Attention Disorder Often Missed or Ignored in Girls
Fri Sep 6,12:21 PM ET By JoAnne Allen WASHINGTON (Reuters) - By her own account, the first six years of school were a struggle for Britney Joyal. She had difficulty paying attention, completing assignments and maintaining enough concentration to stick with soccer, ice skating or the gymnastics classes she loved. "I would rush through tests just to sit there and draw on the back of the paper, and then just sit there in my own dream world," said Britney, now 15. "I knew, basically, that was a sign that something was wrong." [Fred A. Baughman Jr., MD:
At age 12 when she was in the sixth grade, Britney learned the reason behind her inability to focus when she was diagnosed with attention deficit hypertension disorder, or ADHD. Her younger brother, Joseph, who is now 12, has the same condition, but was diagnosed at age 9. Commonly perceived to be a boy's problem, ADHD is a condition associated with altered brain functioning and characterized by an inability to focus on tasks, as well as by hyperactive behavior or inattention, or both. [Fred A. Baughman Jr., MD:
It is usually passed on genetically. [Fred A. Baughman Jr., MD:
The U.S. Centers for Disease Control and Prevention estimates that up to 5 percent of school-age children suffer from ADHD. [Fred A. Baughman Jr., MD:
But researchers who study the condition say girls often go undiagnosed and untreated, putting them at greater risk than boys for long-term problems in social development. [Fred A. Baughman Jr., MD:
"People don't think it can happen in girls ... we're not looking for it," said Dr. Patricia Quinn, director of Washington's National Center for Gender Issues and ADHD. [Fred A. Baughman Jr., MD:
"For years and years, we've been focusing on the hyperactive, behavior-disordered little boy who might be restless and fidgety and acting out," said Quinn, a pediatrician and ADHD researcher, who has authored several books on the subject. 'SUFFER IN SILENCE' Quinn said girls with ADHD may suffer more than boys with the condition in part because their symptoms are more internalized, such as anxiety, withdrawal, lack of focus, disorganization and forgetfulness. Many girls with ADHD suffered in silence, according to Quinn, with their problem often ignored or misdiagnosed by the educational and medical communities. "They sit in the back of the class. They don't raise their hands. They don't call attention to themselves," she said, adding that research indicated "we're missing about 75 percent of girls" with ADHD. [Fred A. Baughman Jr., MD:
Quinn also said studies suggested girls who went undiagnosed were more likely to have problems with low self-esteem and engage in risky social behavior. "Girls with ADHD are at greater risk of substance abuse than boys with ADHD. They also smoke more and earlier," she said. The researchers' theory is supported by the results of a recently released Harris Interactive survey of more than 3,000 people that found that compared with boys, girls with ADHD reported more difficulty in the development of basic social skills, making friends and getting along with parents. The survey -- sponsored by the Novartis Pharmaceuticals Corp. -- also found girls with ADHD were three times more likely to be treated for depression that their male counterparts. Novartis manufactures Ritalin, one of the standard treatments for ADHD. Critics contend the drug is overprescribed. 'REFERRAL BIAS' The "acting-out" behavior sometimes displayed by boys with ADHD gets them referred for clinical treatment earlier and in greater numbers than girls "who sit there quietly with the condition," said Dr. Timothy Wilens, a clinical researcher at Massachusetts General Hospital in Boston. [Fred A. Baughman Jr., MD:
"Most clinics are finding anywhere from five to 10 boys to one girl, and yet the epidemiology is closer to two to three boys for one girl," Wilens told Reuters. That bias underscored the need for "aggressive identification and intervention" to address the gender disparity, Wilens added. Emilie Joyal, the mother of Britney and Joseph, believes the experiences of the children illustrate a "gender gap" in the detection of ADHD. Her son's teachers realized right away he had a problem, Joyal said, while Britney's inattentiveness and difficulty in school were attributed to her being "just a daydreamer." "The behavior my son exhibited was the kind of behavior you wanted to correct. Britney, on the other hand -- very quiet, not hyper, but dreamy ... always out of focus," Joyal said in a telephone interview from her home in North Smithfield, Rhode Island. "Britney lost a lot of time," her mother says. "It took a lot of time and it took a lot of effort for the school to agree to test her," said Joyal. "And it took a lot of detective work ... to eliminate all the other possibilities before we realized that this might not be an educational issue but a neurological issue." [Fred A. Baughman Jr., MD: exactly what they
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