Over the years we’ve written a lot of great posts about ADHD.  We thought you might find it helpful to get a quick index to all of the topical posts.  When you scan down the list it seems like there are few topics regarding high school and college students with ADHD that we haven’t covered!  If there is something we’ve missed, please don’t hesitate to let us know.

Okay, we noticed, we don’t have a “Z” topic.  What is the Z of ADHD?

Last August, Edge interviewed Dr. Patricia Quinn regarding her work with girls and ADHD.  Dr. Quinn, an Edge Foundation board member, has published four books about the special ADHD challenges that women and girls face that are different men and boys.  Some of those challenges include:

• Under diagnosis due to symptoms that don’t echo the male standard for ADHD
• Hyperactivity presenting as talkativeness and emotional behavior instead of the classic “propelled by a motor.”
• Greater disorganization, depression and anxiety than boys.

This fall Dr. Quinn will publish a new book, 100 Questions and Answers about ADHD in Women and Girls.  We thought this would be a good time to ask her a few questions of our own.

Edge: Is there anything about the challenges ADHD girls and women face that has emerged for you since our last interview?

Dr. Quinn: I think we have seen more in the way of confirming the development of eating disorders in girls with ADHD.

Edge: What, if anything, is unique about diagnosing ADHD girls with eating disorders than is different from other girls?

Dr. Quinn: Well first, the symptom of impulsivity seems to be a significant factor in the development of eating disorders in girls with ADHD. Poor self-esteem may also play a role, but one does not see the impaired body image seen in girls with eating disorders in general.  Girls with ADHD may binge and develop bulimia, but not because of a desire for thinness, but rather because of mindless or impulsive eating. Women with ADHD often report that they eat to feel better or for stimulation.

Edge: What should parents do when they suspect their daughter with ADHD has an eating disorder?

Dr. Quinn: Parents of these girls should pursue a complete assessment with an eating disorder specialist trained to realize that ADHD may be part of the picture. Girls will need to be treated for their ADHD symptoms (inattention and impulsivity) in order to be able to follow a program to address their disordered eating. Stimulants not only treat the symptoms of ADHD, but, according to some experts, may actually decrease the urge to binge.

Edge: Is there anything else you want people to know about girls and ADHD?

Dr. Quinn: Girls tend to suffer silently for many years, and as a result develop poor self-esteem early on. In addition, many develop anxiety because of their untreated ADHD symptoms. Their symptoms seem to sneak up and ambush them and they worry that this will happen again. So, they get anxious or develop compensatory strategies. They may worry and begin checking to see if they have a test they have forgotten about, or a book they forgot to bring home from school.

They can even develop obsessive compulsive personality disorders where they try to control one aspect of their life to the exclusion of others.  I have seen girls with ADHD become perfectionists to compensate for their symptoms. They spend a great amount of time and energy trying to compensate until it all gets too much for them and they get depressed or just give up.  It is, therefore, important to treat ADHD in girls even if they seem to be doing well academically and holding it all together because they may be doing so at a great cost.

I also want to send the overall message that the disorder does not remit but continues to cause significant problems and functional impairments particularly in girls with the inattentive type ADD.

Edge: What would you say, then to parents who are hoping their daughter will just “outgrow it?”

Dr. Quinn: ADHD is a chronic, life-long disorder. Symptoms may be less impairing as we learn to live with them and develop strategies and a life style to better cope. However, girls who demonstrate the most success are those that have adopted a multi-pronged approach to treating the disorder including, medication, therapy and appropriate treatment goals early on. ADHD coaching, like the Edge Foundation offers, can be an important component in learning compensatory strategies and behaviors.  Girls who as adolescents continue to have significant functional impairments are those who are usually not taking medication even though they have briefly made use of other services in and outside of school. These, however, may not be enough.

Edge: What are some of the most common questions you are asked about women and girls who have ADHD?

DR. Quinn: I am constantly asked why girls and women aren’t diagnosed as early as boys. I think this is because girls are not identified by teachers or others. Often teachers are comparing girls’ behaviors to those of boys rather than the performance of other girls. Mothers may be more likely to compare their daughter’s behavior to that of other girls thus may be more reliable at referring their daughters for an evaluation.  Girls are less disruptive and don’t call attention to themselves, so they don’t get referred. In addition girls and women work hard to compensate for their symptoms and to not let others know the problems that they are having.

Edge: Do women’s hormones have any impact on how medication levels need to be prescribed over time? For instance, does going through puberty or menopause mean medication levels need to be adjusted during those periods?

