired attention and concentration—girls who are labeled as either “dreamy” or “spacey,” rather than hyperactive and impulsive.

Unfortunately, research has shown that this stereotype often leads parents, teachers, and health professionals to misdiagnose girls with depression or anxiety. Sometimes the significant difficulties they’re experiencing are dismissed altogether. Whether boy or girl, a child who has trouble learning and maintaining healthy peer relationships is more likely to be ignored, while the child exhibiting disruptive behavior is not only more likely to be noticed, but also more likely to be referred for evaluation and treatment. The sad result is that girls are often under-treated, which results in years of suffering in silence, and subsequently leads to self-doubt and low self-esteem. Recent studies have even shown that women with ADHD suffer from depression much more frequently than men with the same disorder.

Slipping Through the Cracks
Here are some signs to look for that may indicate ADHD:

    • Gradual or sudden decline in academic achievement
    • Forgetting to turn in homework assignments
    • Easily frustrated when learning something new
    • Always losing personal possessions or leaving things all over the house
    • Trouble making friends
    • Easily upset over minor incidents
    • Overly anxious about trying new things or minor changes in routing or surroundings

What else could be causing these symptoms?

    • Sometimes normal child development or a child’s temperament
    • Undiagnosed learning disabilities
    • Adjustment disorder
    • Anxiety disorder
    • Depression

As ADHD children get older, boys are more likely to receive additional diagnoses of disruptive or conduct disorders. Boys and girls appear to have an equal opportunity to have co-occurring anxiety and depression. However, ADHD girls seem to be more likely to smoke or drink than ADHD boys during the teen years. Another recent study has shown that they are more likely to have eating disorders.

One answer to the problem of misdiagnosing ADHD is for educational professionals to get additional training to be better able to spot the disorder sooner, as early intervention can prevent more serious symptoms down the road. Mental health professionals also need to develop instruments that may be more sensitive to detecting ADHD in girls. This will require shifting some resources to more in-depth research on the diagnosis and treatment of the disorder in girls.

What You Can Do for Your ADHD Girl Right Now
If you are the parent of a girl with ADHD, you need to work closely with teachers. Don’t put off addressing problems related to poor academic achievement or your daughter’s difficulty getting along with other kids. Whether the school is concerned or not, you should be an advocate for your child and insist on an evaluation to determine the cause of her difficulties. Whether they are related to ADHD, learning disabilities, anxiety, delayed maturation—or  a combination of one or more of these--the sooner the cause is identified and appropriate interventions are initiated, the better for your child.

Another good reason to have ADHD diagnosed early in both girls and boys: Once everything is out in the open, the “blame game” can stop and help can begin. An early diagnosis ensures parents and children that no individual is the cause of the problems. Rather, the child has a brain difference that can be addressed and improved.

You should not be afraid to seek help, thinking that your child will immediately be placed on medication. Depending on the findings of the evaluation, special education and/or psychological treatment may be sufficient to turn things around and keep your child moving in a positive direction.  

School is often a source of anxiety for kids with ADHD and for their parents. Perhaps your child’s lack of concentration skills and difficulty following through on projects makes it hard for her to feel good about school. The good news is, when a student meets the eligibility criteria for special education services set forth in federal and state guidelines, an Individual Educational Plan (IEP) will be developed and implemented. Even when a student may not meet criteria for special education, they may be eligible for counseling and classroom modifications to help them improve their academic achievement, as well as develop a more positive self-concept and get along better with other kids and adults.

Early Intervention Helps. Does Your Child Need to be Medicated? Maybe Not…
While there is no doubt that there is a group of ADHD kids with moderate to severe symptoms who definitely need to be on medication, there is also a group with only mild to moderate symptoms that will be fine with only psychological treatment. The unanswered question is how to accurately determine to which group your child belongs.

