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ADHD in girls can be serious but is often overlooked, UC Berkeley study shows

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  • Ian Pitchford
    Public release date: 1-Oct-2002 Contact: Carol Hyman cph@pa.urel.berkeley.edu 510-643-7944 University of California - Berkeley http://www.berkeley.edu/ ADHD in
    Message 1 of 1 , Oct 1, 2002
      Public release date: 1-Oct-2002
      Contact: Carol Hyman cph@... 510-643-7944
      University of California - Berkeley

      ADHD in girls can be serious but is often overlooked, UC Berkeley study shows

      Berkeley - Although boys with Attention Deficit Hyperactivity Disorder (ADHD)
      greatly outnumber girls, girls have been underdiagnosed and their condition is
      greatly underappreciated, according to a pair of studies in the October issue
      of the Journal of Consulting and Clinical Psychology. The lead author is
      Stephen Hinshaw, professor of psychology at University of California, Berkeley.
      These new studies contradict earlier findings about girls with ADHD. But
      Hinshaw's explanation is simple: Unlike the six-to-12-year-old girls in his
      studies, girls in several previous studies were taking ADHD medication.
      Hinshaw's work also included a much larger sample than nearly all earlier
      studies and was conducted over a longer period of time.

      "These girls, compared to a matched comparison group, are very impaired,
      academically and socially," said Hinshaw, an expert in child clinical
      psychology and developmental psychopathology, who continues to study them.

      Hinshaw said the girls are rejected by their peers and have a harder time
      making and keeping friends. "Social problems with peers are quite predictive of
      long-term adjustment problems," he explained, "so it will be essential to
      observe outcomes as the sample matures."

      The girls also were more likely to have had early experiences such as being
      adopted and histories of language problems and learning difficulties.

      Hinshaw's study involved one of the largest samples in the world of
      preadolescent girls with ADHD. A total of 228 girls - 140 diagnosed with ADHD
      and 88 not diagnosed with ADHD - were studied intensively at six-week summer
      camps held three years in a row. There were approximately 80 girls at each
      year's camp, which ran in 1997, 1998 and 1999.

      The girls were recruited to participate in the camps in a number of ways. For
      the ADHD sample, Hinshaw sent mailings to health maintenance organizations,
      clinics, hospitals, mental health centers, pediatric practices and local school
      districts. In addition, presentations were made to self-help groups, and
      advertisements were placed in newspapers.

      For the comparison girls, similar mailings were sent to school districts and
      community centers in the San Francisco Bay Area, and advertisements were placed
      in papers. The ads were almost identical to the ads for girls with ADHD, except
      the wording emphasized "summer enrichment programs" rather than "summer
      enrichment programs for girls with attentional problems."

      The girls who appeared to be good candidates for the program participated in
      several levels of family screenings and evaluations to make sure they met
      appropriate criteria for the study. In addition, the families of the girls with
      ADHD had to agree to take the children off of ADHD medication during the six
      weeks so that their natural behavior patterns could be observed.

      The sample was ethnically diverse - 53 percent Caucasian, 27 percent African
      American, 11 percent Latina and 9 percent Asian American. Incomes of these
      families ranged from upper class to those receiving public assistance. Girls
      with IQs lower than 70, overt neurological damage, psychosis and medical
      conditions that precluded participation in camp activities were excluded from
      the study.

      The girls spent six weeks enjoying the same activities that children who go to
      other summer camps enjoy, but they were very closely monitored by people who
      had training in micro-observation.

      Their "counselors" took copious notes relating to each girl's activities; the
      staff was not aware of which girls had ADHD diagnoses.

      The summer programs were located on the campus of a local school and featured a
      structured series of classroom, art, drama and outdoor activities. In addition,
      all the girls received individual neuropsychological assessments.

      Hinshaw said that, during outdoor sports and play at camp, "the girls with ADHD
      were less likely to follow the directions of the teacher than the comparison
      girls. They were also more likely to tease their peers and show aggressive
      behavior, though not at the same rate as boys with ADHD in previous summer
      camps. They were also more likely to display social isolation-wandering and
      failing to become engaged in activities.

      "As a group, these girls show as much executive function deficit on
      neuropsychological tests as boys who have been diagnosed with ADHD."

      Hinshaw said that selected girls from the study sample are participating in
      brain imaging studies at UC Berkeley to better pinpoint both working memory and
      "executive function," through examination of brain-behavior relationships.
      "Executive function" refers to actions such as goal setting, planning,
      organization, monitoring one's behavior during an activity and changing
      strategies in response to alterations in a situation.

      "These functions are crucial for long-term academic, social and occupational
      success," Hinshaw said. "Deficits in executive functions are seen in other
      disorders, such as autism, but they may well be the core underlying problems
      for youth and adults with ADHD."

      The girls and their families currently are participating in a follow-up study,
      so some of them have been followed for five years into adolescence.

      Although boys diagnosed with ADHD outnumber girls approximately three to one,
      said Hinshaw, it may be that some girls have been underdiagnosed, particularly
      those with the "inattentive type" of the disorder, which seems more prevalent
      in girls.

      "The inattentive type of ADHD is marked less by disruptive, impulsive behavior
      and more by disorganized, unfocused performance," Hinshaw said. "The latter
      isn't as likely to be recognized or cause as much concern to teachers."

      Hinshaw hopes his project will bring attention to a population of young girls
      whose problems may have been ignored.

      "Our hope," he said, "is that these efforts will spur the field towards
      theoretically rigorous attempts to understand the underlying processes and
      mechanisms responsible for ADHD in both boys and girls and to provide a sound
      scientific basis towards better classification, prediction and intervention."

      Along with Hinshaw, the authors of the neuropsychological assessment paper are
      Nilofar Sami and Jennifer Treuting of UC Berkeley; Estol T. Carte from the
      Kaiser Permanente Medical Group; and Brian Zupan from the Minnesota Department
      of Health.

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