Girls & ADHD: Are You Missing the Signs
2007-03-09

By Caralee Adams When you think ADHD, do you think boy? You’re not alone. Boys are three times more likely to be diagnosed with ADHD, even though they’re no more likely to have it. Too many young girls are not getting the help they need.

That’s why teachers are so important. When it comes to learning disabilities, teachers are right there on the front line. We’re often the first to spot a child’s difficulties and to bring it to the attention of parents and specialists. It’s important that we know the different ways ADHD may manifest in our girl students and the reasons we may miss it.

Alarmingly, some studies estimate that as many as 50% to 75% of girls with ADHD are missed. Worse, girls with ADHD are diagnosed on average five years later than boys—boys at age 7, girls at age 12. Five crucial years girls could be getting help are lost.
“ADHD is not gender-linked,” says Dr. Patricia Quinn, director of the Center for Gender Issues and ADHD and an expert on ADHD in girls. Recent data shows medication for ADHD is dispensed equally to men and women. It follows that if adults are experiencing the disorder in equal numbers, children might too.

“The diagnosis should be 50-50 between boys and girls,” says Quinn. So the big question is, why isn’t it?

One major reason is that girls’ symptoms manifest differently. “ADHD doesn’t show up in the same ways in girls,” says Kathleen Nadeau, a clinical psychologist in Silver Spring, Maryland, and coauthor of Understanding Girls with AD/HD. For instance, girls are much less likely to display hyperactive or impulsive symptoms. Instead, they may just appear “spacey,” unfocused, or inattentive. Or they may have trouble staying organized or remembering directions or homework.

But even when these symptoms are clearly present, ADHD may be missed. Nadeau puts it bluntly, “Girls are less likely to be referred because they cause fewer problems in the classroom.” Socialized to please their teachers and parents, girls can be very good at compensating for the disorder, making it much harder to spot. When teachers do see it, says Nadeau, “[girls’] behavior is often misunderstood as immaturity or lack of academic ability rather than as ADHD.”

As educators, we need to be informed and aware. School is the number one place where ADHD gets identified, says Mohab Hanna, child and adolescent psychiatrist and author of Making the Connection: A Parent’s Guide to Medication in ADHD. “This is the context where it gets magnified. Teachers interact with kids academically and see how they do socially. A lot of parents don’t know what’s normal.”

So, what are the signs of ADHD in girls? Here are some of the cues you can look for and some simple ways to help.

Sign #1: Nonstop Talking
Do you have a student who’s always talking with her friends? It may not be that she’s a social butterfly, she may have ADHD. This student may keep talking “accidentally” after being asked to stop, even though she doesn’t mean to be defiant, says Nadeau. A girl with ADHD may also interrupt impulsively when you’re leading the class. While a boy might leave his seat continually, many girls with ADHD express their restlessness verbally.

What you can do: Try seating your student near the front of the class and away from other talkative students. Throughout your lesson, pause periodically and ask students to buddy-share—exchange ideas, compare strategies. This is beneficial to all, but will particularly help your student with ADHD by giving her an acceptable outlet for talk. You might also try giving her a task such as handing out papers to help refocus her energy.

Sign #2: Friendship Troubles
Does your student barge into a group and, more often than not, find herself unwelcome? Sadly, girls with ADHD tend to struggle to fit in with their peers. “They can be talkative and outgoing, but by the end of the week, they may not have many friends because they got too bossy or interrupted too much,” Nadeau says. A girl with ADHD may be slow to pick up on social cues and may even be verbally aggressive when she feels frustrated. Conversely, boys with ADHD are less likely to suffer peer rejection. The rules for boys’ play are less stringent; their games are more physical. But for girls with ADHD—if they don’t receive help and guidance—self-esteem can take a pummeling.

What you can do: Recognize that a girl with ADHD often needs help negotiating her relationships with peers. Be patient with her and—without making this student your focus—encourage your class to be patient and generous with other children’s differences. Teaching social conventions explicitly—how to join a group in play or how to give a compliment—can make a world of difference. Calmly explain social conventions to her and give her an opportunity to practice. Lastly, “make your classroom feel like a safe place to make mistakes,” suggests Nadeau. Understanding goes a long way.

Sign #3: Difficulty Paying Attention
It’s tempting to describe the girl who fiddles with her crayons while you’re explaining fractions, then quickly says, “I don’t get it” as ditzy—a word that somehow seldom gets attached to boys. But trouble listening can be a symptom of ADHD. This girl may have difficulty listening and retaining multistep directions, says Nadeau. Finding it hard to stay tuned in when the teacher is talking for several minutes at a time is often a sign of the disorder.

What you can do: Try involving her in your lessons so those crayons aren’t so alluring. Ask her to pass you a manipulative, for example, or keep time during round robin reading. You might also lecture for five or ten minutes at a time rather than 20. Again, it’s important to model focused attention to the entire class, not just your ADHD students. Ask kids what someone who’s paying attention looks like (shoulders squared, eyes on speaker, hands folded on desk, quiet). Then practice the behavior as a class.

When an ADHD student does drift off, draw her back in without reproach. Quinn suggests having a signal, such as a secret word, that you say as a cue to tune in.

Sign #4: Exceptional Messiness
While girls with ADHD are far less likely than boys to be disruptive in class, they are just as likely to have organizational problems. A very visible sign of a girl struggling with ADHD may be her disorganized desk or backpack. She may also have issues with homework and classroom routine—i.e., she’s not able to keep her papers in order or find a pencil when needed. While all kids can be sloppy at times, the frequency and degree may be a clue.

What you can do: A first step is to reduce the papers shuffling back and forth between school and home. An easy way to do this is to post your homework assignments and newsletters online (www.scholastic.com offers free homepages to teachers). Next, reconsider your assignments. Is your ecosystems poster project putting more emphasis on neat execution than on swamps and deserts? Offer students the opportunity to present what they’ve learned in different ways, whether it’s a typed report or a skit.

Sign #5: Unfinished Work
Since girls may try hard to mask their disorder, teachers don’t always realize how much they are struggling to finish assignments. They may appear shy and studious in the classroom and don’t often stand out to teachers. Take note
of girls who consistently fail to finish classroom assignments or tests in the allotted time even though they seem to know the material.

What you can do: Help break down work into smaller tasks to address sequencing problems. For students who are slow at processing, cut back on the number of questions or assigned problems. Ask yourself how many problems really need to be done to practice the learned skill. Since ADHD students can be inconsistent with their performance, it may be appropriate to allow them to retake tests now and then.

Sign #6: Emotionality
So, you have a student who bursts into tears at the slightest reproach or turns into a ball of fury when play doesn’t go her way. You think “Hannah’s so sensitive,” but it might be more than that. If she has ADHD, her impulsivity might make it hard for her to control her emotions. At the same time, compensating for ADHD in the classroom and on the playground is exhausting and may leave her depleted and vulnerable. We all want approval and success, and when it’s hard to come by, the tears may seem to flow over the smallest incidents.

What you can do: Do what you can to help her feel like an important member of the class. Share with her some calming techniques that will help her regain control—e.g., breathing deeply, thinking positive thoughts, counting. Insist that all your students treat one another’s feelings respectfully (even when a child seems to have too many).

As you read through these signs, did you find yourself thinking, “Oh my, this is so-and-so in my class?" If so, now is the time to initiate a conversation with her parents. Ask them what they are seeing at home and perhaps follow up with your school psychologist. You could be the one who helps her find the school success she deserves.