Is it ADHD?

Let's do a little thought experiment:  Imagine you are teaching a student with ADHD. They have trouble focusing in class and controlling their actions. They are disorganized, procrastinate on assignments, and have difficulty completing even the simplest of tasks. Assignments are cluttered with careless mistakes and sloppy handwriting. Classroom behavior is unruly, at best.

Now, my big question:

What gender did you picture the student as?

If you pictured a boy, you are not alone. A recent Webmd The Magazine article reveals that ADHD often goes unnoticed and under-diagnosed in young girls. In fact, boys are diagnosed at three times the rate of girls, despite the fact that there is no proof that disease incidence is any higher in boys.

The reason for the disparity lies in the manifestation of the disorder. Drawing upon the expertise of clinical professor of pediatrics at the University of Washington School of Medicine, Harlan Gephart, the article neatly summarizes this point:

"The big problem with ADHD in girls is that it presents itself differently," says Gephart. "Boys are just more obvious." Of the three traits that define ADHD -- hyperactivity, impulsiveness, and inattentiveness -- the first two are thought to be more descriptive of boys and the last of girls, though there's certainly crossover, says Gephart. 

"Boys who are hyperactive tend to be recognized very early, by kindergarten or first grade," says Gephart, typically because of behavior issues. Girls, who predominantly have the inattentive form of the disorder, often show more subtle symptoms: dreaminess, forgetfulness, or messiness.

In other words, we are quick to diagnose the loud, boisterous, always-out-of-seat, always-fidgeting, always-climbing, always-shouting behavior of boys as ADHD, yet we often miss the subtle, spacey, inattentive behaviors of girls which would lend themselves to the same diagnosis.* Of course, this itself is gendered, as we are quick to praise the qualities of passivity and quiet in all girls, and are therefore liable to misread signs of ADHD as “good behavior.”

At a professional development two weeks ago, we discussed the book How Girls Thrive, by psychologist and educator, Dr. Joann Deak, which has interesting relevance to the above-mentioned issue. Deak, in a discussion of how pedagogical methods influence gender equity, introduces the concept of “air time” in the classroom. “Air time” is the amount of attention that each child gets in the classroom, especially from their teacher. Numerous studies confirm that boys simply get more air time than girls--- albeit not as result of favoritism, but rather due to redirection of negative behaviors. However, whether the attention is positive or negative, the result is the same: more attention for boys, less for girls.

This has special pertinence to the identification of learning disabilities in girls. Deak mentions that because girls receive less air time, it is far less likely that they will be diagnosed for learning disabilities. The results are very serious. Without diagnoses, girls often go without the services and interventions to which they have a right. By letting girls “fly under the radar,” in the words of Deak, we are not giving them full opportunity to achieve academic success.

So how do we turn this around?

A few things need to happen. First, within the classroom, teachers need to find strategies to ensure gender-equitable air time in class. Second, teachers also need to be trained to look for symptoms of learning disabilities and how those symptoms might present in different ways depending on a student's identity and background. Finally, there is a larger argument to be made for gender-sensitive readings of mental health problems, in general. The medical community needs to do research into gender-specific manifestations of different conditions and then responsibly disseminate that information to interested parties. We need to move beyond a one-size-fits-all approach to diagnosis, disease, and treatment in order to foster the health and development of all individuals.

*As a side note, I should mention that until reading this report, I had not realized that what was formerly known as “ADD” has been merged into the category of “ADHD.” Consequently, as Gephart mentions, it is possible to have ADHD without the outbursts of hyperactivity and impulsive behavior that were once considered fundamental to the diagnosis.