Girls in particular will benefit from interventions that develop improved attention, concentration and memory functions. They also thrive on the techniques that reduce anxiety and increase self-esteem and confidence.  Learning to use problem-solving to cope with difficult situations and relaxation to help with frustration is also very helpful. Girls are usually quick learners when it comes to learning and applying specialized training in social skills.

When considering psychological treatment, the key to success is intensive and comprehensive treatment. Parents are often drawn to products that promise a quick and easy fix. Your best bet is to choose a program that provides a psychological treatment that is based on not one, but a combination of research-supported modalities that are sufficiently intense and comprehensive to provide the desired results. The sooner you can get your child the help she needs, the better off she will be in the long run.


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Dr Robert Myers is a child psychologist with over 25 years of experience working with children and adolescents with Attention Deficit Hyperactivity Disorder and learning disabilities and is the creator of the Total Focus Program www.dressesshow.co.uk . Dr Myers is Associate Clinical Professor of Psychiatry and Human Behavior at UC Irvine School of Medicine. "Dr Bob" has provided practical information for parents as a radio talk show host and as editor of Child Development Institute's website, 4parenting.com which reaches 3 million parents each year. Dr. Myers earned his Ph.D. from the University of Southern California.

READER'S COMMENTS

Great article. My daughter has ADHD and it took us years to figure it out. Fortunately, she's thriving now, thanks to our pediatrician and the concentration techniques we use to help her.

Comment By : Geraldine

My son is 4 and half yrs old. Whenever I say not to do a particular thing he intentionally does it. It is like whatever he's asked not to do, he does it.Both myself and my husband lose our temper coz this is day in and day out for everything. Even if explained in a nice way, he doesnt seem to listen. My only worry is if this continues, handling him as he grows will be very very difficult for both of us. Please give us some guidance.

Comment By : Anu

My son is 16 years old and I'm having a problem with his behaviour. His grades plummeted from B to F. Everytime i asked about his assign- ment. He said he did it in class. But when I checked with the teacher nothing was submitted or maybe just some of it. When con fronted he gets mad or gets obnoxious. He does the blaming game. He had said one time that he has ADHD but I didn't bring him to the Dr. thinking it may not be. But now that I read this article about ADHD maybe I should really have him tested. What do you say?

Comment By : Maria

My daughter is almost 12. We suffered the same poor grades, trouble reading, difficulties and tears to get through homework and a complete disinterest in any organized anything! An absolute dreamer. The school was no help other than doing an IQ test in 2nd grade and labeling her "borderline below average intelligence" It got worse from there as teachers expected very little from her. I finally got her tested and diagnosed by a reputable center (It took a year and a half to get through everyone). We tried ADHD med's - it did not help her at all. I held her back in 3rd grade against the schools wishes and bombarded them with test results and researched information. She is in 4th grade now -medication free-and on honor roll. Don't give up hope - maturity helps them work threw and find a way to do what they need to do, even with ADHD YOU MUST FORCE THE INFORMATION ON THE SCHOOL and Keep at them to get your child the additional support. Teachers are given many tools to teach and can adjust their methods to get through to your child but you have to push.

Comment By : Rebecca

Our son was diagnosed as ADHD when he was 4 years old. We have trialled many different combinations of medication along with many parenting courses and counseling for him. Although medication takes the edge of some of his behavior it is not the only answer. Working, without blaming, the schools is paramount as well as loving them unconditionally! Even when it's hard to like them.

Comment By : Kelly

My daughter is now 20yo and a thriving college student with fantastic grades. But we struggled to get her thru all the way up till high school! At an excellent private school in grades 4-6, she was completely ignored by busy teachers who seemed unaware of why I was concerned about such a "nice, quiet" student--whose performance was below ability. We took her out and homeschooled her, then sent her off to college, holding our breath. To our relief, she seems to have developed cognitively enough to overcome her problems. If I had it to do over, I would probably have sought some intervention, but at the time we were reluctant to have an evaluation and apply a label. The point of my comment is to tell parents to find something that works; don't let these girls be ignored; and have hope and expectations for eventual success.