Dr. Quinn: When hormone levels decrease in menopause many women report that their ADHD symptoms increase and that their medications don’t seem to be as effective as previously.  It is often necessary to increase the dose of medications at this time. In addition, I find that during puberty symptoms often worsen in girls with ADHD. A medication dose that worked previously may no longer be effective during this time.

Edge: You’ve been a long-standing champion for women and girls who have ADHD, do you see the rest of the medical profession catching up in awareness or is there still a lot of ground to cover until females with ADHD receive equal medical treatment?

Dr. Quinn: I think that overall the medical profession is doing a better job at recognizing and treating girls with ADHD.  The problem seems to be with educating teachers and school systems about the disorder in females.

Readers:  Do you have a question about ADHD in girls?  Let us know in the comments and we’ll do our best to get you an answer.

Last week we wrote a post about executive function and ADHD inspired by John Medina’s book Brain Rules: 12 Principles for Surviving and Thriving at Work, Home, and School. Each of Medina’s 12 Principals are based on scientifically-proven facts about how our brain works.

Take a look at the 12 rules and you’ll see that much of what he talks about are familiar Edge Foundation topics. Want to get a great preview of what his book covers? Visit Brainrules.net where Medina has free, on-line tutorials covering the important information from each chapter.

We agree that the principals outlined in the book are important insights into living to your full potential with ADHD.  When looking them over, we noticed a few common themes we’ve shared in the posts we have written over the last couple of years.  Here’s our take on each brain rule and how it plays out for ADHD:

Exercise – Rule #1: Exercise boosts brain power.

Treating ADHD with exercise
Spark: Reduce ADHD symptoms with exercise
ADHD and anxiety:  Non drug treatments everyone can try

Survival – Rule #2: The human brain evolved, too.

Wiring – Rule #3: Every brain is wired differently.

Executive function and ADHD success/
Succeeding despite learning disabilities/

Attention – Rule #4: We don’t pay attention to boring things.

Fidgeting helps ADHD people stay focused

Short-Term Memory – Rule #5: Repeat to remember.

Long-Term Memory – Rule #6: Remember to repeat.

Sleep – Rule #7: Sleep well, think well.

ADHD students need to take their sleep seriously
ADHD and sleep
ADHD, anxiety and the sleep connection

Stress – Rule #8: Stressed brains don’t learn the same way.

Improve your focus with water

Sensory Integration – Rule #9: Stimulate more of the senses.

You can do more to manage ADHD
Fidgeting helps ADHD people stay focused

Vision – Rule #10: Vision trumps all other senses.

Gender – Rule #11: Male and female brains are different.

Girls with ADHD face special challenges

Exploration – Rule #12: We are powerful and natural explorers.

Did you read the book or learn anything here you didn’t know about how the brain works?  Let us know in the comments.

Editor:  We are honored to have had Dr. Patricia Quinn involved with the Edge Foundation since our founding.  Dr. Quinn is a leading ADHD expert who has worked with, written about and provided training in the field of ADHD for more than 30 years.  This month we are pleased to be talking with her about one of her primary concerns:  girls with ADHD.

Key ideas:

• Many girls with ADHD are left undiagnosed because their symptoms look different than boys.
• Hyperactivity in girls can appear as being hyper-talkative or hyper-reactive (more emotional).
• ADHD girls have greater problems with disorganization than boys.
• Depression and anxiety are symptoms to watch for in older girls with ADHD.
• ADHD coaching can help girls with ADHD learn what works to be successful in school and in life.

Edge: Thank you for all you’ve done on behalf of people with ADHD over the last 30 years.  What are the ADHD projects you are most excited about these days?

Dr. Patricia Quinn:   I can honestly say that working with young girls with ADHD, helping them understand the disorder and learn to live happy, productive lives is very close to my heart.  My most recent book, Attention, Girls!  A Guide to Learn All about Your ADHD, is special because it focuses on the lives of girls ages 7 to 13 years.

I also feel passionately about my work with college students with ADHD most of whom are newly diagnosed and struggling to stay in school.  When I get a call from someone who has just earned his law degree, and he says that he couldn’t have done it without my help when he was in college, it makes my day!

Edge: Girls have had a history of being under-diagnosed with ADHD in part because their symptoms can look very different from boys who have ADHD.  Can you speak to that a little bit?

Dr. Patricia Quinn: Boys with ADHD are easy to spot in the classroom, and are much more likely to be referred for an evaluation.

• Most questionnaires used to screen children for ADHD emphasize items that describe these boys, items about hyperactivity, impulsivity and defiant behavior.
• Only those few girls who are like these boys with ADHD are sent for assessment.
• The ratio of children referred to clinics for ADHD evaluations continues to be about four or five boys for each girl.

