Girls & ADHD

[Mayleng]

Suzanne86 sent me this link. thought you all might be interested in this study.

Long term study of ADD/ADHD in girls
www.educationnews.org/writers/michael/An_Interview_with_Steve_Hinshaw_About_ADHD_in_Females.htm

An Interview with Steve Hinshaw: About ADHD in Females
Monday, July 10, 2006
Michael F. Shaughnessy
Eastern New Mexico University
Portales , New Mexico 88130

Steve Hinshaw has just competed a major study regarding Attention Deficit Disorder and Hyperactivity in females. In this interview, he responds to questions regarding this problem and the results of his research.

1. You have recently completed a major research study about ADD and ADHD in females. What have you found?

In short, we performed an unprecedented, 5-year prospective, longitudinal follow-up—from childhood into adolescence—of our large sample of girls with ADHD as well as our matched comparison sample of girls without ADHD. We originally evaluated both samples together during our summer camp programs in the 1990's, documenting that (a) ADHD does indeed exist in girls and (b) when it does, noteworthy impairments in social and academic functioning are evident. In our follow-up study, we evaluated 92% of the 140 girls with ADHD and 88 comparison girls, now aged 12-17 years. The key findings were as follows: (i) a number of girls with ADHD “lost” symptoms of the condition over time, particularly the most visible hyperactive symptoms. (ii) Still, in all 10 of the domains we examined (delinquent behavior, anxious/depressed behavior, eating disorder symptoms, substance use and abuse, social skills, rejection by peers, academic achievement, self-perceptions, and need for services), the girls with ADHD were far more impaired than the comparison group, 5 years after the childhood ascertainment of the sample. (iii) Few differences emerged in adolescence between girls with the Inattentive type of ADHD and the Combined type (signifying a combination of inattentive and hyperactive-impulsive symptoms), but both types were notably worse off than the comparison group. (iv) Academic achievement in math and reading showed the most significant declines, over time, for the girls with ADHD. Overall, ADHD portends continuing problems—in precisely those domains of functioning that predict long-term success—through middle adolescence.

2. There has been a plethora of medication over the last ten years for the treatment of ADD and ADHD. Where does medication fit into the big picture?

The follow-up study just noted was not a treatment study per se; we observed the girls, whether or not they received treatment (about half of the girls with ADHD receive medication during the 5-year follow-up interval). Overall, a host of studies reveal that medication treatments (stimulants) provide clear benefit for over 80% of children with ADHD who receive them. Side effects are usually manageable, but because in the wrong hands stimulants can be drugs of abuse, they should be prescribed only when needed and must be monitored carefully. These medications help with the core symptoms and with some aspects of academic and social performance, but (a) they are typically not sufficient to normalize functioning and (b) their effects do not persist after the last dose is administered. In other words, the medications help alleviate symptoms but do not constitute a cure. Medication effects for some youth with ADHD are night-and-day; more often, they are helpful, but only if concentrated efforts are also put in place to help families with behavior management, to provide teacher consultation, and to provide academic and social skills to the child.

3. What kinds of counseling issues need to be addressed with adolescent girls?

Counseling per se, or play therapy for younger children, is not a proven treatment for ADHD; only medications and behavioral treatments (parent training, school consultation, social skills) are truly evidence based. Yet at the same time, adolescents do not like to feel singled out as needing treatment or having a mental disorder; counseling may assist with self-esteem issues, motivation to keep taking medication, and the like. Also, behavioral parent training with adolescents needs to focus less on “star charts” and more on contracting and negotiating rewards and punishments between the teen and his or her caregivers.

4. There is always debate as to the incidence of ADD and ADHD. Some liberal individuals indicate it to be about 25 % of the population and other conservatives say 2%. What is your take on this issue?

It's a lot like saying “how much hypertension is there”? That is, like blood pressure, ADHD symptoms exist on a continuum in the normal population, and there's no magic cutoff point above which ADHD clearly occurs and below which it clearly does not. The best estimates, however, using cutoff points that strike a careful balance between under-diagnosis and over-diagnosis, are that about 5% of boys and 2% of girls have clinically significant ADHD.

5. What kinds of counseling should parents of kids with ADHD receive? What kinds of counseling should adolescent girls with ADHD receive?

Parents need education about ADHD, support (groups can be helpful here), and explicit training in how to provide more regular and more consistent rewards and punishments. As noted above, adolescent girls need family and school environments that are programmed for consistency and regularity; a sensitive counselor, or an appropriately conducted social skills group, could also be valuable.

6. In terms of conjecture, do you think that girls who have ADD have self –esteem, self concept issues that perhaps later leads them into difficulty?

The self-esteem issue is an important, but tricky one. That is, children and adolescents with ADHD often show, over the years, lower overall self-esteem than their peers—undoubtedly as a function of the negative feedback they so often receive from parents, teachers, and classmates. On the other hand, compared to how significant others appraise their functioning, youth with ADHD tend to over-rate or over-inflate their own appraisals. These inflated perceptions are most likely to occur in just the domains of functioning in which their own behavior is most problematic. So, at one level, global level self-esteem may be headed downward over time. But at another level, there may be poor self-monitoring (as well as defensiveness) in exactly those areas in which the most improvement is needed. You can see why motivation for change would not routinely be strong.

7. I have read about and see various “attention training programs” that attempt to help children with ADD pay attention. Are there programs simply too expensive or too labor intensive to be viable and feasible?

It would be great if an individually administered ‘attention training program' could help individuals with ADHD to focus for long periods of time. The problem is that, despite some small case report-style studies, rigorous data from clinical trials—of the types that are plentiful for medications and behavioral treatments—are simply lacking for such attention training modules. And, to raise a crucial point, even if some of these do show promise in future studies, it is not at all clear that the benefits will generalize from the lab or clinic or study carrel to the classroom or social environment of the child/adolescent. One thing we know for sure about treating individuals with ADHD is that one-on-one interventions typically do not show transfer of their benefits to the everyday worlds where the problems and impairments are most salient.

8. Why is it that girls with ADD later seem to have depression, juvenile delinquency and eating disorders? Do you have any hypotheses regarding this?

There are undoubtedly several pathways. In some cases, the failure experiences generated by ADHD begin a downward spiral. For others, the skill deficits that accrue from poor attention and dysfunctional impulse control mean that youth with ADHD hang out with the “wrong crowd” and lose interest in the traditional roads to success. For still others, it may be that risk factors (including genes) for ADHD are the same risk factors for depression, antisocial behavior, or eating pathology. In short, we are just beginning to address the mediating factors that explain why ADHD is such a potent risk factor.

9. How hard or difficult is it for parents to get help for their children with ADD? Are the schools doing all they should? How much responsibility should the schools have for adolescents with ADD?

Parents need to be strong advocates, as well as patient teachers and effective behavior managers. Medication treatments have certainly grown in popularity, but they are rarely monitored with sufficient care. Behavioral treatments are hard to obtain in many communities, because of the domination of play therapy and other traditional one-on-one approaches. Public schools are already overburdened budgetarily, and it may well take strong advocacy to get appropriate accommodations and/or school-based behavior management programs in place. Schools are mandated under IDEA to provide appropriate evaluation and accommodations for learning problems related to ADHD, but the actual provision of such is highly variable.

10. Where was your study published and who supported it?

Journal of Consulting and Clinical Psychology , Vol 74, pp. 489-499.

The research was supported by a grant from the National Institute of Mental Health.

11. What question have I neglected to ask?

This has been quite thorough! Thank you for allowing me to share this information with your readers !

[d]

Here's another write-up on the girls study from the Washington Post:

At Last, Attention Shifts to Girls
Symptoms May Differ, but ADHD Risks Are as Real as for Boys, Study Finds

By Sandra G. Boodman
Washington Post Staff Writer
Tuesday, July 11, 2006; Page HE01

A major long-term study of girls diagnosed with attention-deficit hyperactivity disorder (ADHD) in elementary school has found they are at greater risk for substance abuse, emotional problems and academic difficulties in adolescence than their peers who don't have the common neurobehavioral condition. The results, experts say, should help dispel the myth that the disorder, which affects an estimated 4.4 million American children, poses less of a risk to girls than to boys, on whom most research has focused.

