Exemplary Counseling Strategies for Developmental Transitions of Young Women With Attention Deficit/Hyperactivity Disorder

Young women between the ages of 11 and 24 years who have attention deficit/hyperactivity disorder (ADHD) present unique challenges to educators and counselors in career, employment, mental health, and rehabilitation settings. In females, attentional impairments are frequently undiagnosed completely or remain undiagnosed longer than in males because expression of the disorder is more subtle in girls, who tend to be compliant and nondisruptive in school activities. Solden (1995) recounted several case studies in which girls with attention deficit disorder were first described as "boy crazy, party girls, tomboys, or not academically oriented" (p. 44). She also described girls whose behavior was misattributed to family problems (e.g., divorce, late development, and loneliness). The consequences of misdiagnosis or missed-diagnosis are important because they have an impact on young women's (a) self-image and self-esteem; (b) interpersonal sensitivity skills and awareness of relationship dynamics; (c) information processing skills, such as the ability to retain important information and filter out what is unnecessary; (d) ability to plan and organize effectively without feeling overwhelmed; and (e) emotional reactivity (Erk, 2000). All of these factors influence maturity, career goals, work personality, and work competence. Moreover, misdiagnosed persons with ADHD often receive unnecessary or inappropriate help, and those who are "missed" in diagnosis do not get help at all. The Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association [APA], 2000) defines ADHD as "a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and severe than is typically observed in individuals at a comparable level of development" (p. 85). The DSM-IV-TR notes that these types of symptoms should be observable before the age of 7 years and should be observed across a variety of situations, contacts, or environments. The diagnosis may be made if (a) six of nine symptoms related to inattention are present and have persisted for at least 6 months or (b) six of nine symptoms of hyperactivity and impulsivity have persisted for an equal amount of time. According to DSM-IV-TR criteria, inattention can range from failing to give attention to details; to seeming to not listen or not follow through on instructions; to having difficulty organizing tasks; to losing things, including homework; to being easily distracted or forgetful. Hyperactivity ranges from fidgeting, to running about, to having difficulty playing or engaging in leisure activities alone or with others, or talking excessively. Impulsivity can range from blurting out answers to interrupting or intruding on others. Despite the need, there is precious little knowledge and research about the unique needs, educational patterns, and career obstacles facing young women with ADHD. This article provides a framework for (a) recognizing attentional impairments in young women; (b) understanding the effects of the disorder on psychological, psychosocial, and career development; and (c) identifying interventions that will help counselors work more successfully with this population. Several strategies were used in the development of this framework and included the following: searching PsycINFO, MEDLINE, and ERIC databases for studies of (a) the neurophysiology of attentional impairments; (b) gender differences in ADHD; (c) psychosocial dynamics; (d) developmental approaches to treatment; and (e) career development and transition issues for young women with ADHD and comorbid disabilities, such as anxiety and depression. We conducted additional searches that targeted empirically focused dissertations and policies from government and advocacy groups. We also consulted with leading experts in the field. * Recognition of Attentional Impairments in Young Women Inattention, impulsivity, and hyperactivity are the "holy trinity" of ADHD (Sadock & Sadock, 2003). …