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Dear Dr Quinn:
I recently attended your lecture on Girls with AD/HD. After listening to your speech, I feel my 5 1/2 year old daughter shows many signs of AD/HD.
Last year, her preschool teacher brought to my attention her inability to focus and how easily she was distracted by other kids. At that point, she felt my daughter's problem was more a fine motor skill issue.
My daughter is now in kindergarten and her teacher tells me that she is always the last to finish projects. Overall, she is slow at most tasks they are asked to complete. However, the teacher said she is not yet concerned because Susie is not the last one to finish her academic worksheets.
My husband and I have also seen signs of limited focus at home. We have to ask Susie many times to do things and then when she finally does the task she tends to still get side-tracked. I notice her daydreaming a lot even in her extracurricular activities like dance class. This may not be related, but she tends to still have bathroom accidents. She always waits till the last minute before going to the bathroom. Although, Susie has a lot of friends, I am also starting to notice a difference in maturity and social skills versus other kids of her age.
With all this said, when is the time to get her tested? Her teacher feels that since she is doing OK academically that we should wait. I feel, why wait until there is an academic problem to address the issue. I would appreciate your feedback and any other suggestions.
Thanks for your help!
Dear Susie's MOM:
Your email perfectly describes a young girl with AD/HD. Often girls with AD/HD, who are bright and don't have serious behavior problems, can do well academically for several years. Instead of demonstrating the behavior problems typical of many boys with AD/HD, girls often work very hard to compensate at school. Often, however, these girls have difficulties at home and with peers. The "take home" message is:
Because girls are doing well academically
does not mean they don't have AD/HD.
Inattentive Girls Look Different
Girls who are shy and withdrawn may look very different than
hyperactive/ impulsive girls in the early school years. Their behaviors
may isolate them from other children and they may frequently be
seen observing other children from the sidelines of the group. Some
are daydreamers while others are highly distractible and have difficulty
staying focused on a task. They have difficulty transitioning from
one task to another and may always be one step behind the others.
They may frequently misplace or lose mittens, hats, coats, and even
their shoes. They certainly march to the beat of a different drummer.
These girls may be seen to prefer solitary play and frequently over-focus on an activity. They become "lost" in what they are doing and unaware of what is going on around them. At times they seem confused. Naptimes and clean-up time are difficult because of the transitions involved. These girls are not very adaptable and have difficulty with new routines or changes in classroom personnel. Field trips can present problems because of the break in routine and the new surroundings.
Ability
to following directions and auditory processing may be delayed for
these girls. They may have difficulty expressing themselves and
some have actual language delays. They may have difficultypaying
attention to a story read to them and may not be able to relate
clearly what went on at home or during the day at school. These
girls benefit from sameness in their daily patterns and environment,
and respond well to visual cues as reminders.
Many pediatricians aren’t trained to identify
inattentive young girls
Talk with your pediatrician. He or she should be able to discuss
your child's development up to this point and any risk factors related
to the pregnancy and/or family history. However, as many pediatricians
are not trained in the diagnosis of AD/HD in children this young,
it is important to convey your concerns and assess whether they
are being seriously addressed. Don't feel that your pediatrician
has all the answers or that you are being disloyal for seeking help
elsewhere. It is still rare that a pediatrician recognizes AD/HD,
especially without hyperactivity, in a preschooler or kindergarten
age girl.
Become Your Daughter’s Advocate
AD/HD is a diagnosis based on history and observed behaviors (symptoms).
There is no specific test for AD/HD and the disorder cannot be ruled
in or out by looking at a child's behavior in only one setting.
Ask questions and read as much as you can. Be aware that the diagnosis
exists in preschoolers and how it presents in girls. This is the
only way that you will be able to ascertain if your daughter has
AD/HD. Using questionnaires and asking questions, such as the one's
I've listed here are the two best ways for gathering information
to make the proper diagnosis.
One of the most consistent characteristics of AD/HD is its inconsistency. Coupling that with the appropriateness of some of these characteristically AD/HD-behaviors before the age of three, makes AD/HD difficult to diagnose in the preschool years. However, having said this, it is imperative that we begin to do a better job at doing just that, diagnosing AD/HD in preschool/kindergarten populations.
All school systems must have programs to identify children "at risk" for behavior or learning problems, and that is another avenue that you may wish to pursue at this time. Head Start and early identification programs in your area should offer screenings and evaluations.
Importance of Early Diagnosis
The early diagnosis of AD/HD is important for several reasons. Early
diagnosis leads to earlier treatment and intervention programs.
Such early intervention programs can prevent many secondary problems
from developing. Early diagnosis allows for the establishment of
good habits and patterns, sets up positive relationships, and encourages
the development of better parenting skills. Your daughter will feel
better about herself and can avoid being dismissed by others as
being willful or "not very bright".
There is much that we can do to help girls with AD/HD live happier, more satisfying lives, and the sooner we start the better. Preschool/kindergarten is NOT too early. Much of the damage to self-esteem and interpersonal relationships is already well under way by the age of seven. If you feel that your daughter is experiencing difficulty (and from your letter, it sounds like you do) seek an evaluation or professional guidance. You and she will be glad that you did!
(This list was designed for use in the book, Understanding Girls with AD/HD by Nadeau, Littman, and Quinn available at www.ADDvance.com)
Consider your preschooler/kindergarten aged daughter:
- Is she restless or overactive?
- Does she run instead of walk?
- Does she have trouble sitting still?
- Is she always up and on the go?
- Is she squirmy and fidgety?
- Does she have a short attention span? (10-15 minutes is average for this age.)
- Does she have difficulty concentrating on or playing with one toy for any length of time?
- Does she have difficulty listening to a story being read to her?
- Does she engage in dangerous activities?
- Does she not show appropriate fear?
- Does she have frequent accidents (stitches, cuts, bruises, broken bones, or visits to the ER)?
- Does she "bully" other children?
- Is she "bossy"?
- Does she kick, bite, or hit others?
- Does she share toys?
- Does she often stare into space?
- Is she a daydreamer?
- Does she give up easily?
- Does she often stand on the sidelines and watch before entering into an activity?
- Does she worry excessively?
- Does she prefer to play on her own (solitary play)?
- Is she fearful or afraid of new situations?
- Does she talk very little in public?
- Does she have delayed speech or language skills?
- Does she have difficulty expressing herself?
- Does she misplace or lose belongings?
- Is she irritable?
- Is she miserable or unhappy?
- Does she cry often and easily?
- Does she have temper tantrums?
- Is she fussy or overly particular?
- Does she blame others?
- Do others like her?
- Does she destroy toys?
- Does she have difficulty sharing toys?
- Is her toilet training delayed (beyond three years)?
- Does she still wet or soil herself?
- Does she never naps or rest quietly, even when tired?
Patricia O. Quinn, MD
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