Does Education Fail Girls With ADHD More Than Boys?
Regardless of which paradigm of learning differences and ADHD you subscribe to (medical model or diversity model) you can’t deny that our educational system is inequitable. Some students–regardless of intelligence– will be more successful than others. As a teacher I work hard every day to differentiate and I constantly re-evaluate whether or not my teaching is valid and reliable. Did my students learn what I intended them to learn today? Why did that lesson work in one class but not another? To do this I rely mostly on my intuition which sometimes has to do with the background knowledge of the student, including previous academic and psycho-ed testing. I always take testing reports with a grain of salt for a variety of reasons but this recent study by Grskovic and Zentall made me think of another reason to trust my experience and gut and not to solely rely on an educational file.
Previous literature suggests that ADHD referrals made by teachers are likely to be in response to disruptive classroom behavior that may be limited to the identification of overt hyperactivity, thus girls are less likely to be identified with ADHD than boys. Girls with ADHD exhibit classic ADHD symptoms during younger years, specifically in pre-school. The disorder manifests itself as impulsivity in the higher grades however girls are more responsive to consequences set forth by teachers because of social concerns—they don’t want the other kids to view them as different. Girls are likely to want to avoid these social consequences and thus may further react by reducing their involvement in social groups and thereby reducing the probability of “getting caught” being hyperactive. The researchers suggest that the older a girl gets the more important the avoidance of social isolation and peer acceptance becomes, thus the girl may begin to decrease her overt hyperactive behaviors. Related to this phenomenon, girls are also more likely than boys to internalize the symptoms of ADHD and have a higher rate of negative emotional characteristics such as depression, anxiety, alcohol and drug use, and eating disorders. Furthermore, previous studies have indicated that teachers are less likely to describe characteristics of ADHD that are exhibited by females with this disorder because the teachers view the girls’ behaviors as more manageable in the classroom. Grskovic and Zentall engaged in this study to identify the characteristics of girls with ADHD with hopes to increase the identification and intervention.
The authors compiled a list of forty five items that are symptomatic of females with ADHD from review of the literature and their own personal work (specifically teaching and clinical counseling). Additionally the researchers compiled a focus group of five adult women with ADHD, between the ages of 27 and 57 with a mean age of 36. Two of the women were undergraduates, two were graduate students and one was not a student. The women spoke in a focus group setting that addressed the forty five points while the researchers recorded emerging themes in order to better understand female ADHD.
Following the focus group the researchers recruited girls with ADHD from five districts from a two mile radius of the university resulting in a sample of 262 participants. For each of the 262 participants they were asked to complete ACTeRS (ADD-H Comprehensive Teacher’s Rating Scale) along with a teacher and parent. Parents and girls further completed the Supplementary Descriptive Assessment. The girls were then broken into two groups- the ADHD group (n=20) in which membership required a diagnosis of ADHD located in school records, or as an account by the school nurse or family. The diagnosis was considered reliable as it was strengthened by a percentile ranking on the ACTeRS, a common screening tool. A comparison group of girls was attained by including girls with “Rating equal or greater than the 40%ile on both the parent and teacher ratings of the ACTeRS scale” The ACTeRS indicates that a score above the 50%ile indicates no hyperactivity while a score between 40-50%ile indicates mild hyperactivity. The Supplement Descriptive Assessment involved emotionality, specifically unregulated emotions and anxiety, as well as impulsivity/hyperactivity, pro-social activity, and cognitive stimulation.
The purpose of this study was to look at traditional measures used to identify, and subsequently begin intervention for girls with ADHD and to test a supplementary measure that specifically targets the manifestation of ADHD in girls. Traditional scales target behaviors such as “large” motor behavior (jumping out of seat, motoring around the classroom) that are suppressed in females with ADHD, lending them less useful in the identification of the disorder in the female population. The supplementary scale asked ratings of “small” motor behavior such as foot tapping or hair twirling. Similarly the supplement was more sensitive to social behaviors such as “swearing, using gestures, breaking rules with unsupervised and stirring up trouble” rather than the generic “behaves positively with classmates” as seen in the ACTeRS. The supplement also took into account the girls’ opinion of the quality of their impulsive and/or hyperactive behavior as well as when they had negative self judgments.
While teachers were able to identify girls with ADHD, they fail to refer them for intervention due to their ability to control the student in the classroom.
Furthermore, the researchers identified an alarming pattern that the girls diagnosed with ADHD performed more poorly than their non-ADHD matches– even when they had the same IQ– suggesting that early intervention is essential for academic achievement.
Even though I personally believe that kids with ADHD are not intrinsically “disabled” you can’t deny that they often have to deal with an inequitable learning environment that does not take advantage of their ability to multi-task nor does it utilize their constant scanning and searching for stimulation. Is better and earlier identification the puzzle piece that we’re missing?
Grskovic, J.A. and Zentall, S.S. (2010). Understanding ADHD in Girls: Identification and Social Characteristics. International Journal of Special Education; 25 (1) 171-184.