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AD/HD and Girls

Girls with ADHD are more likely to slip through the cracks than boys, says Dr. Debra Seltzer, an assistant clinical professor of developmental behavioral pediatrics at New York Presbyterian Hospital in New York City.
That’s because girls with the condition tend to exhibit fewer behavioral problems in school than boys, Seltzer explained. “The girls are daydreaming,” she says. “The boys are blurting out jokes in the middle of class, jumping out of their seats and running around pulling books off of shelves. The girls just aren’t disrupting class like the boys are.”

Seltzer and others believe the criteria used to diagnose ADHD need to be changed a bit to take these gender differences into account. Perhaps the ADHD gender gap would close if this happened, she says. Right now, no one knows for sure what percentage of girls actually have ADHD — that study still needs to be done, Seltzer says.

It’s easy for girls with ADHD to be missed, particularly if they’re bright, agrees Dr. Anthony Rostain, an associate professor of psychiatry and pediatrics at the University of Pennsylvania School of Medicine in Philadelphia. 

Rostain points to the example of a senior high school girl who recently came to see him for evaluation. “She’s got an IQ over 140,” he says. “But lately she’s been getting Cs, Ds and even Fs in her classes. Because she’s so bright, she fooled people for years into thinking she didn’t have ADHD. She caught enough of what was going on to get by. But when she entered a very high academic environment where she was asked to sit down and write papers and take advanced placement courses she started having real problems.”

RITALIN’S ROLE 

This all adds up to girls with the disorder not getting a very effective treatment — Ritalin. Although the popular press has occasionally demonized the drug, experts agree that it is well studied and safe for children and teens with disabling ADHD. 

By imaging the heads of children with ADHD, scientists have confirmed that these children’s brains do not work the same as those of normal youngsters. Certain parts of the frontal lobe are underactive in these children, Rostain says. These are the parts of the brain that are involved in inhibiting movement, in selecting what to pay attention to and in planning ahead, he adds. 

Ritalin tunes up the brain so that ADHD sufferers can focus better and ignore inappropriate impulses. “Ritalin increases the signal to noise ratio, so you get better transmission of signals in the brain,” Rostain says. “It allows those centers that are relatively inefficient to work better.”

Still, with all the bad press given to Ritalin, many parents are afraid to give the drug to their children.
But, says Seltzer, “It’s better studied than aspirin and Tylenol and we use those medications without giving it a thought. For children with authentic, organic ADHD, withholding Ritalin is the same as refusing to give insulin to a kid with diabetes.”

THE CONSEQUENCES OF NOT TREATING

The consequences of undiagnosed, untreated ADHD can be devastating to a girl. Rostain’s patient, for example, has had to completely change her academic plans. “Now she’s very depressed because she’s not finishing high school in time to go on to college,” he says.

I have a good understanding of how difficult it can be to live with what I suspect is probably an attention deficit problem. 

That daydreaming little girl you sat next to could have been me. ADHD wasn’t being diagnosed much when I was growing up, so teachers just thought I was a bright, but inattentive — and annoying — child. Over the years I’ve learned to cope. I don’t buy expensive sunglasses — I eventually lose every pair I get anyway. I try to do things when I think of them, rather than putting them off until later, when I know won’t remember.
I don’t know whether my parents and I would have chosen for me to take Ritalin if it had been available. I was able to do well in school despite my daydreaming and attention problems. 

I do know that if I had a child who was depressed and unhappy because ADHD was making school a torture, the drug would be an option I would seriously consider.


Linda Carroll, a Philadelphia-based freelancer, writes frequently for Newsday and The New York Times Syndicate.