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ADHD in Children Health Center

Slowly, ADHD Gender Gap Closes

Focusing on the Female
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ADHD is the most commonly diagnosed behavioral disorder in childhood, with an estimated 3% to 5% of the general population suffering from it, according to the National Institute of Mental Health. Symptoms can include hyperactivity, a lack of attention span, and impulsive behavior. People with the disorder often are disorganized, cannot complete tasks, and have trouble following more than one instruction at a time. Symptoms can begin as early as age 3 and usually are noticeable by age 7.

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 Jaksa.

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