INSTRUCTOR MARCH/APRIL 2007 31

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Are you missing the signs?&GIRLS ADHD

That’s why teachers are so important. When itcomes to learning disabilities, teachers areright there on the front line. We’re often thefirst to spot a child’s difficulties and to bring itto the attention of parents and specialists. It’simportant that we know the different waysADHD may manifest in our girl students andthe reasons we may miss it.

Alarmingly, some studies estimate that asmany as 50% to 75% of girls with ADHD aremissed. Worse, girls with ADHD are diag-nosed on average five years later thanboys—boys at age 7, girls at age 12. Five cru-cial years girls could be getting help are lost.

“ADHD is not gender-linked,” says Dr.Patricia Quinn, director of the Center

WHEN YOU THINK ADHD, DO YOU THINK BOY? You’re not alone. Boys arethree times more likely to be diagnosed with ADHD, even though they’re nomore likely to have it. Too many young girls are not getting the help they need.

By Caralee Adams

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for Gender Issues and ADHD and anexpert on ADHD in girls. Recent datashows medication for ADHD is dispensedequally to men and women. It followsthat if adults are experiencing the disor-der in equal numbers, children might too.

“The diagnosis should be 50-50between boys and girls,” says Quinn. Sothe big question is, why isn’t it?

One major reason is that girls’ symp-toms manifest differently. “ADHD doesn’tshow up in the same ways in girls,” saysKathleen Nadeau, a clinical psychologistin Silver Spring, Maryland, and coauthorof Understanding Girls with AD/HD.For instance, girls are much less likely to display hyperactive or impulsivesymptoms. Instead, they may just appear“spacey,” unfocused, or inattentive. Or they may have trouble staying organized or remembering directions or homework.

But even when these symptoms areclearly present, ADHD may be missed.

Nadeau puts it bluntly, “Girls are less likely to be referred because they causefewer problems in the classroom.”Socialized to please their teachers andparents, girls can be very good at compen-sating for the disorder, making it muchharder to spot. When teachers do see it,says Nadeau, “[girls’] behavior is oftenmisunderstood as immaturity or lack ofacademic ability rather than as ADHD.”

As educators, we need to be informedand aware. School is the number oneplace where ADHD gets identified, saysMohab Hanna, child and adolescent psy-chiatrist and author of Making theConnection: A Parent’s Guide toMedication in ADHD. “This is the con-text where it gets magnified. Teachersinteract with kids academically and seehow they do socially. A lot of parentsdon’t know what’s normal.”

So, what are the signs of ADHD ingirls? Here are some of the cues you canlook for and some simple ways to help.

Sign #1: Nonstop Talking Do you have a student who’s always talk-ing with her friends? It may not be thatshe’s a social butterfly, she may haveADHD. This student may keep talking“accidentally” after being asked to stop,even though she doesn’t mean to be defi-ant, says Nadeau. A girl with ADHD mayalso interrupt impulsively when you’releading the class. While a boy might leavehis seat continually, many girls withADHD express their restlessness verbally.WHAT YOU CAN DO: Try seating your stu-dent near the front of the class and awayfrom other talkative students. Throughoutyour lesson, pause periodically and askstudents to buddy-share—exchange ideas,compare strategies. This is beneficial toall, but will particularly help your studentwith ADHD by giving her an acceptableoutlet for talk. You might also try givingher a task such as handing out papers tohelp refocus her energy.

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Sign #2: Friendship TroublesDoes your student barge into a groupand, more often than not, find herselfunwelcome? Sadly, girls with ADHD

tend to struggle to fit in with their peers.“They can be talkative and outgoing, but by the end of the week, they may nothave many friends because they got toobossy or interrupted too much,” Nadeausays. A girl with ADHD may be slow topick up on social cues and may even be verbally aggressive when she feelsfrustrated. Conversely, boys with ADHD

are less likely to suffer peer rejection.The rules for boys’ play are less strin-gent; their games are more physical. But for girls with ADHD—if they don’treceive help and guidance—self-esteemcan take a pummeling. WHAT YOU CAN DO: Recognize that a girlwith ADHD often needs help negotiatingher relationships with peers. Be patientwith her and—without making this stu-

dent your focus—encourage your classto be patient and generous with otherchildren’s differences. Teaching social conventions explicitly—how to join agroup in play or how to give a compli-ment—can make a world of difference.Calmly explain social conventions to herand give her an opportunity to practice.

Lastly, “make your classroom feel likea safe place to make mistakes,” suggestsNadeau. Understanding goes a long way.