Comment By : Cindy

Parents are/were not provided with information involving the dangers of using Methylphenidate (Ritalin) as "treatment" for Attention Deficit Hyperactivity Disorder. One of these dangers includes the fact that Methylphenidate, Ritalin causes constriction of veins and arteries, causing the heart to work overtime and inevitably leading to damage to the organ itself. Have parents been made aware of the large number of children's deaths, that have been linked with these types of drugs, i.e. Ritalin, used as "treatment". Ritalin is part of the "cocaine" type mind altering drugs! Highly abused, passed around now, in schools, because the children know this..... The drug can affect the heart and arteries by hyper activity the drug causes in them. I grieve for the parents who are not made fully aware of this choice as opposed to behavior changing/coping techniques that can be taught by the parents and learned by the child as in Dr. Lehman's program. It's as if many Doctors, school nurses just toss out Ritalin to parents as "the" solution so often, it is absolutely frightning. I have learned too, that young men and women wanting to enter the military, may not be accepted, based on the use of this drug because of it's mind altering affects being that it is derived from cocaine. The power of attention, time and love, the power of prayer for our children - moves mountains.

Comment By : ukar99

I have had this article sitting in my inbox for days. I was talking to my daughter's guidance counselor regarding her issues. And by chance I was clearing old emails and decided to read this one (I save many of the articles). It was one I so needed to read. My child has NOT been diagnosed yet. We are in the beginning stages of research and discussions. I think this article shined a light for me and was a blessing to receive. It described our plight. I am making sure our pediatrician sees the article, too. It made me less weary about the possible diagnosis and more hopeful of the outcome! Thank you so much.

Comment By : Trish

I'm having very difficult time with my 14 yr. old.failing grades, angry behavior, stubbornness etc..I'm going to push for the school to help retest . I was told 3yrs. ago "no she definitily does not have ADD her IQ is too high to qualify for resourse room."Thanks for this article,its a start for what I suspect is the problem.

Comment By : diane

This is for Diane- IQ and ADHD have nothing to do with one another, the school seems to be only metering out resources for those that are demonstrating educational deficits based on irrelevant criteria. See your pediatrician or a qualified counselor before accepting the qualifications based on the "resource room"

Comment By : karmafo

* Dear Maria: Given your description of your son's behavior, I would definitely have him evaluated by a physician or psychologist.

Comment By : Dr. Bob

Hi Fellow "worn-out" parents, I have 3 children who fall into the add-adhd spectrum. All are bright and talented in their own ways. They each have their strengths and weaknesses. I have 2 daughters and one son who fall into this "category" of my four children. I have tried many alternative diets, and remediations of many kinds. Medication is but one part of the solution in my experience. I've tried many alternative treatments as well before going to medication. I practice homeopathy and herbal medicine in my home along with organic diets and yes, all 3 are on different medication. What I have found is that the medication (if it is the correct dosage and medication) will help get your child in a place of receptivity to learn the skills and behavior modification they need to succeed. You sometimes have to go "out of the box" for help as well. For example after years of tutoring and extra curricular activities to find something my daughter could excel in, we finally asked her what do you want to learn to do? She wanted voice lessons. We stopped all the running around to all the "remedial" therapists and did something she really was interested in instead of another remedial program. We all needed a break. Also talking with other parents and getting the latest research from reputable people b/c as parents we need to build our parenting skills and "tool-boxes" of resourcefulness. There are a lot of good books and information out there and online. While in the process, take care of yourself. You need to be the best parent you can be and its worth all of the effort and at times tears that come along with the frustration and roadblocks that pop-up throughout the different stages of development. You have to be vigilant to keep up with the changes and keep up your resolve to get your child what they need. Then over time they will start managing their affairs ie: homework and friendships and disorganized backpacks etc. better and better. Always be available for support and help if they ask for it. Studies have shown that kids who were on proper doses of medication for their specific add and adhd related issues were more successful in school and life when intervention took place at an earlier age than kids who went undiagnosed for a long time. They were more likely to self-medicate through drugs, cigarettes and alcohol than those who got the proper intervention by giving their brains the meds they needed to function effectively.Go to workshops and seminars. Educate yourselves so you know whats going on and what to ask for as you advocate for your child. Also these kids are sensitive to many foods like wheat and dairy and sugar. Build up their immune systems and give them plenty of quiet down time and clean healthy good food and lots of hugs and love. They are great kids once we start the process of educating ourselves to understanding what is going on. Keep up the hard good work and keep the Faith!!

