ADHD Girls Go Undiagnosed

People always said she was a "good girl." And why not? Britney Joyal was quiet in class and did what she was told.

"Her kindergarten teacher said Britney just marched to the beat of a different drummer," says Britney's mother, Emilie. "And I thought, 'How bad can that be? Certainly, she's not causing any trouble.'"

Sure, Britney may not have been trouble for teachers, but school always troubled her. Multiplication problems, spelling tests, science reports - all nightmares for Britney no matter how hard she worked. Britney, now 15, has attention-deficit/hyperactivity disorder (ADHD). She wasn't diagnosed until she was 12, an age most experts consider late. Her younger brother, Joseph, who also suffered from the problem was diagnosed in third grade. And it was Joseph's doctor who suggested Britney might have the same problem.

It was a lucky catch. Many girls with ADHD are never diagnosed and enter adulthood without any idea there might be a problem in the way their brains are wired, a problem that can lead to frustrated careers, poor relationships and even depression.

New research

A new survey from Harris Interactive on gender differences in ADHD shows how young girls and teenagers are affected when doctors, educators and parents miss the problem. Prior research found in Family Practice News newsletter suggests that as many as 75 percent of girls with ADHD are missed.

"Girls are the silent sufferers," said Timothy Wilens, M.D., an associate professor of psychiatry at Harvard Medical School in Boston and one of the survey's creators. The survey was sponsored by Novartis Pharmaceuticals Corporation.

He said some results surprised him. "I was struck by the amount of depression and angst that girls go through," he said.

The survey looked at several groups: boys and girls with ADHD between 12 and 17 years old; parents of children with ADHD; teachers; and the general public. More girls than boys said they had problems making friends, getting along with their parents, finishing things and focusing on school work - probably results of ADHD.

Wilens said as these girls enter adulthood, their behavior shows the classic symptoms of ADHD - acting impulsively by jumping into marriage at a young age, taking longer to finish college or having trouble with their professional lives. The survey helped verify this feeling of restlessness.

The consequences

The survey found 74 percent of girls' parents "strongly agreed" that, in general, untreated ADHD has serious long-term implications, compared with 63 percent of boys' parents. Results suggested that girls with ADHD were about three times more likely to be treated for depression than boys with ADHD. Girls also said it was "very or somewhat difficult" for them to feel good about themselves and feel happy prior to treatment.

Wilens said the correlation between ADHD and depression in girls and women is not yet clear. Do they exist independently? Is the depression created by the ADHD struggles in school? That has yet to be determined, he said.

Most teachers surveyed (85 percent) said they thought girls with ADHD were more likely to go undetected; 92 percent of teachers said it was because girls don't act out in class.

Almost 70 percent of all children with ADHD continue to have problems into adulthood, according to Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), a national nonprofit organization for parents and their children with ADHD.

The reason?

Girls usually struggle silently and tend not to act up or become hyperactive, a behavior symptomatic of ADHD that is more commonly seen in boys with the disorder. Wilens said it's probably physiology. Starting from the womb, girls are physically different from boys with girls' brains acting differently. And girls tend to have more insight into their own struggles, making them aware something is wrong. As a result, they may blame themselves. These sufferers may not realize a neurological problem is making it difficult for them to keep up.

"Bias begets bias," Wilens also points out.

Schools, parents and doctors traditionally look for the problem in boys but usually don't with girls. When girls have trouble with their work, they are urged to keep trying, to keep working at it. "It used to be that we didn't put a lot of emphasis on girls and their education," Wilens said. "If you were having trouble in school, they (educators and parents) would say, 'Well, hope you marry well.' We're beyond that now. Now, we have similar (academic) expectations of girls as we do with boys."

Some patients that Wilens sees are adults. The oldest ADHD patient to get a diagnosis was 75, although the age of the typical patient he sees is 38. And they are relieved to have some kind of neurological answer for their lifelong struggles, that all along it wasn't a character flaw.

Success

Today Britney is able to focus on her work. Instead of 10 math problems taking six hours, it may only take an hour. And she feels better about herself.

"I used to think I was stupid," she said. "Now it's, 'Oh, I can get this done!'"

But Emilie, Britney's mother, said the survey's results made her consider her own academic struggles and give her a new confidence that she, too, has an ADHD-related problem.

"I made an appointment for a neurologist," she said. "I'd like to go to college."

Related Articles ADHD How Is ADHD Diagnosed in Children and Adults? Educating Children With ADHD

External Sources Children and Adults with Attention Deficit/Hyperactivity Disorder National Center for Gender Issues and AD/HD Federal Resource Center for Special Education

This article was reviewed and updated June 2007.

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