ADHD: The Differences between Boys and Girls

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Jack, age nine, constantly gets into trouble in school, squirming in his seat, shouting out answers without being called on, and sometimes standing up for no apparent reason. His homework and classroom assignments are a mess, his backpack is disorganized, and his room at home is in disarray. He has trouble staying focused on schoolwork, but his mom says in frustration, "He can concentrate on Play Station games for hours without losing focus."

Emily, also nine, has been called a daydreamer for as long as she can remember. In class, the teacher frequently observes her doodling in her notebook, curling a strand of her long brown hair around her finger, or staring out of the window. When she sits down to do her homework at night, she often discovers that she forgot to write down the assignment or that she left a book she needs in her desk at school. Although Emily is very bright and never gets into trouble in school, her difficulty with organization and concentration have begun to negatively affect her grades.

Two children, a boy and a girl. Although their behaviors look very different, they have both been diagnosed with having attention deficit/hyperactivity disorder (ADHD), a behavioral disorder characterized by three major symptoms:

• Inattention: the child has difficulty sustaining attention, listening, and attending to details. He or she is easily distracted, often loses things, and presents as forgetful and disorganized.
  
  
• Impulsivity: the child may have poor frustration tolerance and may have trouble waiting, taking turns, or sharing.
  
  
• Hyperactivity: the child seems to be constantly in motion, squirming, fidgeting, running, and climbing more than other children. He or she talks excessively and at inappropriate times.

Clinicians may diagnose a child with ADHD, combined type, or with attention deficit/hyperactivity disorder, predominantly either inattentive type or hyperactive-impulsive type.

More than one million children in the United States have been diagnosed with this disorder, which until recently was believed to be anywhere from four times to nine times more prevalent in boys than in girls. However, researchers have reported that, partially because girls tend to be inattentive rather than hyperactive and therefore less disruptive in school and at home, many girls go undiagnosed or are mistakenly believed to suffer from anxiety or depression as a primary diagnosis. One oft-quoted study suggests that as many as 75 percent of girls with ADHD may be missed.

In 1994, ADHD researchers at a conference sponsored by the National Institutes of Health concluded that there was a need to develop rating scales that are more sensitive to ADHD as it typically manifests itself in girls, since the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) were and are somewhat limited, not necessarily reflecting the signs and symptoms exhibited by a girl with ADHD who is predominantly inattentive and distractible, rather than hyperactive.

Pediatrician Williams Sears, MD, author of The ADD (Attention Deficit Disorder) Book, states that boys with ADHD are more likely to act out in school, becoming either the class discipline problem or the class clown, whereas girls tend to be more withdrawn and "spacey." In some respects, adds Sears, boys enter school with a disadvantage, since the traditional classroom mode of teaching is usually geared more to the female gender. Girls seem to adapt better to the traditional classroom situation, which requires children to sit still for long periods of time. Sears feels that children with ADD often do better with male teachers, who may talk less and who may have a teaching style that helps restless or disorganized children to more consistently pay attention. Not surprisingly, he also finds that fathers tend to be more tolerant of their child's hyperactive behavior than mothers. Other researchers have found that mothers of girls with ADHD are more critical of their offspring's behavior than are mothers of sons with ADHD.