Why Girls with Attention Deficit Disorder Go Undiagnosed

Many people think Attention Deficit Disorder (ADD) is a boy's disease. Boys are more often diagnosed, but the rates are about the same in both genders. Boys more often have the variety called Attention Deficit/Hyperactivity Disorder (ADHD) that gets their problem noticed. That means that girls are often undiagnosed and untreated. The consequences of unrecognized ADD in females can range from failure to reach their potential to risky adolescent behavior to depression.

Their Symptoms are not the Same as in Boy

Parents, teachers, and health professionals alike picture the classic case of ADD as a boy with a lot of hyperactivity. The average girl with ADD acts differently. In girls, the disorganization and distraction results in lack of activity--they are too confused to get things started. They tend to be daydreamers. This is in stark contrast to the boys. Their distractibility is expressed as impulsivity--a flurry of activity. Both genders have trouble learning the nuances of social interactions. Girls end up shy and withdrawn. They don't like the negative reactions they get when they don't clue in to the nuances. Boys are more likely to proceed with social behavior that is considered inappropriate. While they are bewildered when they get negative reactions, they continue.

A girl's enviroment is more likely to be disorganized -- their locker, their bedroom, even their handwriting is a mess. Both genders have problems in this area. But simply, girls are expected to be the organizers for themselves and others. While males are more likely to get this done for them, when they can't do it on their own.

As these girls hit the teen years, the increased organizational demands of junior high and high school become too much. They may become tired and disheartened by poor school performance. The girls with hyperactivity may throw themselves into social relationships to compensate. They may be described as "boy-crazy" or "party girls". ADD and ADHD girls alike begin to show more risky sexual and other behaviors. They may use drugs or alcohol both due to increasing impulsivity and to self-medicate. Shoplifting, teen pregnancy, and eating disorders are also found more often in females with ADD.

Why the Symptoms are Different

The differences in actual enviromental disorganization are clearly due to social factors. But, no one knows for certain why there is such a large difference in hyperactive behavior between the two genders. It could be that girls have more pressure to conform. Coarse, loud social behavior in a boy may be tolerated. But, a girl may be more pressured into silence. Likewise for girls, the impulsive actions may get a more negative reaction from adults and peers alike. In fact, it has been found that girls with ADHD (those who do express the hyperactive qualities) have more negative social consequences than boys. This is true even though the boys have more hyperactivity. No physical differences have been identified.

Girls with ADD Are Not Considered a Problem to Their Teachers

Girls are much more likely to have straight ADD. This is in contrast to ADHD (Attention Deficit Hyperactivity Disorder) that boys tend to have. Because a girl doesn't tear up the classroom, her problem does not create a problem to be solved for the adults in her life. Her inability to concentrate and execute goals is likely to be overlooked. A girl with ADD has fewer learning problems in early grades, than her male counterparts. Boys often get diagnosed through evaluation of learning problems. Girls with ADD, especially those with high intelligence, may actually be good students and/or well-behaved.

Parents aren't as Concerned

The girls who do have low academic performance may not be as big a concern to their parents. Parents may worry more about their boy's future. The girls' quiet, people pleasing behavior may be considered desirable, when it would be viewed as wimpy in a boy.

Society Mis-labels them

When girls with ADD do not conform to social roles, it is often is described in gender-specific terms, rather than as a medical problem. They are labeled tomboys or spacey as girls, and boy-crazy or party girls, as teens. Again, girls meet more social pressure to conform, rather than recognition and treatment of a disease.

Doctors Mis-Diagnosis it

The symptoms of ADD in girls overlap with the symptoms of depression. In both problems there are low energy levels, disorganization, social withdrawal, and trouble concentrating. Even more confusing, the unrecognized ADD can lead to major coping problems, which in turn lead to actual depression on top of the ADD. This most often occurs at adolescence (although it can happen earlier). Doctors tend to zoom in on the diagnosis of depression, which is more common in females and especially female adolescents. They think of ADD as a "boys' disease".

Getting Evaluated

Undiagnosed adult women have been found to have everything from underachievement to low self-esteem to depression and substance abuse. The medical profession is awaking to this gap in identifying and treating girls. It is easy for a girl to read something like this article and say "OMIGOD, that's me!!". Being unprepared, shy, or daydreamy are part of every girl's life to some degree. Impulsivity with boys or drugs are part of many teens' lives too. Still, it never hurts to bring it up with the parents or a school counselor, if she suspects this might be her problem. This would be the first step to deciding on formal medical evaluation. If she is not ADD, she will have the reassurance of knowing. If she is, she can get treatment or change her enviroment to maximize her potential.

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Comments

This article seems to have something of a feminist agenda. For a start it suggests males with ADD are very rare - they aren't, about a third of ADD cases are boys. There are plenty of males with ADD who are also well behaved and as far as I know neither males or females with ADD seem to engage in a lot of high risk behaviour(in stark contrast to both males and females with ADHD who are much more extroverted). Males with ADD are also just as likely to be ignored as females with ADD).

If ADHD is more common in boys it is probably because young males tend to have slower frontal lobe development, so are more likely to exhibit extreme ADHD behaviours. The assumption that girls are forced to hid their ADHD due to social pressures is suspect since extreme frontal lobe dysfunction is much less common in girls.

Admittedly, though this doesn't explain why ADD is more common in girls than boys, and more research is needed to explain this.

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