The federally funded study by researchers at the University of California, Berkeley, involves more than 200 girls who have been followed since 1997, when they were 6 to 12. The broadly focused study is designed to measure the ways ADHD, a disorder characterized by pervasive inattention and impulsivity, affects peer relationships, impairs school performance and is linked to substance abuse and psychological problems.

Photo Caption
Molly Zametkin, diagnosed with ADHD, struggled in school until she started drug treatment. ADHD-related impulsivity, she says, can lead girls into trouble.

Molly Zametkin, diagnosed with ADHD, struggled in school until she started drug treatment. ADHD-related impulsivity, she says, can lead girls into trouble. (By Bill O'leary -- The Washington Post)
Is It ADHD? Or Is It Depression?
The symptoms of attention-deficit hyperactivity disorder (ADHD) in girls can be difficult to distinguish from those of clinical depression, especially when hyperactivity is not present, say experts who treat the disorder. The difficulty can be compounded because the two problems can co-exist:...

"Can you believe it's 2006" and the first long-term prospective study of girls with ADHD is just being published, asked psychologist William Pelham, an ADHD expert at the State University of New York at Buffalo.

Girls, Pelham said, have been under-diagnosed and overlooked in large part because their behavior tends to be less disruptive -- although their problems may be just as severe.

Psychologist Stephen P. Hinshaw, lead author of the study -- published in the June issue of the Journal of Consulting and Clinical Psychology -- called the results "surprising and discouraging."

"The cumulative picture is that girls with ADHD are at risk for a lot of problems," said Hinshaw, chairman of the psychology department at Berkeley and a prominent ADHD researcher. Hinshaw said he and his colleagues did not expect the "breadth of impairment" they found. The team began the study with 228 girls: 140 had ADHD, while 88 did not.

Five years later, researchers conducted a follow-up study involving 209 of the girls, who had entered middle and high school. In nearly a dozen areas examined by researchers -- including academic performance, prevalence of eating disorders, relationships with peers and teachers, and organizational skills -- the girls with ADHD were significantly more likely to have problems than those in a matched control group who did not have the disorder.

The gap in reading and math ability had widened in five years and new concerns had emerged: About 30 percent of the girls with ADHD were at least mildly depressed, compared with 10 percent of the control group, Hinshaw said. The same percentages were seen in substance abuse.

One area showed marked improvement: The girls in the ADHD group showed fewer signs of hyperactivity as they grew older, the same trend seen among boys in other studies.

Pelham called Hinshaw's results "very important" because so little is known about teenage girls with ADHD. Too often, he said, the problem is either overlooked or misdiagnosed as depression.

A long-term study published in May by researchers at Massachusetts General Hospital in Boston found that teenage girls with ADHD were more likely to have mood or anxiety disorders than those without the disorder.

"Most girls do as well as boys" when their ADHD is treated, Pelham said. The optimal treatment combines the use of stimulant medications, such as Ritalin or Adderall, with behavioral therapy that provides structure, teaches organizational skills and rewards desired actions, experts say.

To Washington area developmental pediatrician Patricia Quinn, who has specialized in the treatment of ADHD for nearly 30 years, the results of Hinshaw's study serve as a warning.

"People think if a girl is ditzy she's not going to have serious problems, but this study confirms that's not true," said Quinn, who has co-authored books about girls and women with ADHD.

Molly Zametkin, 18, a recent graduate of Walter Johnson High School in Bethesda, knows firsthand that girls can be as affected as boys, even if their problems seem less obvious.

First diagnosed in elementary school, Zametkin, who described herself as "a little space cadet who was never hyperactive," vehemently fought her parents' efforts to treat ADHD with medication and therapy. Her father is a research psychiatrist at the National Institute of Mental Health.

Only after years of struggling in school, Zametkin said, did she accept that "it was a problem I couldn't fix by myself"; she began taking medication regularly when she started high school.

The Berkeley findings, she said, mirror aspects of her experience as well as what she sees in other girls who have ADHD, especially their battles with food and their use of drugs, alcohol and cigarettes.

"Any girl with ADHD is going to be more impulsive and more of a risk-taker," Zametkin said. "And impulsivity makes it easier to give in to peer pressure in any situation."

Hinshaw's study was launched at a time when officials at the National Institutes of Health, which is funding it, were seeking to include more women and minorities in medical research.

Berkeley researchers recruited an ethnically and economically diverse group of girls: Slightly more than half were white, 27 percent were African American, 11 percent were Latina and 9 percent were Asian American.

All attended a free five-week summer program where they were closely monitored by the staff, who did not know which girls had been diagnosed with ADHD. Most of those taking medications agreed to stop while the program was in session, though treatment decisions were left to parents. Observations by the staff were augmented by testing, interviews and other assessments.

In the first study of these girls, published in 2002, Hinshaw and his colleagues reported that the ADHD group had more problems making and keeping friends, and functioning outside school; they also lagged behind their peers academically.

How, Hinshaw and his team wondered, would they fare after five years? To answer that question, researchers reassessed 92 percent of the group who agreed to cooperate and had dispersed to eight states as well as South Korea and Australia. Researchers conducted eight-hour assessments of each girl.

Some in the ADHD group had received no treatment during the intervening five years, while others received extensive help. About 50 percent, Hinshaw said, had taken medication at some point and 80 percent were receiving special services, mostly in school. Some had made significant recoveries and no longer had ADHD, but most continued to struggle.

Previous studies have found that about 30 percent of children diagnosed with ADHD in childhood appear to outgrow the problem during adolescence; by adulthood about 50 percent are no longer impaired.

To Hinshaw, devising effective treatments for girls remains paramount.

"Girls have a different way of relating and deserve study in their own right," he said, and should receive treatments that are not mere imitations of those boys receive. "This is not a short-term disorder." ·

Comments: [e-mail].

www.washingtonpost.com/wp-dyn/content/arti
cle/2006/07/10/AR2006071000703.html

[d]

I stickied this thread bc I thought it would be a good idea to keep the female ADHD info in one place. Anybody/everybody please feel free to add on to this!
______________________
Drs. Kathleen Nadeau and Patricia Quinn are pioneers in female ADHD.

Here is their website:

www.addvance.com/index.html

There is a lot of info on that site. You can also subscribe to a free email newsletter.

Also, they set up a non-profit org to further the interests of female ADHD and here is that link:

www.ncgiadd.org/index.html

Sari Solden is also a pioneer. She tends to focus on female adult ADHD.

www.sarisolden.com/

[d]

This is from this morning's David Rabiner's Attention Research Update email newsletter. If you don't already subscribe, see helpforadd.com.
____________________________

In this issue of Attention Research Update I review an interesting new study on the long-term adjustment of girls with ADHD. As you are probably aware, research on girls with ADHD is extremely limited relative to the large number of studies of boys, so this work makes an important contribution to the literature. In addition, rather than just documenting the contribution of ADHD to girls' adjustment over time, the authors examine factors that may help protect girls with ADHD, or who are rejected by their peers, make more positive outcomes during adolescence. This focus on identifying protective factors is important and may contribute to a better understanding for how to promote more positive long-term adjustments in children with ADHD, both boys and girls.


** New Issue - Interesting New Findings on Girls with ADHD **
*************************************************************************************

Although it is well established that childhood ADHD and rejection by peer each predict a wide range of future adjustment problems, it is also apparent that some children with these risk factors fare quite well during adolescence. What helps some youth at risk for negative developmental outcomes make more satisfactory adjustments while many others do not? This is an extremely important question as understanding what protects some children with ADHD from developing significant emotional and behavioral problems during adolescence could perhaps help to prevent many more from experiencing these negative outcomes.

Identifying factors that protect some children with ADHD and/or peer rejection from experiencing negative outcomes during adolescence was the focus of a study published recently in the Journal of Abnormal Child Psychology [Mikami & Hinshaw (2006). Resilient adolescent adjustment among girls: Buffers of childhood peer rejection and attention-deficit/hyperactivity disorder, 34, 825-839]. The focus on examining protective factors in children with ADHD is a unique aspect of this study; what makes it more unique is that it examines development in a sample of girls with ADHD as well as the contribution that ADHD may make to the development of eating pathology.


