FRIDAY, Aug. 23, 2002 (HealthDayNews) --
Young girls are often ignored when it comes to a proper diagnosis for attention-deficit/hyperactivity disorder (ADHD), claims a new survey of gender differences in the treatment of ADHD.
That's especially troubling because their suffering, particularly in terms of self-esteem and socializing, is more pronounced than that of boys with ADHD, and the disorder hits girls as often as it does boys, says a doctor who specializes in ADHD.
"This is the first national survey that confirms what we've seen clinically, that we've missed diagnosing about 50 percent of the girls who have ADHD," says Dr. Patricia Quinn, director of the National Center for Gender Issues and ADHD and an independent advisor on the survey. "The diagnosis ratio of male to female with this disorder should be 1:1. We're way behind the curve."
ADHD affects 3 percent to 5 percent of all children, perhaps as many as 2 million American children. However, at least twice as many boys are diagnosed with the disorder, according the National Institute of Mental Health.
More than 3,000 people responded to the survey, which was conducted by Harris Interactive: 346 adolescents who had been diagnosed with ADHD; 541 parents of children with ADHD; 550 elementary and high school teachers, and 1,797 adults in the general population.
Among the findings with the ADHD children, aged 12 to 17, were that more girls than boys reported it was "very difficult" to make friends (27 percent versus 18 percent), to get along with their parents (39 percent versus 25 percent), to get things done in general (57 percent versus 39 percent), and to focus on schoolwork (77 percent versus 66 percent).
The girls were also more likely to report it was "very or somewhat difficult" to feel good about themselves before treatment compared to the boys -- 68 percent compared to 57 percent.
Further, before diagnoses, the girls were three times as likely as the boys to have been treated for depression, the survey found.
The parents of the ADHD children concurred with the children's assessments: 55 percent of the girls' parents reported their daughter's ADHD affected her self-esteem a great deal, compared to 46 percent of the boys' parents; 78 percent of the girls' parents said, if left untreated, the disorder negatively affected relationships with peers and classmates, compared to 64 percent of the boys' parents.
"Girls tend to internalize their problems and withdraw," which lowers their self-esteem, says Quinn, who is a pediatrician at Georgetown University.
Teachers, too, seem to be aware that girls are under-diagnosed, the survey found.
Eighty five percent of the teachers thought that girls with ADHD are less likely to be diagnosed than boys, with 92 percent reporting it was because girls don't "act out."
Quinn agrees, explaining there are three subsets of ADHD: inattentive; hyperactive/impulsive; and a combination of the two.
While most boys with ADHD fall into the latter two categories, most girls with ADHD exhibit the less noticeable symptoms of inattentive behavior.
"A boy will often manifest ADHD by getting up to go to the pencil sharpener and being disruptive in the classroom, while a girl will be sitting quietly staring at the teacher praying she won't call on her," Quinn says.
Girls will often exhibit forgetfulness, a lack of organization or daydreaming, she says, all things a teacher might not notice.
It's a problem," says Nadine Kaslow, chief psychologist at Emory University School of Medicine. "Girls have more of the attentional difference, and might be considered not as smart or not hard-working, rather than suffering from a disorder."
Quinn says recent research shows the disorder is a neuro-biochemical one, meaning that parts of the brain that help with concentration and organization are not activated in patients with ADHD. Medications can stimulate those areas of the brain and improve performance.
"The drugs stimulate the areas that aren't 'turned on,'" she says.
It is important that other treatments be used as well, Kaslow adds.
"Patients need a thorough evaluation and treatment that can include parent training, remedial help for the child in school, and patients may also need therapy," she says.
The survey was funded by Novartis Pharmaceuticals, which manufactures Ritalin, a drug used to treat ADHD. It was conducted over the Internet, using Harris' standard polling techniques, and the data was weighted to reflect age, gender, race, region, income and education in the general population.
What To Do
To see if your daughter might be suffering from ADHD, you can look at the self-report questionnaire at Addvance, a Web site focusing on women with ADHD. A fact sheet about ADHD can be found at The Center for Children and Youth with Disabilities.
