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ADHD's Severity in Girls Overlooked

Study finds it's partly because they're less aggressive than boys with condition

WEDNESDAY, Oct. 2, 2002 (HealthDayNews) -- Many parents and pediatricians assume girls don't suffer as much from attention deficit/hyperactivity disorder as boys.

However, researchers in Northern California observed girls with the disorder at summer camps, and found they are much more impaired than their counterparts who don't have the condition.

The findings suggest the medical community doesn't appreciate the frequency and severity of ADHD in girls, says Stephen Hinshaw, a professor of psychology at the University of California at Berkeley and co-author of the new study.

"Boys and girls are similarly afflicted and impaired by the symptoms of the disorder," Hinshaw says. "Girls appear to be as affected as boys, if not more so in some instances."

ADHD affects an estimated 3 percent to 5 percent of American children, possibly as many as 2 million kids. Three boys are diagnosed with the disorder for every one girl.

However, several researchers have argued that many affected girls have been left behind, largely because they are less likely to be hyperactive and more likely to have trouble paying attention. "The hyperactivity tends to come to the attention of teachers and parents, and gets kids in trouble with their peers," while a lack of attention is less noticeable, says Nadine Kaslow, chief psychologist at Emory University School of Medicine.

In the UC-Berkeley study, researchers enrolled 228 girls aged 6 to 12 in day camps held from 1997 to 1999. Of the girls, 140 had ADHD and were specially recruited; the others, who weren't diagnosed with ADHD, were told the camps were for "enrichment."

The girls with ADHD went off their medications for the six-week day camp periods so researchers could observe their "natural" behavior.

The findings appear in the October issue of the Journal of Consulting and Clinical Psychology.

Researchers watched the girls closely, and found those with ADHD were often socially isolated and uninterested in following directions.

The girls with ADHD weren't as physically aggressive as boys with the disorder, but Hinshaw says they were more likely to engage in what is called "relational aggression" -- "getting back at someone by excluding them from an activity or social group, or spreading rumors rather than directly aggressing against them."

The girls scored as poorly as boys on tests of their abilities to set goals, alter strategies in response to changing situations, and make plans.

Kaslow praises the study, and says more attention to the ADHD problems of girls will help them later in life. "This really underscores the importance of teacher, parents and pediatricians paying attention when girls aren't doing as well as one thinks they should be," she says. "The longer these problems go untreated, the worse kids feel about themselves, the more social difficulties they have, and the harder life becomes for them."

Some adult women appear in her office with cases of ADHD that have been undiagnosed since childhood, Kaslow says. "They didn't know they had it, but they knew they struggled more to organize their work and their thinking. Sometimes teachers would say these kids weren't that smart, but it's not an intelligence issue. It's about an ability to organize it, and get it all together."

The good news is that ADHD drugs appear to work as well in girls as in boys, Hinshaw says. "ADHD is a serious, but treatable, problem in girls."

What To Do

Find out more about ADHD from the National Attention Deficit Disorder Association, the National Institute of Mental Health or Children and Adults with Attention-Deficit/Hyperactivity Disorder.

SOURCES: Stephen Hinshaw, Ph.D., professor, psychology, University of California, Berkeley; Nadine Kaslow, Ph.D., chief psychologist, Emory University School of Medicine, Atlanta; October 2002 Journal of Consulting and Clinical Psychology
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