- Participants -

Participants were 228 6-12 year old girls with ADHD from the San Francisco Bay Area, and 88 comparison girls without ADHD recruited from the same communities. Girls with ADHD were recruited from medical settings (e.g. pediatric practices, HMOs), mental health settings, school districts, ADHD parent groups, and newspaper advertisements. Comparison girls were recruited from similar school districts, newspaper ads, and medical settings. All girls in the ADHD group received a rigorous diagnostic evaluation - regardless of whether they had been previously been diagnosed - to insure that all met DSM-IV diagnostic criteria. (For a review of current ADHD diagnostic criteria go to www.helpforadd.com/criteria.htm For information about evaluation guidelines, go to www.helpforadd.com/evaluate.htm )

Fifty-three percent of girls were Caucasian, 27% were African American, 11% were Latina, and 9% were Asian. Girls from families across the entire socioeconomic spectrum - from families on public assistance to upper income families - were represented.

All girls - those with ADHD as well as the comparison girls - participated together in a 5-week summer enrichment day camp. Parents of girls who were already taking medication were asked to have their daughters participate in the camp while unmedicated, and the majority complied with this request. Daily activities included classroom, art, drama, and outdoor activities that allowed for ample social interaction and extensive observation of girls' behavior. Classes of 25-26 girls (60% with ADHD and 40% comparison) participated together for each day's events. Activities were supervised by a head teacher and 4-6 counselors who were unaware of which girls had been diagnosed with ADHD and which had not. These staff provided daily ratings of the girls' behavior. (Note: Results pertaining to behavior ratings were published earlier in another study reviewed in Attention Research Update. You can find the review of this prior study at www.helpforadd.com/2002/october.htm

Baseline measures (described below) were collected on all girls during their participation in the summer program. Approximately 4.5 years later, participants and their families were invited to return for a follow-up assessment so that girls' current functioning could be assessed.


- Baseline Measures -

The primary focus of this study was to examine how adolescent adjustment among girls with ADHD is related to the combination of risk and protective factors that were present during childhood. The risk and protective factors that were assessed during the summer camp program are described below.


- Risk Factors -

- Girls were asked to identify 3 girls in their group that they liked the most and 3 girls that they liked the least. These nominations were used to identify girls that were consistently disliked and rejected by their peers. As noted above, findings from a number of studies indicate that children who are rejected by peers are at increased risk for a range of negative outcomes during their development.

Externalizing behavior - Externalizing behavior refers to acting out behavior such as aggression, oppositionality, and delinquent acts. Externalizing behavior tends to be stable over time, and many children with high levels of externalizing behavior show this pattern across development and get into more serious trouble during adolescence. Measures of externalizing behavior at baseline were obtained by having each girl's parents and teachers complete standardized behavior rating scales. In addition, camp staff provided daily ratings of the externalizing behavior displayed by each girl.

Internalizing behavior - Internalizing behavior refers to feelings of anxiety, depression, and worry. Although internalizing behavior tends to be less stable than externalizing behavior, girls develop depression and other internalizing disorders in adolescence at higher rates than boys, and internalizing behavior during childhood may thus be an important risk factor for girls. Baseline measures of internalizing problems were derived from ratings provided by parents, teachers, camp staff, and girls themselves.

Academic Achievement - Poor academic achievement during childhood is also a risk factor for negative adolescent outcomes. To assess academic achievement, each girl was administered the math and reading portions of the Wechsler Individual Achievement Test, a well-normed and widely used test of academic achievement.


- Protective Factors -

Protective factors are those that buffer a child against the development of negative outcomes, even when one or more risk factors are present. The factors hypothesized to serve this role for girls with ADHD that were investigated in this study are described below.

Self-perceived scholastic competence - This pertains to an individual's belief that she is capable of academic success and may be especially important for girls with ADHD because of the major academic difficulties that ADHD frequently contributes to. Girls who believe they can succeed academically, even if ADHD is contributing to academic struggles, are more likely to remain invested in school and continue to focus on achievement. The authors suggest that believing in one's ability to succeed academically will predict better more positive adolescent outcomes above and beyond the child's actual level of academic achievement. In other words, believing you will succeed will predict better outcomes irrespective of what the child's actual academic competence at the time happens to be.

This protective factor was measured using the scholastic competence scale from the Harter Self-Perception Profile for Children. This 6-item self-report measure described different children (e.g., "some kids feel that they are very good at their school work, but other kids worry about whether they can do the school work assigned to them") and asked the participant to indicate which description was most like herself. The different items assessed the degree to which children perceived themselves to be good at understanding class work, good at tests, and intelligent.

Popularity with adults - Longitudinal studies of at-risk youth have consistently found that positive relationships with a non-parental adult increases the likelihood of youth becoming competent adults. Because girls who are popular with adults would be more likely to develop positive relationships with them, the authors hypothesized that girls with ADHD who were better liked by camp staff would have more positive outcomes as adolescents. Popularity with adults was assessed by having camp staff identify the 3 campers they liked most and the 3 they liked least. Ratings were averaged across the different staff so that a composite popularity score could be computed for each child.

Goal-directed play - The authors hypothesized that constructive, goal-direct play when alone, as opposed to disorganized and purposeless solitary behavior, would also buffer girls with ADHD from negative adolescent outcomes. This was based on the belief that purposeful, goal-directed play may reduce a child's feelings of sadness and loneliness when isolated. Girls' tendency to engage in goal-directed play was assessed by having camp staff make repeated observations of girls' behavior during the camp session, and recording girls' activity during periods when they were by themselves.


- Adolescent Outcomes -

Approximately 4.5 years after attending the summer camp program, all girls - those with and without ADHD - and their families were invited back so that girls' adjustment during adolescence could be evaluated. Externalizing and internalizing behavior was measured by parent and teacher rating scales as well as girls' own self-reports; academic achievement was measured by the same achievement test that had been administered previously. Girls also completed the Eating Disorders Inventory so that pathology related to eating behavior could be assessed and the Substance Abuse Questionnaire so that information related to this important adolescent outcome could be obtained.


- Results -

Although the authors' primary interest was to examine whether self-perceived scholastic competence, popularity with adults, and goal-directed solitary play protected girls with ADHD from negative adolescent outcomes, they first examined how adolescent functioning in girls with and without ADHD compared.

Not surprisingly, compared to girls without ADHD, those with ADHD had significantly higher rates of internalizing and externalizing symptoms at follow-up. They also had lower levels of academic achievement, higher rates of substance use, and, interestingly, higher rates of eating pathology.

Peer rejection during childhood was also independently associated with all of these negative outcomes except for substance use. Contrary to the authors' predictions, the combination of childhood ADHD and peer rejection did not confer additional risk above that associated with each risk factor independently.

- Does Childhood ADHD Predict Increases in Behavior and Academic Achievement Problems? -

The authors make the important point that just because girls with ADHD showed higher rates of behavior problems and lower levels of academic achievement during adolescence does not necessarily mean that their ADHD symptoms contributed to increases in these difficulties over time. After all, at the baseline assessment, girls with ADHD were already showing more internalizing and externalizing behaviors than comparison girls, as well as lower levels of academic achievement. Thus, it is important to test whether ADHD directly contributed to negative change in problem behaviors.

To examine this, the authors reran their analyses predicting adolescent outcomes of interest with the baseline scores for these outcomes included. The question addressed by these analyses is whether ADHD or peer rejection in childhood predicts changes over time in internalizing symptoms, externalizing symptoms, and academic achievement. In other words, if a girl is already showing high rates of emotional/behavioral/academic problems during childhood, does having ADHD or being rejected by peers contribute to these difficulties increasing over time?

Results indicated that this was not the case for either externalizing or internalizing behavior, i.e., after controlling for baseline scores on these variables, childhood ADHD and peer rejection did not predict increases in these problems over time. For academic achievement, however, childhood ADHD and peer rejection both predicted significant declines in achievement over time. Because baseline measures of eating pathology and substance use were not collected, they could not examine whether ADHD or peer rejection predicted changes in these variables over time.


- The Role of Protective Factors - As noted above, the authors' primary interest was whether any of their hypothesized protective factors - self-perceived scholastic competence, popularity with adults, or engagement in goal directed play - would predict better adolescent adjustment in girls with ADHD. The results obtained were quite interesting.

