ADHD: Girls Get It, Too

The stereotypical boy with Attention Deficit Hyperactivity Disorder bounces off the wall of his classroom, unable to sit still or pay attention to lessons. Boys are three times more likely to be diagnosed with ADHD than girls, but a new study suggests that when girls do have the condition, they are likely to have serious challenges.

Girls diagnosed with ADHD in childhood were more likely to attempt suicide, cutting and other self-harming behaviors as teenagers than those without the condition, according to the study, by Stephen P. Hinshaw, of the University of California, Berkeley, among others.

It is well established that people diagnosed with ADHD are also more likely than others to have other conditions, like depression, bipolar and eating disorders. It's as if their brains are more vulnerable to all sorts of hits, not just ADHD. But Hinshaw said he's particularly worried about girls.

It's not clear whether the girls who are diagnosed with ADHD have more problems than boys with the condition, or whether girls with milder forms of ADHD are just missed by clinicians, because they don't fit the stereotype. Or, perhaps, the trauma of growing up as a girl with ADHD scars these girls so much that they resort to self-harm, Hinshaw said.

The old assumption that children will grow out of ADHD is wrong, with roughly 60 percent continuing to have symptoms into adulthood, research shows.

Girls with ADHD have few friends and get repeatedly rejected by their peer group, he said. "I think this isolation is leading to some despair by the time they hit 18-19-20-21."

The girls who had problems with impulsivity were the most vulnerable, he said.

Hinshaw said the clear message of his research is that parents and caregivers need to take ADHD in girls seriously, and get them help.

"This is a real condition," he said. "Thinking it will just go away with time, or maybe she’ll be better. If she's 3, that’s early, but if she's 7 or 8 or 9 and there is this pattern of symptoms that is persisitent, get help now."

Standard treatment for ADHD is medications – either stimulants or non-stimulants – plus behavioral therapies to help children cope with organizational and other challenges. Many people refill their ADHD prescriptions only one or two times, he said. while the short-acting drugs must be taken daily in order to help.

We hear a lot today about ADHD being over-diagnosed, but Hinshaw, like many other ADHD experts, says it's both over- and under-diagnosed.

Most people are diagnosed in a 10- to 15-minute doctor's visit, which really isn't enough time to figure out if the person has a longstanding pattern of symptoms, or whether the problem may really be seizures, family troubles or something else, he said. Some kids can hide their symptoms well enough during a quick doctor's visit to escape a diagnosis; others, looking for drugs, can fake it for a few minutes. Instead, a true diagnosis should take a few hours to make, he said.

It may be even more likely to be under-diagnosed in girls. Although three times more boys are diagnosed with ADHD than girls, there is nearly gender parity among adults being diagnosed with the condition, suggesting that girls are being missed or are less likely to outgrow it than boys.

The new study, published in the Journal of Consulting and Clinical Psychology, is part of an in-depth examination of 140 girls with ADHD begun a decade ago. Hinshaw said each girl, then aged 6-12, went through 6-8 hours of interviews and testing to make sure she really had the condition.

It's not clear whether early diagnosis will save teenage girls from the trauma Hinshaw found in his recent study, but there are suggests that it helps. School achievement falls for every year a student with ADHD doesn't get treatment, he said; children who are treated lose less ground.

In some ways, because ADHD is not as disabling as conditions like schizophrenia and bipolar can be, it's easy to dismiss it and assume the person could just "pull it together" if she tried harder. But his research suggests that's not the case, Hinshaw said.

"We’re sobered by the findings, and really beleive that taking assessment and diagnosis seriously and initiating treatment as early as possible and maintaining the treatment" is crucial, he said.

Karen Weintraub, a frequent contributor to CommonHealth, is writing a book on adult ADHD, Fast Minds, with Dr. Craig Surman of Massachusetts General Hospital, and Dr. Tim Bilkey, to be published in Feb. 2013.