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GIRLS WITH ADHD: What the research reveals about their inner lives and what it means for their futures ❖ ELLEN LITTMAN, PhD Mount Kisco, NY DrEllenLittman.com GIRLS WITH ADHD LEAD SECRET LIVES Under Under--recognized Under Under--studied Misunderstood Misdiagnosed Mistreated Suffering in silence ADHD - A PRODUCT OF ITS HISTORY 19th century parents struggled with willful hyperactive children Management problems referred to clinics Overwhelming majority were young boys ‘moral defect’>Minimal Brain Damage>ADHD grouped with Disruptive Behavior Disorders of Childhood 1 WHY BOYS HAVE SET THE PRECEDENT FOR DIAGNOSIS Clinic data described these boys Early research utilized this data Diagnostic criteria based on these studies Very few girls met hyperactivity criteria Assumed ADHD only affected boys and resolved at puberty WHY THE IMPACT OF ADHD IS DIFFERENT FOR GIRLS Neurological gender differences Biophysiologic gender differences Hormonal gender differences Gender differences in rates of development Gender differences in role expectations and socialization HOW GIRLS WERE OVERLOOKED Lacked hyperactivity hallmark More likely to have subtle, inattentive symptoms Inattention without hyperactivity not acknowledged until 1980 Tendency to internalize symptoms Anxiety, depression often comorbid Symptoms rarely overt by age 7 cutcut-off 2 WHY GIRLS REMAIN UNDER UNDER--DIAGNOSED Myth as a male disorder lingers Gender referral bias slow to change Many rating scales perpetuate bias yp y toward hyperactivity Gender role expectations make girls reluctant to complain or ask for help About 1% of research studies females Clinicians unfamiliar with current research THE PREDOMINANTLY HYPERACTIVE PRESENTATION Difficult to manage by age 3 Tantrums, aggression, willfulness Very active, active competitive, competitive risk risk--taker Prefer company of boys Low frustration tolerance Demanding, defiant, nonnon-compliant More likely to have learning problems THE COMBINED PRESENTATION Hyper Hyper--talkative, poor listeners Hyper Hyper--social, charismatic, bossy Emotionally reactive, drama queens Fidgety, Fidgety restless Trouble falling asleep Blames and criticizes others Controlling, stubborn Avoids taking responsibility 3 THE PREDOMINANTLY INATTENTIVE PRESENTATION Daydreamers, tuned out slowly, passive academically Compliant, socially awkward, shy Easily overwhelmed & discouraged Avoidant, easily over over--stimulated Difficult to wake up, often fatigued Forgetful, disorganized, Low selfself-esteem, rejection rejection--sensitive Process ESTROGEN’S HIDDEN ROLE Brain - target organ for estrogen Impacts mood, cognition, sleep ADHD symptoms intensify as estrogen increases after puberty Moodiness, anxiety and emotional reactivity fluctuate with monthly estrogen levels Interacts with dopamine to amplify addictive potential TWICE--EXCEPTIONAL GIRLS TWICE Intellectually 3 years beyond peers Socially/emotionally 3 years behind peers Huge disparity is confusing, stressful Compensate at a high emotional cost Burdened by expectations of success Anxiety, perfectionism, shame Feel like an impostor Least likely to be diagnosed 4 ADOLESCENT GIRLS –THE CATCH CATCH--22 Need limits but resent supervision Need structure but resent rules Need reminders but resent ‘nagging’ Need help selfself-monitoring but resent feeling dependent Drawn to risky behaviors but resent ‘preachy’ warnings Drawn to addictive behaviors but insist that they’re in control Need objective input and support but resist treatment at parents’ behest COMMON STRESSORS Feel different, misunderstood Feel unfairly criticized Feel demoralized by poor academic performance Feel alienated from peers Feel ashamed of perceived inadequacies Feel frustrated and irritable Feel ambushed by unanticipated situations POTENTIAL RISKS Underachievement Choosing unhealthy relationships Accidents and trauma Promiscuity and STDs Eating disorders, distorted body image Drawn to risky, addictive behaviors Low selfself-esteem, selfself-doubt, shame Tendency toward selfself-harm 5