Contrary to the authors' predictions, neither popularity with adults nor high levels of goal directed play predicted more positive adolescent outcomes for girls with ADHD. Self-perceived academic competence, in contrast, was associated with more positive outcomes in every area. Specifically, even after controlling for actual academic achievement at baseline, girls who were more confident about their ability to succeed academically showed:

- reductions in internalizing symptoms over time;
- reductions in externalizing symptoms over time;
- actual gains in academic achievement;
- lower levels of adolescent substance use;

Interestingly, girls' actual level of academic achievement at baseline did not emerge as a significant predictor of change in externalizing or internalizing problems, nor did it predict girls' substance use. Not surprisingly, however, it was a strong predictor of academic achievement in adolescence.


- Summary and Implications -

Both peer rejection and ADHD in childhood predicted a wide range of negative adolescent outcomes including externalizing behavior, internalizing behavior, poor academic achievement, and eating pathology. In addition, ADHD - but not peer rejection - predicted higher levels of adolescent substance use. The finding that AHD in girls predicted greater eating pathology is an important one, and suggests that "...girls with ADHD may be at particular risk for eating pathology because of the impulsivity that is central to both ADHD and bulimia/binge eating disorders."

In examining change in problem behavior from childhood to adolescence, peer rejection and ADHD did not predict increases in externalizing and internalizing problems from childhood to adolescence. Instead, the only significant predictor of these problems during adolescence was how much difficulty girls were displaying in these areas 4.5 years earlier. Thus, while ADHD may have contributed to the development of these difficulties in childhood, once they have emerged, it does not appear that ADHD contributes to their escalating over time.

This was not the case, however, for academic achievement. In this important domain, both ADHD and peer rejection predicted significant declines in achievement over time, even after controlling for academic achievement in childhood. This finding points to the enduring negative impact of ADHD on girls' academic success. It also highlights the importance of carefully monitoring academic performance over time and working to provide whatever academic supports may be required by the child.

Of particular interest was that girls with greater confidence in their ability to succeed academically, regardless of their actual level of academic achievement, had better outcomes in all areas. Thus, perceived scholastic competence protected girls against increases in internalizing behavior, externalizing behavior, and substance use. It also predicted actual gains in academic achievement.

While the reasons for this important protective effect cannot be determined from this study alone, it is possible that girls who believe they can succeed academically remain more invested in school and achievement. As a result, they may do better in school over time and be less inclined to become involved in activities that could undermine their success. As exciting as this finding is, it would be important for it to be replicated in another study. Also, it is not possible to know whether the protective effects conferred by girls' feelings of competence would be specific to the academic domain, as was assessed here, or whether perceiving oneself as competent in other areas, e.g., social, athletic, etc., would provide the same buffering effects. Because this study was limited to girls - a rarity in the ADHD literature, it also cannot be assumed that a protective effect of self-perceived scholastic competence would be found for boys.

In summary, this interesting study sheds new light on the development of girls with ADHD. Important new findings are that ADHD may predispose girls to the development of eating pathology and that self-perceived scholastic competence may help protect girls with ADHD from negative developmental outcomes. The study highlights the value of longitudinal research and will hopefully inspire other researchers to examine factors that promote resilience in children with ADHD and to understand the mechanisms by which these resiliency-promoting factors operate.

[d]

From this today's David Rabiner's Attention Research Update email newsletter.

** New Issue - The Social Impact of Girls with ADHD **
**********************************************************************************************

The social difficulties of boys with ADHD have been well-documented and initial research on girls with ADHD point towards similar social problems (for a review of one such study go to www.helpforadd.com/2003/march.htm ). Research on the social interactions of girls with ADHD remains limited, however, and has primarily relied on parent and teacher reports of girls' social behavior while direct observations of girls' behavior have been rare. This is an important limitation because parents and teachers are not necessarily privy to subtle aspects of social interaction that may play a significant role in the success - or lack thereof - that a girl experiences with her peers.

A study published in a recent issue of the Journal of Abnormal Child Psychology [Ohan & Johnston (2007). What is the social impact of ADHD in girls? A multi-method assessment. JACP, 35, 239-250] begins to address this limitation by examining girls' social interactions with observational methods in addition to incorporating reports from parents and teachers.

Participants were 40 9- to 12- year old girls diagnosed with ADHD and 40 comparison girls without ADHD. Among the girls with ADHD, 22 met criteria for the combined type of ADHD (i.e., they had high rates of both inattentive and hyperactive-impulsive symptoms) while the remained were diagnosed with the inattentive type of ADHD ( i.e., high rates of inattentive symptoms only). Twenty-two of the girls with ADHD also met criteria for a diagnosis of Oppositional Defiant Disorder (ODD; for a description of ODD symptoms, go to www.helpforadd.com/oddcd.htm ). Almost all of these girls were from the ADHD Combined type group; the vast majority of girls with ADHD only were of the inattentive type.

The researchers were interested in comparing the levels of prosocial and aggressive behavior of girls with and without ADHD and they used a variety of measures to do this. Before summarizing these measures, it is important to note that they chose to examine 2 types of aggression: overt aggression and relational aggression.

Overt aggression is the type of aggression that tends to be common among boys and involves physically aggressive behavior, intimidation, and threats. This is the type of aggression that boys employ to bully others and establish themselves in the dominance hierarchy. Although parents and teachers are not privy to all such aggressive acts, it is the type of aggressive behavior that is easy to observe.

Relational aggression, in contrast, refers to behaviors that are intended to harm or disrupt the victims' relationships with peers and is evident in gossiping or social exclusion. A child is engaging in relational aggression when she/he spreads rumors about a peer to damage that peer's social reputation, attempts to turn others against a peer, or deliberately excludes a child from social activities. Although the evidence remains somewhat equivocal, there are indications that relational aggression is more common among school age girls than boys, perhaps because girls tend to place greater value on intimacy and group belongingness. In contrast to overt aggression, relational aggression is more subtle and difficult to observe, and is therefore less accessible to parents and teachers.


- Measures - Below is a brief description of the measures that were collected on participants.

Child Behavior Checklist (CBCL) - The CBCL is a widely used measure of child behavior problems containing 114 items that parents rate from "never true" to "often or always true". Items are grouped into a number of problem behavior scales that reflect internalizing difficulties ( e.g., worries, sadness, anxiety), externalizing problems (e.g., disruptive behavior, oppositional behavior, aggression), and adaptive skills. This form was completed by children's mothers. For girls with ADHD who were being treated with medication, mothers were asked to report on their child's behavior when not on medication.

Children's Social Behavior Scale - This scale was completed by mothers and teachers to assess each girl's level of overt aggression, relational aggression, and prosocial behavior.

Observational Measure - The unique aspect of this study was the use of an clever paradigm to collect observational data on girls' aggressive and prosocial behavior. Girls were brought into the lab and given the choice to play a computer game called the "Girls Club!". Each girl was told that the game was developed for girls their age to play with each other and that she would be playing on-line with 2 other girls who were in other rooms and who she would meet at the end of the game. In reality, however, no other girls would be playing; instead, the moves and comments (see below) of the "other" players were simulated and pre-programmed to be the same for every participant.

Each game began with girls in the "clubhouse". The game involved rolling computerized dice to move around the board with the winner being the first girl back to the clubhouse. Along the path, were 5 "chat centers" where girls could send messages to the "other girls", either to both at the same time or to one girl or the other. In reality, of course, there were no other girls receiving the messages.

As noted above, all moves and dice rolls were predetermined by the computer. The participant always "won the game" and was appointed "Girl's Club President". This gave her the right to make decisions about her "co-players" that each girl was told would be provided to future presidents to aid in their selection of who to play with. Thus, each girl could indicate who to include or exclude in future games and could provide information about what the other girls were like and how good a friend they would be. This provided an opportunity to assess overtly aggressive and relationally aggressive comments. Girls were led to believe that the ratings of their peers collected after the game would not be shared with the other players.

Messages that girls sent at the Chat Centers, as well as the comments about other girls that were collected after the game, were coded into the following categories:

Overt Aggression - harmful/destructive messages that threatened, bossed or taunted; e.g., "shut up", "Ha, Ha, look like you lost!"

Relational Aggression - harmful/destructive messages that manipulated the victim's relationship with another player; e.g., "Don't tell her but I don't like her very much, do you?"

Prosocial - skilled and friendly messages; e.g., good game to everyone," "I really like playing with you guys.

Awkward - comments that were out of synch with social expectations; e.g ., out-of-the-blue comments that did not fit into the flow of normal social exchange such as "I like fish," "Volleyball is a fun sport".

