SUNDAY, Feb. 16, 2003 (HealthDayNews) -- When Kathleen Nadeau was a little girl, she spent so many hours studying that her mother wondered what was wrong.
Nadeau was bright. Yet, while other girls were enjoying parties and after-school activities, Nadeau avoided all social events throughout junior high and high school as she struggled to keep up her grades.
It wasn't until she was an adult that Nadeau, now a psychologist in private practice in Silver Spring, Md., realized she had attention deficit hyperactivity disorder (ADHD).
"Only by keeping this hyper-focus on what I was doing could I do well," Nadeau says. "I knew I couldn't balance all the distractions the way most people do."
ADHD is a condition marked by distractibility, difficulty setting priorities and following through, impulsivity, difficulty with social relationships and, in some people, hyperactivity.
For years, it was believed that only boys suffered from ADHD.
However, a growing body of research -- and a greater awareness on the part of parents and doctors -- is finding that ADHD is quite common among girls.
Though boys with ADHD still outnumber girls, the gulf is not nearly as large as previously believed, says Stephen Hinshaw, a professor of psychology at the University of California at Berkeley.
Some estimates put the ratio at five boys for every girl with ADHD or even 10 to one, but Hinshaw believes the number is closer to two to one.
"ADHD can and does exist in girls," he says. "But many girls are diagnosed as having anxiety or depression, or their diagnosis is missed altogether."
Part of the problem in diagnosing girls is that their ADHD symptoms are often more subtle, as in Nadeau's case.
Many boys with ADHD, though not all, are hyperactive. They are defiant and disruptive in classrooms, which brings them to the attention of teachers and parents quickly.
Some girls with ADHD show symptoms of hyperactivity and aggressiveness. However, many more girls have what's known as "inattentive type" ADHD, Hinshaw says.
They are bright but have to work very hard to keep up in school. They can't follow their teachers' or parents' directions. They are often dismissed as "scatterbrained" or "flighty."
"Boys are clearly more aggressive and disruptive than girls in a physical sense, so they are the ones that get referred," Hinshaw says. "The 'inattentive type' is a less visible type because you're not disrupting a class, you're not running round. You are in some ways suffering in silence, because you're not processing information, you're not focusing attention on parents' demands or teachers' directions."
And it doesn't mean girls aren't struggling to cope with the difficulties of life with ADHD.
Hinshaw and his colleagues enrolled 228 girls aged 6 to 12 in day camps held from 1997 to 1999. About 140 of the girls had ADHD. The others were not suspected of having ADHD and were told the camps were for "enrichment."
The girls with ADHD stopped talking medicine such as Ritalin for the six-week duration of the camps so researchers could observe their behavior.
Some of the girls with ADHD were overactive. Many others had problems following directions and getting organized.
Most striking was the social problems the girls with ADHD had, Hinshaw says.
The overactive girls weren't liked because they were aggressive and disruptive. The inattentive girls, meanwhile, became socially isolated.
"They were very poor at reading social cues," Hinshaw says. "But they did it in a more passive, 'clueless' way."
Hinshaw's study was published in a recent issue of the Journal of Consulting and Clinical Psychology.
About 2 million U.S. children, or 3 percent to 5 percent, have ADHD. The condition can run in families -- about 80 percent of the underpinnings of the disorder are due to genetics, previous research has found.
Years ago, doctors believed children outgrew ADHD. It's now known that some do outgrow the hyperactivity, but the cognitive problems often last a lifetime.
When Nadeau was growing up, her brother had a classic case of "hyperactive-type" ADHD. He did poorly in school. He was defiant, disruptive and took physical risks.
"I was so utterly different no one suspected I could have it, too," she says.
Nadeau continued her obsessive work habits throughout college and graduate school. She earned a Ph.D. and began a psychology practice. While treating children with ADHD about three decades ago, it dawned on her she had many of the same difficulties.
"I realized I was making all sorts of accommodations in my life for ADHD," she says.
At about the same time, a pediatrician diagnosed ADHD in her youngest daughter, now grown and working as a real estate agent.
Both she and her daughter have found Ritalin-like medications help them stay organized and think clearly.
And Nadeau has found ways to cope. She keeps her office calm and quiet to minimize distractions. She has an office staff that takes care of organizing paperwork and paying bills.
"But I still struggle with these issues every day," she says.
Not every case of a hyperactive or unfocused child -- or adult -- is a missed case of ADHD.
"Diagnosing ADHD requires a careful psychological assessment to find out if it really is ADHD, and not some other problem or poor child rearing," Hinshaw says.
What should parents look for?
Girls who are very intelligent but have problems at school is a telltale sign, Nadeau says. So are frequent stomach aches or anxiety about school.
Girls with ADHD are also often dismissed as "social butterflies," she says. In women, hyperactivity is often manifested as talkativeness.
More information
ADDvance has more information about ADHD in women and girls. The Attention Deficit Disorder Association can help you find local support groups and other resources.
