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By Christina Boufis
WebMD Magazine
Reviewed by Patricia Quinn, MD

Neil Peterson, a transportation specialist in Seattle, knew something was "not quite right" with his bright, sociable daughter Kelsey when she was in elementary school. "It took her so long to learn to read," Peterson says. "She was not hyperactive, but she had tremendous distractibility and an inability to follow through and stay with something." Kelsey's teachers told Peterson not to worry, and he listened.

On the surface, Kelsey was no different from other kids her age -- all young students, at one point or another, can become easily bored or distracted, flit from one thing to the next, and forget their homework. But if these behaviors are persistent, they might be a sign of ADHD, which affects 3% to 7% of all school-age children, or about one to three kids in every classroom.  

Sometimes girls like Kelsey are missed. Though boys are diagnosed at about three times the rate of girls, that doesn't necessarily mean the disorder is more common in boys, says ADHD expert Harlan Gephart, MD, clinical professor of pediatrics at the University of Washington School of Medicine in Seattle.

Rather, asks Gephart, "Is it just not as recognized in girls?"

The short answer is yes, according to researchers. One national study found that the majority of parents and teachers thought ADHD to be more common in boys, who they believed had more behavior problems. Almost half of the teachers who took part in this study also reported that they had trouble recognizing the signs of ADHD in girls.

An Australian study found that even when parents and teachers acknowledged the disorder in girls, they were less likely to recommend that the girls get extra assistance. That's because they thought it wouldn't help them as much as it would boys.

"The big problem with ADHD in girls is that it presents itself differently," Gephart says. "Boys are just more obvious."

ADHD Symptoms in Girls

Of the three traits that define ADHD -- hyperactivity, impulsiveness, and inattentiveness -- the first two are thought to be more descriptive of boys and the last of girls, though there's certainly crossover, according to Gephart.

"Boys who are hyperactive tend to be recognized very early, by kindergarten or first grade," typically because of behavior issues, Gephart says.

Girls, who mostly have the inattentive form of ADHD, often show more subtle symptoms: dreaminess, forgetfulness, or messiness.

Often, an ADHD diagnosis isn't made until middle or high school or even later, when school becomes more demanding and a girl is having trouble completing her homework, or if her undiagnosed ADHD leads to depression.

ADHD or Something Else?

"But then you have to ask, is this ADHD? Or is the child falling behind because of a learning disability or some other psychological issue?" Gephart says. Researchers estimate that 30% of children with ADHD also have a learning disability such as dyslexia or difficulty solving math problems.

Peterson thought he found the key to Kelsey's school difficulties when he had her tested and learned she was dyslexic. But despite moving to a special school, Kelsey continued to struggle.

It wasn't until teachers suggested Peterson have his son Guy tested for ADHD that Kelsey, who was then 14, was tested as well. Both children and their father were diagnosed with ADHD, which can run in families.

"In hindsight, the thing I wish more than anything is that I had discovered [Kelsey's ADHD] way, way earlier," Peterson says, "so we could have dealt with it appropriately all those years."

Could Your Child Have ADHD?

Talk to your doctor if you notice one or more of these signs, says Gephart:

Dreads school."If your child doesn't like school or is not happy or excited about going, that's a warning sign in any child," Gephart says.

Feels inadequate.Self-critical comments like "I'm dumb" or "I'm not good at reading or math" can indicate low self-esteem that accompanies ADHD, particularly in girls.

Expresses anxiety about school or social situations, such as not making or keeping friends. For girls, that might mean bossy or just socially inappropriate behavior.

Looks to you for significant homework help and needs a lot of one-on-one guidance to stay focused.

Gets reports from teachers that she is not participating in class, requires constant reminders to stay on task , or has trouble completing or forgets to hand in assignments.