All messages were coded into 1 of these 4 mutually exclusive categories and the number of messages in each category was tallied to create a score in that category for each participant. In addition to this coding, the intensity of each message was rated on a 1 to 5 scale. For example, in the overt aggression category, the message "I'm going to win!" would receive a score of 1 while the message "I'm going to spit on you!" would receive a score of 5. Intensity scores were averaged within each category.

The scores resulting from this coding procedure provide an observational measure of the girls' overt and relationally aggressive behavior, as well as their tendency towards prosocial and socially awkward exchanges. They are thus a nice complement to the parent and teacher ratings that were collected.

Some readers may be concerned by the deceptive nature of this study as girls were led to believe they were interacting with peers when this was not the case. It should be noted that in this study, as in all studies conducted with human subjects, the procedures were reviewed and approved by a committee at the researchers' university whose job it is to safeguard the rights of participants in research studies.

In addition, the girls' mothers were aware of the deception involved and provided consent for their child to participate. Finally, at the end of each girl's participation, the researchers provided each girl with a complete explanation of what had occurred, and an explanation for why the deception was necessary. The authors noted that none of the girls appeared to be upset by the experience.


- Results -

Overt Aggression - Comparisons between girls with ADHD+ODD, ADHD only, and control girls for overt aggression were made for parent and teacher ratings as well as for the messages sent in the computer game. On all 4 measures, girls with ADHD+ODD were more aggressive than girls with ADHD alone who, in turn, were more aggressive than girls in the control group.

Relational Aggression - According to mothers' reports, girls with ADHD+ODD displayed higher rates of relational aggression than girls with ADHD alone, and girls with ADHD alone were seen as more relationally aggressive than girls in the control group. For teacher ratings, girls with ADHD+ODD were more aggressive than girls in both other groups who did not differ significantly from each other.

On the lab task, girls in the control group sent fewer relationally aggressive messages than both groups of girls with ADHD. However, the intensity of the relationally aggressive messages was actually higher for girls in the control group than for girls with ADHD alone. After being appointed "president" girls with ADHD+ODD were more prone to suggest excluding peers from future games than girls in the other groups. For rumor spreading, girls with ADHD only spread significantly fewer rumors than girls in the control group.

Prosocial Behavior - According to mothers' reports, girls with ADHD+ODD were less prosocial than girls with ADHD alone, who, in turn, were seen as less prosocial than girls in the comparison group. Teachers reported that girls with ADHD+ODD were less prosocial than girls in both other groups, who did not differ significantly from each other.

On the simulated computer game, both groups of girls with ADHD sent fewer prosocial message than girls in the control group.

Awkward Behavior - Interestingly, girls with ADHD alone were judged to send more socially awkward messages than girls in the other two groups. The intensity of their "awkwardness" was also judged to be higher.


** The Contribution of ODD symptoms, hyperactive-impulsive symptoms, and inattentive symptoms to girls' social behavior **

As a supplementary analysis, the authors examined the relative contribution of 3 types of symptoms - oppositional behavior, hyperactivity, and inattention - to the different types of social behavior rated in the study.

Girls' level of overt aggression was related to their ODD symptoms and hyperactive-impulsive symptoms, but not to their level of inattentive symptoms. Findings for girls' relational aggression were more mixed, with ODD, hyperactive, and inattentive symptoms all predicting relational aggression according to at least one source ( i.e., parents, teachers, or lab observations).

Girls who were higher in ODD symptoms were seen as less prosocial by mothers, teachers, and in the lab task. Hyperactivity was related too less prosocial behavior only during the lab task, and inattention was not related to prosocial behavior on any of the measures.

Finally, for awkward behavior in the lab task, only inattentive symptoms emerged as a significant predictor.


* Relationship between lab task measures with mothers' reports of psychopathology for girls with ADHD *

To examine the validity of the lab task measures, the authors also calculated the association between these measures and mothers' reports of their child internalizing and externalizing problems from the Child Behavior Checklist. Results indicated that higher rates of externalizing behavior problems were positively associated with the frequency and intensity of overtly aggressive messages, of exclusionary and rumor spreading messages, and with socially awkward messages. Externalizing problems were also negatively associated with prosocial message frequency and intensity.

Internalizing (e.g., worries, sadness, anxiety) were strongly linked with the frequency and intensity of socially awkward messages, but not to overtly aggressive or relationally aggressive messages.

Finally, girls rated higher by mothers on adaptive skills sent fewer overtly and relationally aggressive messages that were also judged to be less intense.

Overall, therefore, clear and meaningful relationships were found between mothers' ratings of their child's difficulties and children's behavior during the lab task used to assess their social behavior.


- Summary and Implications -

Results from this study indicate that girls with ADHD+ODD were more overtly and relationally aggressive and less prosocial than girls without either disorder, with girls having ADHD only falling in between these girls and girls without ADHD.

It was especially noteworthy that compared to girls in the control group, girls with ADHD only showed less frequent prosocial behavior, more overt aggression, more frequent relationally aggressive messages, and more awkward social interactions. Thus, even when not accompanied by significant oppositional behavior, ADHD was significantly associated with lower levels of social competence in girls. Because girls were not taking medication at the time of the lab assessment, the degree to which these differences might be alleviated by medication treatment is not clear.

One apparently paradoxical finding was that girls with ADHD only showed more frequent relationally aggressive messages than girls in the control group, but these messages were rated as being less intense. They also engaged in less rumor spreading than girls in the control group. To explain these apparently contradictory results, the authors suggest that relational aggression that involves planning and organizational skills ( e.g., gossiping and spreading rumors to damage another child's reputation) may be less common in girls with ADHD because they lack the planning and executive functioning skills that this behavior requires. Thus, they may have been less able to generate the kinds of rumors about peers that were judged to be of an intense nature.

If, however, relational aggression takes the form of a rash and angry response to a conflict, girls with ADHD may engage in more of it than other girls because of their greater tendency to act impulsively. Future research should thus look more closely at the type of relational aggression that girls with ADHD tend to display.

The authors also call attention to the findings pertaining to socially awkward behavior, something that has not been examined in prior research. They suggest that the inattentive nature of ADHD can make it difficult for children to accurately track ongoing conversational exchance, and may explain why girls with ADHD sent more tangential and awkwardly appearing messages.

In summary, results from this interesting study add to current knowledge of the social difficulties of girls with ADHD by highlightng a pattern of social behavior that includes higher rates of relational aggression, reduced prosocial behavior, and higher rates of socially awkward behavior. When accompanined by ODD, increase in overt aggression are also prominent. As with all studies in which children with ADHD are compared to other children, it is important to recognize that not all children in the ADHD group displayed the behavioral deficits and excesses that were found to characterize the group as a whole.

Subsequent research should build on these findings through incorporating observational methods such as those incorporated hear and focus on the development of effective methods for addressing the pattern of social difficulties that was found.

**********************************************************************************************

David Rabiner, Ph.D.
Senior Research Scientist
Center for Child and Family Policy
Duke University
Durham, NC 27708

[TerryB]

That is absolutely fascinating. My daughter is inattentive without ODD and she is lacking in Prosocial behavior but I think she can be trained somewhat so I'll have to get back to that issue after she is settled into medication (Just changing to Strattera.) She also doesn't generally gossip and this explains it. The social awkwardness also fits right in with the comorbid of anxiety that she has.

This research also helps me to pinpoint what social measures are important in relationships. Then I have a more specific idea of what to work on.

This is really great info. Thanks for posting it. I feel like our girls are finally getting some real research time now.

Terry

[Mayleng]

Terry, d wanted to post this thinking you and swmom would get some insights into your dds.

[TerryB]

Thanks a bunch d!!!!!!!!!!!!!!!

[baysmommy]

Great info, thanks!

[mom2xs]

This is great information, thanks for posting it! I have a daughter with ADHD and this information is very helpful.

[mamak]

I had always read that the ADHD tests were all normed to boys but this one has female norms as well. Just an FYI if your having a girl tested.



Attention Deficit Disorders Evaluation Scale: Secondary-Age Student (ADDES-S)
Stephen B. McCarney, Ed.D.
Attention Deficit Disorders Evaluation Scale: Secondary-Age Student (ADDES-S) (00865)

The ADDES-S is based on the APA definition of Attention-Deficit/Hyperactivity Disorder (DSM-IV™) and the criteria most widely accepted by educators and mental health providers.