Comment By : Mother of four

This is for Diane: My grandson is gifted and his gifted teacher went to bat for him because he has challenges in areas of communication, etc. Because he is too smart, like your child, they "resource room" program and special programs wasn't going to work with him. The answer is to learn what your rights are under the No Child Left Behind program. There are provisions for the gifted as well as the challenged ones; and take on the school. I was fortunate I had backing from his teacher and another counselor last year; and this year when he experienced some difficulty I called a conference and now they're re-evaluating his IEP. Firmness and loving discipline is also helping with some of the problem.

Comment By : Pat

Excellent article! I wish I had known this back when my daughter (now a thriving adult) was younger. I fought the school and the board to have her tested for a learning disability, but was told that she couldn't have a disability because she was "such a smart and well-behaved" girl. As an adult, she had herself tested, and guess what? Yup, she is ADHD. Now I'm dealing with my son, who shows many of the same inclinations. For years, I was told the same thing, by the school and our family doctor. I pulled in third party help (through our local family services), and finally got him tentatively diagnosed. Almost a happy ending....then he turned 14, and in our area, kids over 14 can turn down any offers of help, treatment or testing. So, what I have is a child/young man who is rapidly dissolving into a person I don't like much (still love him, of course!) who is combative, stubborn, and refuses to do anything at school. Until he realizes he needs help, all I can do is reinforce our home rules as much as possible, and wait. I just wish the "quieter" side of ADHD had been publicized more when I still had the control. Thanks for the article - I hope parents with younger kids wills ee this and question a bit more than I did at the time.

Comment By : Christa

My daughter, who is 17 and in her senior year of high school, was diagnosed the beginning of this school year. I was often told that she was "very young" for her class. That she would catch up. She has so many friends, is a pretty girl and is so talented in sports that she would make up for any delays. Her grades all through school were horrible. Though I was often told her grades were no indication of her ability. Her discipline issues at school were usually centered around lack of impulse control. The biggest problem we had at home was the fact she hardly ever slept. She has been on medication since her diagnosis. It has only had a positive effect on her. She has commented, "I never knew that when people lay down and close their eyes at night that they could simply go to sleep". Her personality is still as bright and bubbly as ever. Her attitude toward school has been positive for the first time in many years, though it may be because she sees the end is so close. She rejoiced in fact that she missed honor roll by only one point and didn't have to worry about being ineligible for sports. She has even applied to area colleges and spoken with coaches who are eager to have her play for them. The cloud of school anxiety has been lifted from my home. Homework is now done nightly without my prodding. Needless to say I am elated to have my happy and loving child back. Medication may not be the answer for all children, but in our world it has made a significant difference. As parents, we need to look at all of our options and choose that which is best for our individual families.

Comment By : Tina

Good article, but what a tease!! You write, "... interventions that develop improved attention, concentration and memory functions." We need these at our house! Other than "nagging" and suggesting, what are they, and where can I find out about them? School counselor has never mentioned anything like that.

Comment By : Shan

* Dear Shan: It's unfortunate that busy educators and health providers often resort to recommending medication for children with mild to moderate ADHD symptoms. Actually, there are alternatives such as behavior modification, Cognitive Behavioral Therapy, relaxation/biofeedback training and cognitive rehabilitation (brain training) that are research-based alternatives. They take a little time to learn and implement and the available materials cover only one or two of these interventions. I created the Total Focus program for this reason -- it is an easy and effective way to make all of these tools available. I wanted to give parents a comprehensive yet practical approach to helping children with ADHD improve concentration, attention, impulse control, social skills and coping skills.

