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
- 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:
- No problematic behavior
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!
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,
- 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.