The ADDES-S School Version was standardized on a total of 1,280 students, including identified Attention-Deficit/Hyperactivity Disordered students.

The standardization sample included students from 19 states and represented all geographic regions of the United States.

The ADDES-S was factor analyzed to create the factor clusters (subscales).

The subscales, Inattentive and Hyperactive-Impulsive, are based on the most currently recognized subtypes of ADHD.

The ADDES-S provides separate norms for male and female students 11.5 through 18 years of age.

The School Version can be completed in approximately 15 minutes and includes 60 items easily observed and documented by educational personnel.

The ADDES-2 Home Version can be completed by a parent/guardian in approximately 12 minutes and includes 46 items representing behavior exhibited in and around the home environment.

The Pre-Referral Attention Deficit Checklist provides a means of calling attention to the behavior for the purpose of early intervention before formal assessment of the student.

The ADDES-2/DSM-IV Form provides a comparison of the behavioral characteristics from the ADDES-S to the Attention-Deficit/Hyperactivity criteria from the DSM-IV™.

The Attention Deficit Disorders Intervention Manual:Secondary-Age Student includes IEP goals, objectives, and interventions for all 60 items on the School Version of the scale.

The ADDES-S Quick Score computer program converts raw scores to standard and percentile scores and makes the scoring of both the ADDES-S School and ADDES-2 Home Version rating forms efficient and convenient..

Complete Kit includes: Pre-Referral Attention Deficit Checklists (50), Intervention Strategies Documentation Forms (50), ADDES-S School Version Technical Manual, ADDES-S School Version Rating Forms (50),ADDES-2 Home Version Technical Manual, ADDES-2 Home Version Rating Forms (50), ADDES-2/DSM-IV Forms (50), Attention Deficit Disorders Intervention Manual: Secondary-Age Student, and Parent's Guide to Attention Deficit Disorders

[healthy11]

On Dec. 16th, Kathleen Nadeau will be participating in a free CHADD online chat about "Raising girls with ADHD"....you don't have to be a CHADD member to participate. I mentioned the details here: www.millermom.proboards107.com/index.cgi?board=Education&action=display&thread=6849

[mamak]

I came across this book to help TWEEN girls with ADHD on amazon. I haven't read it but it has several sincere reviews.


www.amazon.com/Attention-Girls-Guide-Learn-About/dp/1433804484/ref=cm_cr_pr_product_top




From School Library Journal
Grade 5–8—Quinn has attention deficit hyperactivity disorder and is a medical doctor; she addresses the types of AD/HD; who can help; differences between girls and boys with AD/HD; making friends; talking with adults about the condition; relaxation techniques; and medication. Her aim is to give girls a variety of ways to manage their disorders. She has created fictional AD/HD girls with various problems and situations that readers might face and then provides a variety of solutions. She suggests that her book does not need to be read in chapter order and that girls should begin with the topics of their greatest concern. The book is attractive and inviting with colorful cartoon illustrations, sidebars, and highlighted reminders. Beth Walker's The Girls' Guide to AD/HD (Woodbine, 2005) covers most of the same topics, but is not as visually appealing.—Elaine Lesh Morgan, Multnomah County Library, Portland, OR END --This text refers to the Hardcover edition.


Product Description
This is the first book written for 'tween' girls (ages 7-11) who have ADD/ADHD. It offers girls, their parents, and professionals practical tips and techniques for managing attention disorders and the many aspects of life that these disorders can affect. It was written in an engaging style that doesn't 'talk down' to girls. It is packed with useful and empowering lessons that are simple to apply. It was written by a developmental pediatrician who is a well-known author.

[dhfl143]

Here's another article to add to the discussion related to girls who were diagnosed in college with ADHD:

www.chron.com/disp/story.mpl/health/7012630.html

[dwolen]

Thanks for posting this article link. I sent it to my daughter.

[kc4braves]

I am interested in finding some info on how puberty affects already diagnosed ADD girls. I am having a really hard time because, though I have navigated ADHD with my 17 y/o son since age 7, it seems like the game is totally different for my dd. While my son's symptoms drastically improved with puberty ( less impulsive, less hyperactive, more mature in many ways)and HS has been and "easier" situation for him than was jr high or elementary, everything seems just the opposite with her.

Puberty seems to have stolen my dd. I don't mean that she is bratty or unusually moody, but her ADD symptoms seem to be much worse since her cycle is becoming more regular. She is like a different child in many ways and I am not adapting well. She has always excelled in school, been very independent, average to above average social skills, a problem solver, go-getter, self-advocator, etc. She started on meds between 4th and 5th grades when in 4th grade we began to see struggles. Everything improved and 4th-8th grades were amazing with occasional issues with things like forgetting to turn could increase meds a bit and all is well. Now in HS, we are seeing lots of "lapses", less self-advocating ( she just doesn't go to her teachers with problems anymore), more problems in math and lower grades ( though still A's and B's) in general, less-logical responses to things, often kinda spacey ( this is a new thing), less put-together at times, less prepared and often doesn't know she is unprepared....it's just odd. We had changed to Concerta from the patch but that was disastrous at school. Now back on patch but maxed out and, though, she seems more like the child we are accustomed to, these issues keep being a problem frequently.

So, I would like more info on just how much is somewhat out of our control and how much we/she might be able to change or adapt coping skills for. She is accustomed to doing well on her own and excelling and is not happy with us trying to be helpful....she is fighting us on tools to help her memory. She tells me she's got it ( which means for me to back-off) but where she really had it in the past, she often doesn't now. So....it's killing me. I am not ready to accept that this is the new norm unless I have to. So any good book about puberty and how it affects ADD symptoms in girls would be great, especially if it includes any ideas to help. She has great self-esteem still and is happy and has friends.

Thanks for any suggestions.

[SharonF]

kc4--

I don't have a book or an article to recommend. Just a few thoughts.

When is the last time you talked with dd's prescribing MD about this? It may be that the meds/dosage just aren't doing what they need to be doing.

Is this her first year of high school? Many ADHDers/LDers struggle with adjustments. High school can have significantly higher workloads than middle school. Or kids get really busy with extra-curriculars and don't have time/energy for academics. And on another thread, I think you mentioned she's taking some pre-AP courses. Maybe she's stressed out by the workload. (Smart, capable kid but her executive function ability is overworked and overwhelmed.) Stress can create lapses in attention and judgment.

Or maybe her sleep patterns had to change, either because school starts too early for her body clock or she's up too late at night doing homework. Or maybe she just needs more sleep at age 14 than she did at 12 or 13.

Maybe it's just a stage. If there's anything consistent about ADHDers, it's their inconsistency. And maybe she's going through a phase where she's tired of having to think so hard, tired of having to ask teachers for assistance when she doesn't understand a concept, etc.

Maybe she believes she *IS* getting it, Or maybe she's too embarrassed to admit she doesn't get it, but doesn't want to tell you. That's pretty typical of any teenager, not just one with ADHD or LDs.

I'm sure talking about this with her can be touchy. But have you asked her how she thinks things are going? Does she acknowledge she is less prepared or less proactive than she was in the past? I'm curious if she believes there is a problem.

If she hasn't had a comprehensive well visit/physical exam in a while, it may be a good place to start. Rule out any hormone issues, low iron levels, or any metabolic or physical reasons for her "spaciness." In addition, the doctor who prescribes her ADHD meds needs to be aware of the problems you're describing.

[kc4braves]

SharonF, Yes, I have talked to the prescribing doctor, a child psych provider. We changed back to the patch from Concerta which did help quite a bit. She is having fewer "weird' things happen but I still see issues. Generally, she really thinks she "has it" until she does poorly on a test, quiz or homework. I think part of that is that she is used to having it together and is slow to recognize when she does not. Part of it is just weird things. She is working hard to pull her geometry back up. She will have some wonderful grades....then a 70 or a 60...which keeps her from moving up despite the 3-4 really good grades. But on the 70...they are studying postulates for triangles like SSS, SAS, ASA...etc. Her brain switches the letters. It is driving her nuts. She told me...Mom, I understand it all, I knew the answers but every time the answer was side angle side, I wrote angle side angle. Just strange things like that. And it's not all the time which really makes me wonder if it's just hormone fluctuations....possibly just normal fluctuations.

