Slowly, ADHD Gender Gap Closes
Focusing on the Female
Research conducted at Harvard University and Massachusetts
General Hospital suggests that ADHD in girls, like boys, tends to run in
families, but because girls are not as likely to act out, their symptoms may go
unnoticed. Girls more often have attention problems than the disruptive
behavior that boys can exhibit, says Joseph Biederman, MD, who led the study
published in the July 2000 issue of the American Journal of Psychiatry.
Girls in general are one-third less likely than boys to exhibit conduct
disorder, he says.
"Girls tend to be less obvious because they are less
disruptive," says Biederman, professor of psychiatry at Harvard Medical
School and chief of pediatric psychopharmacology at Massachusetts General.
"If you are a girl and sit in the back of the room and smile, no one will
pay attention to you."
Hyperactivity in girls often shows verbally instead of
physically, in what Nadeau refers to as the "Chatty Kathy phenomenon."
These are the girls who talk in the back of the classroom and are extremely
social, but often are not diagnosed as having ADHD.
About half of inattentive ADHD children are overlooked despite
their gender, says Nadeau, co-editor of ADDvance Magazine, a publication
for women and girls with ADD or ADHD. "An inattentive little boy will be
more obvious. He's just sitting there drawing airplanes or looking out the
window," she says. "A lot of girls will tell you they have learned to
look at their teacher while daydreaming because that won't get them into
trouble. A lot of this teacher-compliant behavior masks the problem."
Screening guidelines for ADHD are "based mostly on
hyperactivity in young boys. These were the kids causing the most problems.
They were the most disruptive. It's a matter of the squeaky wheel," says
Unlike boys whose symptoms decrease at puberty, girls' symptoms
often increase during this time of hormonal change, Nadeau says. The diagnosing
criteria for ADHD, however, require that symptoms begin before age 7, according
to the National Institute of Mental Health.
"We need better criteria," Jaksa says. "We need
more realistic diagnostic [measures] that address what is going on with
Not everyone agrees. Biederman believes that the diagnosing
guidelines are appropriate. Better education on how to recognize inattentive
ADHD, and get girls referred for diagnosing, would help resolve the gender gap,
"The issue is more emphasis on clinicians and educators not
to rely only on aggression to recognize ADHD," Biederman says. "ADHD in
girls may not be as commonly described."
Consider, too, that the most common drug treatment for ADHD is
methylphenidate (Ritalin), yet much of the research has been conducted in men
and boys. One of the most recent studies, published in the Jan. 12, 2001,
online issue of the Journal of Neuroscience, used 11 men as its
subjects. In the study, researchers from the Brookhaven National Laboratory in
Upton, N.Y., and the University of New York at Stony Brook found that Ritalin
amplifies dopamine release in the brain and speculated that this would improve
attention and decrease distractibility. They noted, however, that their tests
were conducted in healthy adult men who were tested in "stress-free"
conditions, and said further research was needed.