Comment By : Dr. Bob Myers

This article has been tremendously helpful! We have been working on an ADHD diagnosis for my five-year-old son for the past few months. He is a poster-child for ADHD - hyperactive, over-reactive, having one meltdown after another, etc. My daughter, on the other hand, has always seemed like the easy child, by comparison. Recently, though, I've begun to wonder about her, as well. She's typically very happy and friendly, but she also reacts very dramatically at times, over insignificant things. Also, while she seems to make friends easily, because she is very gregarious, she is often complaining that she doesn't think her friends really like her, or they don't play with her on the playground, etc. But the most compelling concern is that, despite being very intelligent and being in advanced math and reading programs in school, her teacher is constantly complaining about her lack of focus and her daydreaming. Just yesterday, in fact, her teacher did not allow her to use the restroom because she hadn't gotten enough work done. While I strongly disapprove of denying bathroom privileges, for any reason, I can understand her teacher's frustration. My daughter is notoriously slow at everything she does. She even eats in a lackadaisical manner! Anyway, I intend to bring this up with my son's psychologist, and have her tested, as well.

Comment By : Kerri

i have 5 1/2 year old girl, im continuously being called to the school as she wiggles all the time and the teachers are having problems keeping her attention, she seems to be getting worse as the teachers seem to be putting her on detention and picking up paper at lunch for this. even one on one she cant sit still when at home doing home work.she'd prefer to be outside running arround and doesn't seem to lose any anergy. this term she seems to be getting worse i think cause the teachers are not using positive rewards when shes trying to do the right thing.the teachers just want to repeat her but im unsure and want to do the right thing by her, im not sure of the next step to go as i feel she may have add or adhd.

Comment By : trish

* Dear trish: Start by talking to your child’s pediatrician about your concerns. If your pediatrician feels there is reason to consider a diagnosis of ADHD, he will send evaluation forms to your daughter’s school to be completed by her teachers and returned to him. We hope this information is helpful and that you are able to find the assistance your child needs to succeed.

Comment By : Carole Banks, Parental Support Line Advisor

This was a fantastic article. It so explained my daughter who was diagnosed 4 years ago with ADD. Due largely to her 2nd grade teacher who recognized that she was a very smart child, but just did not have the ability to concentrate I had her tested by a psychologist. My daughter just entered middle school, 6th grade, and panic came over me as to can she handle this new environment. Well two weeks in and she seems to really enjoy it. One key that I have found with having a child with ADD or ADHD is knowledge, be informed. Everytime I read something new I am learning more and more about her and even myself. And the other key is don't be afraid to make changes that will help them. We as parents may have to adjust how we help them organize or do their homework. The point is with a little work and a lot of love you can be a success.

Comment By : kymmleigh

The article makes it seem like the IEP is so easy to get for an ADHD child. My daughters school is fighting it tooth and nail. I feel betrayed by the school, and my daughter is stressed because she is failing and no one will help her. She often could care less whether she goes to school or not.

Comment By : Camelmama

* To ‘Camelmama’: It sounds like you and your daughter are quite frustrated, and it’s easy to see why. I wonder if your daughter might be a candidate for a 504 plan. I have seen many ADHD children get 504 plans, though the process may differ from state to state. You might want to ask your daughter’s school about this. In the meantime, here is an article I think will be very helpful to you: How to Navigate the School System When Your Child Has a Disability. Good luck as you continue on in the difficult role of being an advocate for your daughter. Your daughter is lucky to have a mom like you who is willing to keep fighting, despite the resistance you have met from the school. Hang in there and take care.

Comment By : Sara A. Bean, M.Ed., Parental Support Advisor

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