New research takes a close look at
girls with ADHD in the classroom – documenting differences
that lead to under-identification.
Clinical reports have long described girls with
ADHD as better behaved and more teacher-compliant in the classroom
than boys with ADHD, and many have speculated that these factors
have played an ongoing role in the under-diagnosis of girls with
ADHD.
An important new study has carefully documented
these different classroom behavior patterns. Abikoff and his colleagues
examined 403 boys and 99 girls with combined type ADHD, ages
7-10, in a naturalistic classroom setting, to explore the effects
of gender and comorbid conditions upon behavior.
To fully appreciate the importance of these
findings, we want to underline that all of the girls in this study
met the criteria for both hyperactive/impulsive ADHD, as well as
inattentive type, and were therefore categorized as having “combined
type.” We emphasize this because even these girls demonstrated
few of the behaviors that so often lead to teacher referral. We
can safely assume that girls with inattentive type ADHD would be
even less likely to bring attention to their ADHD challenges.
Observers in the classroom were trained to carefully
measure the frequency many specific behaviors associated with ADHD:
- Interference (clowning, interrupting
others, talking during work)
- Interference to teacher (interrupting
teacher)
- Off-task behavior
- Non-compliance
- Physical aggression
- Verbal aggression to peers
- Verbal aggression to teacher
(arguing, name calling)
- Fidgeting - Minor motor movement
- Gross motor movement (standing,
up from seat w/o permission)
- Gross motor – vigorous
(running, skipping)
- Out of seat (extended time)
- Solicitation of teacher (going
up to teacher, calling out to teacher)
As well as another important category:
Target children in the classroom setting were observed
at specific intervals and the behavior they were engaged in at the
time was noted. If none of the “problematic behaviors”
was observed at that moment, a notation of “no problematic
behavior” was made.
Many important comparisons were made of the
behavior observations recorded in this study. This brief review
will not focus on all of these complex comparisons, but instead
will highlight the gender differences discussed. The reader can
refer to the original article, cited at the end of this article,
for a more detailed analysis.
Comparing ADHD Girls with Female Classmates
Nor surprisingly, girls with ADHD, compared
with their non-ADHD female classmates, talked and interrupted more,
called out to their teacher more, fidgeted and were more restless,
and got off-task more often.
Very importantly, however, girls with ADHD,
compared to other girls, did not argue more with their teacher
and were not more physically aggressive with their peers,
and did not demonstrate more out of their seat more often.
In other words, even though these girls met the strict criteria
for hyperactive/impulsive ADHD, they did not cause the classroom
disruptions (fighting, arguing with the teacher, leaving their desk)
that so often lead teachers to tag children as problematic and in
need of evaluation.
This study also documented the differences in
social interaction that often lead to problems with peer relationships.
Girls with ADHD were observed to be verbally aggressive (teasing,
taunting, and name-calling) with peers three times as often as girls
without ADHD, and twice as often as boys without ADHD – important
observations with clear implications for the types of school-based
social skills interventions that could benefit these girls.
Comparing Boys and Girls with ADHD
Boys and girls with ADHD were quite similar
in some ways – both boys and girls fidgeted and got off-task
during periods of classroom work at about the same rate. However,
boys were more hyperactive (out of seat, running, skipping), more
physically and verbally aggressive, broke more rules, and were more
impulsive.
Significantly, girls with ADHD showed “no
problematic behaviors” often than boys with ADHD.
In other words, when comparing boys and girls
with ADHD, the boys exhibited more disruptive behaviors more
of the time. Sounds like a perfect technique for getting noticed,
referred, and diagnosed!
Implications
One important implication of this study is that
teachers need training to recognize ADHD patterns more typical of
girls instead of overlooking them because of their less difficult
behavior patterns. Red flags to better identify girls – look
for those who are:
- overly talkative,
- fidgety,
- conflict prone with other girls,
and
- frequent interrupters.
Second, the observations of this study strongly
suggest that girls with ADHD need different types of classroom interventions
and support programs at school. These girls will benefit very little
from typical classroom ADHD behavior management programs. Unlike
the boys, girls with ADHD do not tend to confront their teachers,
to be non-compliant, disruptive or aggressive.Instead of behavior
management programs, this study strongly suggests the need for social
skills training for girls to help them learn alternative ways to
interact with peers and to help them become better self-observers
in social situations.
Other studies have documented that girls with
ADHD are more troubled by peer rejection and peer neglect than boys
with ADHD. Importantly, this study catches girls “in the act”
– clearly documenting the kinds of behaviors that can lead
to peer problems - interrupting conversations, interfering with
the activities of their peers through their own off-task behavior,
and becoming verbally aggressive – taunting, name calling and
teasing – when conflicts erupt. While these girls exhibit self-control
when interacting with teachers, they sorely lack the skills to be
more sensitive to their classmates’ reactions and to modulate
their behavior appropriately.
This study brings us one step closer to better
identification of girls with ADHD and to understanding the different
needs and problems of girls with ADHD so that gender-appropriate
classroom interventions and support programs can be developed in
the schools.
Abikoff, HB, Jensen, PS, Arnold, L.L., et al.
(2002) Observed classroom behavior of children with ADHD: relationship
to gender and comorbidity. Journal of Abnormal Child Psychology,
V. 30, #4, pp. 349.
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