It IS her first year of HS so we did expect some transitioning issues but not really the academic issues so much. 4th grade was a bit of a difficult transition. They went from 1 teacher to 3 and the level of difficulty and responsibility changed. This is when we discovered the hearing issues and the ADD. Then 7th grade, the stat of jr high, caused her some stress because of the fast pace of everything with 6 teachers all spread out over a much larger school. Her grades remained excellent but it took her a few months to become comfortable and confident. 2nd semester 7th and all of 8th....excellent...independent...confident... 9th grade is leveling out some but she is just not quite as steady with things and I keep waiting for the other shoe to fall. I mean, she may be on target and on top of everything for 3 days then on day 4, she forgets or doesn't know she needs to prepare for a test or she has to go back inside 4 times to get things before we can leave for school. Just unusual for her. She generally is not the type to be stressed out...at least not visibly...and not something she often identifies. However, she told me one day that she was in tears in geometry because she had gone in early to meet with the teacher to ask some questions about the homework but he was not there that day before school. She got to class and realized that none of her answers were in the right format. ( That was what she had planned to discuss with him.I had helped her but I took the class or....20 plus years ago.) She said she panicked and tears were escaping from her eyes and he let her go correct the format of her answers before turning them in. Talk about making this momma wanna cry. Homework is supposed to be a learning experience but this homework that she needed help with counts 3 times as much as a test. I have talked with the geometry teacher but he still believes she is like "ALL" students in 9th grade...needs to transition...being challeneged more...didn't have a good alg back ground. The last part I know is not true but....she will probably get her first B in math. Not the end of the world but she is not happy.

I think she probably does need more sleep but she is up rather late even without homework because I think the meds have to wear off...and she is a teen and wants down time after homework to text or watch tv. She does have some busy days...Monday and Tuesday usually where she may do homework to 11 or 12....but this year she can't really do it well because the meds are just gone that late. We are trying to make sure she gets to technical homework first and saves what I call "busywork" to do late. I am not a fan of so much homework but, it is what it is...and we are re-considering pre-AP for next year.

I guess it could be a stage but she shouldn't be tired of asking for help or struggling because....it is new this year. I think about how hard my son has had to work and I don't get why she is so upset about having to ask for help just here and there. I know I cannot compare them but it is hard for me to understand why she will not fight for herself. I was very driven ( and always thought she was) and if I forgot a paper at home or made a mistake on my homework or misunderstood the directions, I was up there discussing my options with my teacher. I have told both kids, " Your teacher's cannot read your minds. You have to talk to them. The worst that can happen is that they tell you they are sorry." In our experiences, most teachers want to know that you care and that you didn't just choose to skip an assignment, etc. often they will give extra time for full or partial credit if it is not an habitual thing. I am accustomed to her taking care of everything for herself so am always shocked when this year, she isn't taking care of things. My husband gets mad at me for not "managing" her more but I have tried to be more hand-off because she was handling her life well.

We have a good relationship and talk about most everything..so far. I really think her biggest problem is that she is ADHD and hates it. Usually she does not appear to anyone to be ADD so most people never needed to know unless she told them. She has never so much said this to me but... I know that she was more mature early on than her brother and thought there was something "wrong" with him so she tried to take care of him. She, though 3 years younger, would go with him places, speak for him, remind him of things so he wouldn't get in trouble, etc. She can go into a store and know how much something costs, how much money they need and how much change they should get, etc. He has never been good at that or asking for help like at a store or anything. So...she really thought she was "better" for lack of a better description. Now SHE can't do it all...not perfectly anyway...and she is a perfectionist in many areas ( not cleaning but..) She doesn't want to NEED help. I have told her that , though I too made very good grades, I often had my mom study with me...call out things to me, etc. She didn't understand math but I used her for support in every other way throughout school and never thought twice about it. It's ok to ask for help.

She has not had a physical in a while but we did run some blood work to check tsh and blood sugar, etc. All was normal. I wonder if her pediatrician would handle this well.

Thanks for your thoughts. I have had some of the same but it is good to know I'm not nuts....and neither is she. All that I read about estrogen and how it affects ADD girls, though, made a lot of sense but was kinda frightening. I keep hoping it's a stage but if it is related to fluctuations in estrogen, then it's here to stay to some degree.

[SharonF]

kc4braves--

Thanks for your description. After reading it, my first response is: she's adjusting to a much heavier and complex workload in high school.

>>I think part of that is that she is used to having it together and is slow to recognize when she does not.<<

This is common in nearly every teenager, but especially in ADHDers/LDers. Sometimes, they just overestimate their ability. Other times, they *do* get it, at least temporarily, while the teacher is explaining it. But at home that same evening, they open up the book to do the homework, and they no longer remember the sequence of steps. Or the problem they copied down from the board and put in their notes looks nothing like their homework problems in the textbook.

This is VERY common at the high school (and college) level. I believe most high school students are expected to be capable of a more complex level of problem solving. Not just in math, but in all subjects. The jump from linear, simplistic problem solving to complex, abstract problem solving is rarely taught. It is just assumed. Some 9th graders' brains aren't ready for that yet. It may take several years to develop. Especially for many ADHDers and LDers.

>>she will probably get her first B in math. Not the end of the world but she is not happy.<<

I never want kids to settle for less than they are capable of. However, a B is not the end of the world. If she gets a B (or a C) every year in high school math, she can still go to college and be a happy adult.

So I'm thinking her expectations of all As or mostly As may not be in line with the reality of high school. She should not be putting unnecessary pressure on herself to get an A.

>>but this year she can't really do it well because the meds are just gone that late.<<

Depending on the doctor's advice and the specific medication she is on, can she take additional medicine in the afternoon?

My dd is on Ritalin-Long Acting. She takes two pills every morning. But the script is written so that she can take one more pill, as needed, in the afternoon. This was actually her doctor's suggestion. In high school, dd was busy with soccer and marching band after school. By the time she got started on homework, her meds were wearing off. So the doc wrote the script to allow her to take an additional pill in the afternoon, as needed.

This was also beneficial in college. dd worked as an athletic trainer for sports teams (required to attend practices and games) every afternoon and nearly every evening. Being able to occasionally take an additional Ritalin tablet in the afternoon was important. Our insurance company questioned it (thinking we were gaming the system, getting 45 days worth of meds for the price of 30 days.) But when I explained dd's erratic college schedule, they agreed the option of taking an additional pill in the afternoon was medically necessary for her.

Hating her ADHD is also very common. Few people want to NEED help. They don't want to be dependent on meds. Or dependent on Mom to manage and organize things for them. Or stuck with a stigma-filled label. 15-year olds can be both extremely idealistic about what they think their life should be like AND be very hard on themselves when their life doesn't measure up to that ideal. Accepting herself *as she is* will probably take time. You are wise to encourage her to ask for help, not micro-manage her day to day, and to help her accept that life doesn't have to be perfect to be wonderful.

And keep in mind she's going through the rollercoaster of hormones and emotions that affect nearly everyone her age. Even for neurotypicals, it can be a crazy time. She will get through this. And any struggles she's going through right now may help her develop essential skills for the rest of high school, college (if she chooses to go) and the rest of her life!

[empeg1]

BTW, no research on ADHD has controlled for fetal alcohol exposure. 90% of individuals with FASD have a diagnosis of ADHD. Just of you don't think this is a small problem, it is not. In-school studies with young children in Europe, Canada and the US. (now ongoing in the San Diego Unified School District) reveal a prevalence of 4 to 5% in ALL YOUNG SCHOOL CHILDREN, far, far more than Autism. Also, BTW, Ritalin has an increase in seizures and heart attack in children with FASD treated with this drug! Many children with a FASD do not respond to stimulant medication. The whole body of research on ADHD is contaminated with subjects for whom fetal alcohol exposure was not ruled out or even questioned.

[beth]

What you describe sounds a lot like my son when he went to middle school. So I am not sure how much is a female thing versus an overwhelmed thing. I think at least part of what she is experiencing is higher expectations but weaker than average executive functioning skills. My son couldn't remember anything he was supposed to have and previously did not have any difficulties. But he was overwhelmed by multiple teachers and uncoordinated expectations. He did adjust though and it was smoother going to high school. But we deliberately kept him out of all honors courses. It was easy for him--got all
A's without too much work but I don't think he would have managed more well.