What we are beginning to realize is that there are many girls left undiagnosed because their symptoms look different.  One big difference is that girls are less rebellious, less defiant, and generally less “difficult” than boys.  Sadly, they lose out due to their good behavior.  It’s the squeaky wheel that gets oiled.  When a boy is causing frequent discipline problems, either at home or in the classroom, he will quickly be referred for treatment.  Parents and teachers alike want quick relief from their constant challenges.  Girls with ADHD are more compliant, and are not as easy to spot.  Often they are left to drift along from one school year to the next, never working up to their potential and suffering silently.

Edge: So you are saying girls have the same symptoms as boys, they are just less rebellious?

Dr. Patricia Quinn: Basically there are core symptoms of ADHD that are critical to the diagnosis.  These include problems with attention and hyperactivity/impulsivity.  In general, girls usually have more problems with attention.  However, girls can also have hyperactivity, but it manifests in different ways.  For example, girls with ADHD can be hyper-reactive rather than hyperactive.  They are more emotionally labile with tantrums, slamming doors, etc.  Instead, of running around and being motorically hyperactive and disruptive like boys with ADHD, they can be hyper-talkative.  In addition to problems with attention, girls have problems with disorganization and, after puberty, have greater incidence of coexisting depression and anxiety.

Edge: Is there any advice you can offer to high school or college age young women to help them work with their ADHD to be successful?

Dr. Patricia Quinn: To successfully deal with and manage both ADHD symptoms and their lives, girls with ADHD must accurately assess their strengths, as well as weaknesses, and develop a plan for going forward.  For many girls, this means facing and shouting down the shame, low self-regard and those self-defeating scripts they have in their heads that tell them how terrible they are.  In addition, they need to develop a plan, building on their strengths, to deal with time management, disorganization and the other issues that get in the way of their success.

High school is the perfect time to begin developing strategies to deal with their ADHD symptoms.  However, teens do not need to face these challenges alone.  Family members, teachers, therapists and ADHD coaches are there to help.  By enrolling the aid of a coach early on, the girl with ADHD can learn what works for her and what she needs to do to be successful in college and life beyond.

6/2010 Editor’s Note:  For more about ADHD and Girls, check out the latest interview with Dr. Quinn.

Join Edge Foundation Board Member, Dr. Patricia Quinn, at the National Resource Center on ADHD’s Ask the Experts! chat. This month’s topic: Treatment for Women and Girls with AD/HD.

When: Wed., Jan. 14, 2009 – 1:00 pm (Eastern Time)
What: Treatment for Women and Girls with AD/HD.
Who: Patricia Quinn, M.D., Co-Author of Understanding Girls with AD/HD

From the National Resource Center on ADHD’s announcement:

ADHD is a neurobiological disorder affecting 5 – 8 percent of school age children with symptoms persisting into adulthood nearly two-thirds of the time. According to TheCenter: A Resource for Womena and Girls with ADHD current diagnostic criteria continue to emphasize traits common to boys, leaving the majority of girls with ADHD to remain undiagnosed and misunderstood.

Last month, December 2008, Dr. Kathleen Nadeau, one of the founders of TheCenter, discussed “Raising a Girl with ADHD,” and tackled questions mainly geared towards younger females living with ADHD. Due to the overwhelming response, and a number of questions regarding women as well as girls with the disorder, Dr. Patricia Quinn, another founding member of TheCenter, will pick up the topic and expand on it.

Dr. Patricia Quinn will address questions regarding women with ADHD, girls with ADHD and will discuss treatment options, including medication.

Dr. Patricia Quinn is a developmental pediatrician in the Washington, D.C. area. A graduate of the Georgetown University Medical School, she specializes in child development and psychopharmacology.

Dr. Quinn has worked for over 28 years in the areas of ADHD and learning disabilities. She gives workshops nationwide and has appeared on Lifetime TV’s New Attitudes and the PBS show, To the Contrary, discussing the issue of girls and women with AD/HD.

Dr. Quinn is the author of several books on ADHD and is also co-editor of ADDvance: A Magazine for Women with ADD.

Her books, ATTENTION DEFICIT DISORDER: Diagnosis and Treatment from Infancy to Adulthood and Voices from Fatherhood: Fathers, Sons, and ADHD have been well received. Her latest book, Understanding Girls with ADHD, was coauthored with Drs. Nadeau and Ellen Littman, a licensed clinical psychologist who has worked with attentional issues for more than 18 years, and is groundbreaking in its presentation of this population.

Dr. Quinn lives in Washington, D.C. with her husband and four children, two of whom have ADHD. All of her books may be ordered through Advantage Books or by calling (toll free) 1-888-238-8588.