Fidgeting with one’s hands and feet. Not staying seated. Interrupting instead of waiting for a turn to talk.
As the slides advanced during a community talk about diagnosing and treating attention deficit hyperactivity disorder (ADHD), the symptoms sounded familiar to then 14-year-old Carly Duryea. Oh, yeah, that’s my sister all right, thought Duryea, whose bouncy little sibling was diagnosed with ADHD at age 5.
The next slide flashed the disorder’s inattentive symptoms, among them: being easily distracted, not seeming to listen, and not following through or finishing schoolwork. Duryea was astonished. “I had been so completely opposite of my sister that I never even thought I could have ADHD. But everything on the slide described me. ”
Ironically, Duryea was in the audience because her mother, a family physician in Centre, AL, was giving the presentation. After Duryea mentioned her jolt of recognition, her mom took her to another doctor, who diagnosed Duryea with attention deficit disorder, minus the hyperactivity. For mother and daughter, Duryea says, “It was an aha moment.”
Duryea was almost a decade older than her younger sister had been at the time of diagnosis. Unfortunately, it’s common for parents, teachers, and other adults to overlook ADHD in inattentive, easily distracted girls like Duryea.
“The notion that this is a hyperactive boy condition is not correct,” says Craig Surman, MD, a neuropsychiatrist and ADHD researcher at Harvard Medical School.
“There’s a different trajectory for girls,” he says. Often, they’re the quiet daydreamers who sit in the back of the classroom, unable to focus and follow through on tasks. They don’t raise the same red flags as the hyperactive, impulsive children -- stereotypically, boys -- who disrupt the teacher’s lessons. And yet, they’re just as impaired.
Duryea, now 22, wonders whether being diagnosed and treated in early childhood might have made elementary school less arduous. “I could tell that I was different from my peers, that I was a little off,” she says. “I noticed that I wasn’t, like, as smart as my peers. I worked so hard not to be different and I came up with ways to hide it. One coping mechanism I developed was I would never answer questions. I was always wrong because I didn’t process the question, I didn’t hear all of it, I wasn’t paying attention.”
She simply couldn’t maintain focus, she says. “I would describe myself as a daydreamer. But if you asked me at that age, ‘Carly, are you daydreaming?’ I would say, ‘Of course I’m not. I want to pay attention. I want to learn.’”
Other signs cropped up, too. “I also realized with peers that I couldn’t keep up with conversations that involved more than a few people,” she says, a problem that made group projects hard. As a result, she became, in her own words, “withdrawn or reserved.”
“I was hypervigilant and self-conscious about how people might perceive me. I constantly got headaches and stomachaches,” she says. “I was very sensitive to failure, and I was trying to compensate for a lot.”
In fact, she compensated so well during elementary school that teachers never expressed concern. “I was known for being sweet and helpful,” she says. “I got straight As. I loved running errands.” But outside the classroom, she says, “Everything took twice as long as it should have.”
Girls with inattention can compensate in the early school years, especially if they’re bright. But the strategies often fail when they get to middle school, which demands more planning, time management, and organizational skills. And that’s when girls’ self-esteem can plummet.
In boys with ADHD, “There’s more externalizing behavior,” Surman says. They’re more likely to be “oppositional,” which shows up in defiance and rule-breaking. In contrast, girls tend to turn inward and blame themselves. Beyond the elementary school years, Duryea couldn’t get started on tasks, including schoolwork. “I would tell myself, ‘Carly, you want to do the work. Why aren’t you doing it? Are you lazy? What’s the problem?’”
She felt anxious and depressed, which is common in girls confronted with the daily challenges of ADHD. Fortunately, ADHD medication worked well for Duryea when she started taking it at 14. She still must manage her symptoms, but she’s become a college student with dreams of someday working in the field of ADHD.
As she now knows, the disorder can run in families. Sometimes, parents realize after their children’s diagnosis that they also have ADHD. Duryea’s mother discovered in adulthood that all along, she, too, had the inattentive form.
“When it comes to my future plans, I’ve never felt that ADHD limits my scope,” Duryea says, “especially with my mom being a doctor. She made it through.”
By the Numbers
Among U.S. children ages 5 to 17:
10.6%. Percentage ever diagnosed with ADHD.
14.5%. Percentage of boys ever diagnosed with ADHD.
6.5%. Percentage of girls ever diagnosed with ADHD.
Signs of Inattention
In children who have the predominantly inattentive form of ADHD, these symptoms often appear:
- Lack of attention to details or careless mistakes in schoolwork or other activities; problems paying attention during tasks or play
- Trouble following through on instructions and completing schoolwork, chores, or other tasks
- Difficulty organizing tasks or activities
- Avoidance or dislike of tasks that require continuous mental effort, such as schoolwork or homework
- Trouble listening even when spoken to directly
- Frequently loses needed items, such as books, pencils, toys, or tools
- Easily distracted by surrounding activity or noise
- Often forgetful
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