February 27, 2016 in Parenting

SheJust Likes to Daydream

By Dr. Chris Berrios

Consider the followingscenario: Jane is a bright well-behaved 4th grader whose academicwork is just about on grade level. She chooses to sit in the back of theclassroom and much of the time she’s doodling in her notebook. When asked tocomplete a written assignment, Jane works diligently at first, but then shebecomes easily distracted by noise outside the window and loses track of herassignment. The unfinished work then gets stuffed into her messy backpack andis rediscovered several weeks later. Now take Johnny, a bright 4thgrader who has trouble remaining seated. He is always fidgeting with hispencils and anything else on his desk. He shouts out answers and constantlyinterrupts his teacher with comments and requests to go to the bathroom.Johnny’s academic work is less than expected for his age and capabilities. Whodo you think is more likely to be referred for an evaluation? If you saidJohnny, you are right! Jane on the other hand is likely to be labeled as adaydreamer, spacey, disorganized, and/or lazy and her difficulties are lesslikely to be addressed. Jane may go through her school years withoutintervention and is less likely to reach her full educational potential,frustrated at herself, struggling with self-esteem issues and even perhapsanxiety and depression.

Did you know that thesymptoms of Attention Deficit/Hyperactivity Disorder (ADHD) for girls aredifferent compared to boys? Did you know that many girls do not start to showsigns of ADHD as young as boys do? Just take a minute to think about a fewwords that automatically come to mind when you hear ADHD. Perhaps some of thosewords are: hyperactive, uncontrollable behavior, rowdy, fidgety, etc. Thesewords, or the like, may be automatically used to describe ADHD because that ishow ADHD was first diagnosed in young white boys and thus socialized to be ourunderstanding of this disorder.  Thesecommon behaviors are referred to as externalizing behaviors and comprise oneaspect of ADHD. However, these are not the common symptoms that girls oftendisplay. In fact, girls are oftentimes misdiagnosed or not diagnosed at all,paving the path to a difficult journey into adulthood. On a positive note, thereis an increased awareness regarding ADHD among girls. In a study, between 2003and 2011, parents reported an increase of ADHD diagnoses of 55% for girls,compared to 40% for boys. A 1999 study published in the Journal of the AmericanAcademy of Child and Adolescent Psychiatry found that girls with ADHD were morelikely to have behavioral problems, mood and anxiety disorders, and impairmentin social, family, and school functioning than non-ADHD girls. These girls werealso at risk for substance abuse, panic disorders, and obsessive-compulsivedisorders. However, they also found that rates of behavioral problems werelower in girls with ADHD than in boys with the condition, which may account forthe lower rate of diagnosis in girls.  

So let’s look at somedifferences in girls compared to boys. For starters, unlike boys, ADHD is notabout hyperactivity for girls but mostly inattentiveness and disorganization. Girlswith ADHD often have the inattentive type, whereas boys more often have thehyperactive/impulsive type which is easier to identify. A girl with inattentiveADHD is unlikely to be disruptive in class, but will miss assignments, is slowto process information and following directions, is forgetful, makes carelessmistakes on homework and tests, is easily distracted, is often late (poor timemanagement), is hyper-talkative, becomes easily upset or over-reactive and mayappear to be daydreaming. And while some ADHD symptoms tend to decrease withage for boys, for girls, it becomes worse with age if left untreated. Additionally,girls tend to internalize their difficulties, increasing the potential foradditional psychological disorders such as depression and anxiety. Depressionand anxiety turn into low self-esteem and self-loathing, and the risk forself-harm and suicide attempts is four-to-five times that of girls withoutADHD. The reality is that girls with ADHD are more prone to major depression,anxiety, and eating disorders than girls without ADHD. Girls with ADHD tend tohave fewer friendships and as a result of their low self-esteem, they oftenchoose unhealthy relationships in which they may accept punitive criticism andor abuse. As mentioned earlier, girls tend to develop ADHD later than boyswhich further makes identifying the signs more difficult as it is seen as partof the emotional turmoil during the “teenage years.” Parents and teachers oftenmiss these signs and when they seek help for their daughters, many times theyare misdiagnosed and treated with anti-anxiety or depression drugs whichexacerbate the effects of ADHD. Failure to diagnosis properly can lead to girlsmissing out on critical academic services and accommodations, as well astherapy and medication.

Girls who arepersistently having difficulties in these areas should be referred for an ADHDevaluation. If ADHD is found to be the cause of symptoms, simple interventioncan be put in place including behavior management techniques, organizationalstrategies, medication, therapy and support. Often times, simply understandingADHD’s impact in one’s life relieves girls of a huge burden and frees them fromthe damaging labels of “spacey,” “careless,” “unmotivated,” “stupid,” or“lazy.” They have ADHD and can learn strategies to make life a little easier.