I wonder if she is in too demanding of a course load. This year he struggled at first with honors algebra 2. I spoke to the teacher who thought he'd adjust but said he could go down to regular geometry if he needed to. He got an A on the second test, after a D on the first, so he caught on. But I think knowing that there was another alternative reduced his stress.He had told us there was nothing that could be done and he'd just flunk. He can be a fatalist.

I do think reversing SAS ect is classic LD. Maybe she could write it out instead of using abbreviations? I would think you could with the teacher figure out something that would work.

[healthy11]

www.yahoo.com/health/what-i-wish-id-known-about-girls-with-adhd-110932298583.html

[healthy11]

www.yahoo.com/news/recent-study-discovered-surprising-fact-233558833.html

A new study by the University of Toronto has found that women with ADHD are “much more likely to have a wide range of mental and physical health problems in comparison to women without ADHD.” The article gives additional details, and is worth reading in full.

[dw]

I know this all too well, its playing out in adulthood.

[healthy11]

((hugs, dw)) As the study author said, she hopes people will stop thinking of ADHD as a “boys’ disorder." It's not saying that ONLY girls tend to have more ongoing mental health concerns compared to their peers without ADHD, as those of us with sons who have ADHD know they also have issues into adulthood, too. Hopefully studies will soon clarify what can be done to improve the outcomes, not just identify the problems.

[melvinhoward]

Jul 11, 2006 10:15:55 GMT -5 d said:

Here's another write-up on the girls study from the Washington Post:

At Last, Attention Shifts to Girls
Symptoms May Differ, but ADHD Risks Are as Real as for Boys, Study Finds

By Sandra G. Boodman
Washington Post Staff Writer
Tuesday, July 11, 2006; Page HE01

A major long-term study of girls diagnosed with attention-deficit hyperactivity disorder (ADHD) in elementary school has found they are at greater risk for substance abuse, emotional problems and academic difficulties in adolescence than their peers who don't have the common neurobehavioral condition. The results, experts say, should help dispel the myth that the disorder, which affects an estimated 4.4 million American children, poses less of a risk to girls than to boys, on whom most research has focused.

The federally funded study by researchers at the University of California, Berkeley, involves more than 200 girls who have been followed since 1997, when they were 6 to 12. The broadly focused study is designed to measure the ways ADHD, a disorder characterized by pervasive inattention and impulsivity, affects peer relationships, impairs school performance and is linked to substance abuse and psychological problems.

Photo Caption
Molly Zametkin, diagnosed with ADHD, struggled in school until she started drug treatment. ADHD-related impulsivity, she says, can lead girls into trouble.

Molly Zametkin, diagnosed with ADHD, struggled in school until she started drug treatment. ADHD-related impulsivity, she says, can lead girls into trouble. (By Bill O'leary -- The Washington Post)
Is It ADHD? Or Is It Depression?
The symptoms of attention-deficit hyperactivity disorder (ADHD) in girls can be difficult to distinguish from those of clinical depression, especially when hyperactivity is not present, say experts who treat the disorder. The difficulty can be compounded because the two problems can co-exist:...

"Can you believe it's 2006" and the first long-term prospective study of girls with ADHD is just being published, asked psychologist William Pelham, an ADHD expert at the State University of New York at Buffalo.

Girls, Pelham said, have been under-diagnosed and overlooked in large part because their behavior tends to be less disruptive -- although their problems may be just as severe.

Psychologist Stephen P. Hinshaw, lead author of the study -- published in the June issue of the Journal of Consulting and Clinical Psychology -- called the results "surprising and discouraging."

"The cumulative picture is that girls with ADHD are at risk for a lot of problems," said Hinshaw, chairman of the psychology department at Berkeley and a prominent ADHD researcher. Hinshaw said he and his colleagues did not expect the "breadth of impairment" they found. The team began the study with 228 girls: 140 had ADHD, while 88 did not.

Five years later, researchers conducted a follow-up study involving 209 of the girls, who had entered middle and high school. In nearly a dozen areas examined by researchers -- including academic performance, prevalence of eating disorders, relationships with peers and teachers, and organizational skills -- the girls with ADHD were significantly more likely to have problems than those in a matched control group who did not have the disorder.

The gap in reading and math ability had widened in five years and new concerns had emerged: About 30 percent of the girls with ADHD were at least mildly depressed, compared with 10 percent of the control group, Hinshaw said. The same percentages were seen in substance abuse.

One area showed marked improvement: The girls in the ADHD group showed fewer signs of hyperactivity as they grew older, the same trend seen among boys in other studies.

Pelham called Hinshaw's results "very important" because so little is known about teenage girls with ADHD. Too often, he said, the problem is either overlooked or misdiagnosed as depression.

A long-term study published in May by researchers at Massachusetts General Hospital in Boston found that teenage girls with ADHD were more likely to have mood or anxiety disorders than those without the disorder.

"Most girls do as well as boys" when their ADHD is treated, Pelham said. The optimal treatment combines the use of stimulant medications, such as Ritalin or Adderall, with behavioral therapy that provides structure, teaches organizational skills and rewards desired actions, experts say.

To Washington area developmental pediatrician Patricia Quinn, who has specialized in the treatment of ADHD for nearly 30 years, the results of Hinshaw's study serve as a warning.

"People think if a girl is ditzy she's not going to have serious problems, but this study confirms that's not true," said Quinn, who has co-authored books about girls and women with ADHD.

Molly Zametkin, 18, a recent graduate of Walter Johnson High School in Bethesda, knows firsthand that girls can be as affected as boys, even if their problems seem less obvious.

First diagnosed in elementary school, Zametkin, who described herself as "a little space cadet who was never hyperactive," vehemently fought her parents' efforts to treat ADHD with medication and therapy. Her father is a research psychiatrist at the National Institute of Mental Health.

Only after years of struggling in school, Zametkin said, did she accept that "it was a problem I couldn't fix by myself"; she began taking medication regularly when she started high school.

The Berkeley findings, she said, mirror aspects of her experience as well as what she sees in other girls who have ADHD, especially their battles with food and their use of drugs, alcohol and cigarettes.

"Any girl with ADHD is going to be more impulsive and more of a risk-taker," Zametkin said. "And impulsivity makes it easier to give in to peer pressure in any situation."

Hinshaw's study was launched at a time when officials at the National Institutes of Health, which is funding it, were seeking to include more women and minorities in medical research.

Berkeley researchers recruited an ethnically and economically diverse group of girls: Slightly more than half were white, 27 percent were African American, 11 percent were Latina and 9 percent were Asian American.

All attended a free five-week summer program where they were closely monitored by the staff, who did not know which girls had been diagnosed with ADHD. Most of those taking medications agreed to stop while the program was in session, though treatment decisions were left to parents. Observations by the staff were augmented by testing, interviews and other assessments.

In the first study of these girls, published in 2002, Hinshaw and his colleagues reported that the ADHD group had more problems making and keeping friends, and functioning outside school; they also lagged behind their peers academically.

How, Hinshaw and his team wondered, would they fare after five years? To answer that question, researchers reassessed 92 percent of the group who agreed to cooperate and had dispersed to eight states as well as South Korea and Australia. Researchers conducted eight-hour assessments of each girl.

Some in the ADHD group had received no treatment during the intervening five years, while others received extensive help. About 50 percent, Hinshaw said, had taken medication at some point and 80 percent were receiving special services, mostly in school. Some had made significant recoveries and no longer had ADHD, but most continued to struggle.

Previous studies have found that about 30 percent of children diagnosed with ADHD in childhood appear to outgrow the problem during adolescence; by adulthood about 50 percent are no longer impaired.

To Hinshaw, devising effective treatments for girls remains paramount.

"Girls have a different way of relating and deserve study in their own right," he said, and should receive treatments that are not mere imitations of those boys receive. "This is not a short-term disorder." ·

Comments: [e-mail].

www.washingtonpost.com/wp-dyn/content/arti
cle/2006/07/10/AR2006071000703.html

Its a good read. Thanks for sharing the information.

[healthy11]

What's particularly surprising is that today, over 10 years later, Sandra Boodman is still reporting on medical issues for the Washington Post, in case anyone wants to reach her!