Understanding ADHD in Girls: Identification and Social Characteristics.

The purpose of this study was to identify the hyperactive, impulsive, social, and emotional characteristics of girls with symptoms of attention deficit hyperactivity disorder (ADHD). These characteristics could be used to increase the referral rates of these girls and provide implications for intervention. Parent and self-ratings of a school-based sample of 262 girls with and without ADHD were analyzed. Girls with ADHD were characterized as more verbally impulsive and hyperactive, faster in conversations and school-work, more easily bored, more often stirring up trouble, having difficulty waiting, and demonstrating greater moodiness, anger, and stubbornness than their peers. The girls with symptoms of ADHD also discriminated between their own appropriate versus inappropriate activity and demonstrated normal prosocial activities, the level of which was related to higher self-esteem. Implications are that ADHD characteristic behavior in girls can be identified earlier so that treatments can be studied and improved. The purpose of this study was to address the problem of reduced identification of girls with symptoms of attention deficit hyperactivity disorder (ADHD). That is, teachers typically refer students for schoolbased assessment because of externalizing and disruptive behavior in the classroom. However, girls with ADHD are less likely to exhibit disruptive, externalizing, or out of seat behavior in the classroom than are boys with ADHD (Abikoff et al., 2002). Furthermore, as girls with ADHD age, they manifest hyperactivity in ways that are less likely to suggest ADHD to their teachers (Ohan & Johnston, 2005). During their preschool years, girls with ADHD exhibit overt hyperactive behavior, but by six through ten years of age, they no longer demonstrate this type of behavior in the classroom (deHaas & Young, 1984; deHaas, 1986; Battle & Lacey, 1972; Huessy & Howell, 1988). These findings could suggest developmental changes that make identification of girls less likely than for boys. These changes over developmental levels may also be observed in the classroom over time. That is teachers’ prior experience with girls with ADHD may lead them to expect an eventual modulation of activity/inattention/impulsivity. These expectations could explain what appear to be biased ratings by teachers of girls versus boys in the following study. Greenblatt (1994) asked 57 elementary and middle school teachers and counselors to evaluate case studies of children described with the characteristics of ADHD (hyperactive, fidgety, uncooperative, inattentive, and having difficulty following through). Teachers assessed only 27% of the girl cases to have ADHD but when reviewing the identical cases labeled as boys, teachers identified ADHD in 72% of the cases. In summary, even when there is an equivalent amount of excessive behavior in girls with ADHD, teachers see this as less disruptive or as more modifiable in the classroom. This conclusion is supported by findings that girls, but not boys, with ADHD inhibited impulsive behavior when punishment was a consequence (Milich, Hartung, Martin, & Haigler, 1994). Perhaps older girls learn to inhibit obvious movement in specific contexts to avoid social disapproval and therefore also avoid identification of ADHD. From this research we might conclude that the manifestation of ADHD in girls may be specific to setting. Contexts where teacher disapproval would be more likely are academic settings; social settings may provide a context that could more accurately represent ADHD in females. Social settings involve more complex rules and requirements, which may involve delayed and indirect consequences. These delayed consequences for girls are peer rejection. For example, girls with ADHD had more difficulty