Sign #3: Difficulty Paying AttentionIt’s tempting to describe the girl who fiddles with her crayons while you’reexplaining fractions, then quickly says, “I don’t get it” as ditzy—a word thatsomehow seldom gets attached to boys.But trouble listening can be a symptomof ADHD. This girl may have difficultylistening and retaining multistep direc-tions, says Nadeau. Finding it hard tostay tuned in when the teacher is talking for several minutes at a

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WHY IT’S SO SERIOUSHaving ADHD is often harder on girls. Forone, boys’ symptoms are more likely tobe tolerated. (Studies show that boys areadmired for ADHD-related traits, likeaggressiveness and high energy.) Girls,on the other hand, may pay high penal-ties for not living up to “young lady”expectations—for interrupting or beingloud. For girls, the constant criticism cantake a toll. A recent long-term study ofgirls diagnosed with ADHD shows that bytheir teenage years, if untreated, they areat greater risk for developing emotionalproblems like anxiety and depression andare more likely to engage in high-riskbehaviors such as smoking and alcoholabuse. “It’s a condition we can’t ignore ingirls. It’s real and it’s devastating,” saysresearcher Stephen Hinshaw ofUniversity of California, Berkeley.

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time is often a sign of the disorder.WHAT YOU CAN DO: Try involving her inyour lessons so those crayons aren’t soalluring. Ask her to pass you a manipula-tive, for example, or keep time duringround robin reading. You might also lecture for five or ten minutes at a timerather than 20. Again, it’s important tomodel focused attention to the entire

class, not just your ADHD students. Askkids what someone who’s paying atten-tion looks like (shoulders squared, eyeson speaker, hands folded on desk, quiet).Then practice the behavior as a class.

When an ADHD student does drift off,draw her back in without reproach. Quinnsuggests having a signal, such as a secretword, that you say as a cue to tune in.

Sign #4: Exceptional Messiness While girls with ADHD are far less likelythan boys to be disruptive in class, theyare just as likely to have organizationalproblems. A very visible sign of a girlstruggling with ADHD may be her disor-ganized desk or backpack. She may alsohave issues with homework and class-

room routine—i.e., she’s not able to keep her papers in order or find a pencil when needed. While all kids canbe sloppy at times, the frequency anddegree may be a clue. WHAT YOU CAN DO: A first step is toreduce the papers shuffling back andforth between school and home. An easyway to do this is to post your homework

assignments and newsletters online(www.scholastic.com offers free home-pages to teachers). Next, reconsider yourassignments. Is your ecosystems posterproject putting more emphasis on neatexecution than on swamps and deserts?Offer students the opportunity to presentwhat they’ve learned in different ways,whether it’s a typed report or a skit.

Sign #5: Unfinished WorkSince girls may try hard to mask theirdisorder, teachers don’t always realizehow much they are struggling to finishassignments. They may appear shy andstudious in the classroom and don’toften stand out to teachers. Take note of girls who consistently fail to finish

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Since girls with ADHD may work hard to mask their disorder, teachers may not realize how much they are struggling.”“

classroom assignments or tests in theallotted time even though they seem toknow the material.WHAT YOU CAN DO: Help break downwork into smaller tasks to addresssequencing problems. For students whoare slow at processing, cut back on thenumber of questions or assigned prob-lems. Ask yourself how many problemsreally need to be done to practice thelearned skill. Since ADHD students canbe inconsistent with their performance,it may be appropriate to allow them toretake tests now and then.

Sign #6: EmotionalitySo, you have a student who bursts intotears at the slightest reproach or turnsinto a ball of fury when play doesn’t goher way. You think “Hannah’s so sensi-tive,” but it might be more than that. Ifshe has ADHD, her impulsivity mightmake it hard for her to control her emo-tions. At the same time, compensating

for ADHD in the classroom and on theplayground is exhausting and may leaveher depleted and vulnerable. We all wantapproval and success, and when it’s hardto come by, the tears may seem to flowover the smallest incidents. WHAT YOU CAN DO: Do what you can tohelp her feel like an important memberof the class. Share with her some calm-ing techniques that will help her regaincontrol—e.g., breathing deeply, thinkingpositive thoughts, counting. Insist thatall your students treat one another’s feel-ings respectfully (even when a childseems to have too many).

As you read through these signs, didyou find yourself thinking, “Oh my, thisis so-and-so in my class”? If so, now isthe time to initiate a conversation withher parents. Ask them what they are see-ing at home and perhaps follow up withyour school psychologist. You could bethe one who helps her find the schoolsuccess she deserves. nn

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WHERE TO FIND MORE INFORMATIONn ADDVANCE: Questions and answersfor professionals and parents onADD/ADHD. The section on Women &Girls includes an ADD checklist andsocial-skills help. www.addvance.com

n CHADD: This volunteer organizationadvocates for children and adults withADHD, hosts support groups, and pub-lishes resources, including a new educator’s manual on ADHD.www.chadd.com

n LDONLINE: A solid learning disabilitiesand ADHD web site with discussiongroups for educators, tips on differenti-ating instruction, assessment, and more. www.ldonline.org

n TEACHING CHILDREN WITH ADHD:Recommendations and accommodations for teaching children with ADHD.www.childrensdisabilities.info