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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 Jaksa.

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 girls."

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, he says.

"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.

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