Dr. Patricia Quinn: girls with ADHD face special challenges

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.

The 4 most common anxiety disorders associated with ADHD: Anxiety and ADHD – part 2

Editor’s note:  Last month we talked about how anxiety occurs more frequently in ADHD community than in the mainstream population.  This month we’ll look a little deeper into 4 types of anxiety most commonly occurring for people with ADHD.

The DSM-IV Defined Anxiety Disorders

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) published by the American Psychiatric Association defines 12 anxiety disorders:

  1. Separation Anxiety Disorder
  2. Panic Disorder – with and without agoraphobia
  3. Agoraphobia –  without history of Panic Disorder
  4. Social Phobia – exaggerated fear of embarrassment or humiliation
  5. Specific Phobia – e.g. of spiders, elevators, flying, etc.
  6. Obsessive-Compulsive Disorder (OCD)
  7. Post Traumatic Stress Disorder (PTSD)
  8. Acute Stress Disorder – symptoms< 30 days
  9. Generalized Anxiety Disorder (GAD)
  10. Anxiety Disorder due to a General Medical Condition
  11. Substance-induced Anxiety Disorder
  12. Anxiety Disorder Not Otherwise Specified

The 4 most common anxiety disorders associated with ADHD

  1. Generalized Anxiety Disorder (GAD)
  2. Separation Anxiety Disorder
  3. Social Phobia
  4. Post Traumatic Stress Disorder (PTSD)

The remainder of this article will talk in more depth about the unique characteristics of each of these anxiety disorders.

Generalized Anxiety Disorder (GAD)

General Anxiety Disorder is a serious issue for the ADHD community.  It is far more likely to occur during the lifetimes of children with ADHD than in the general population (25% ADHD versus 2.9 – 4.6% general population).  Half (52%) of adults with ADHD will experience GAD in their lifetimes – opposed to only 5% of adults in the general population.

General Anxiety Disorder is the big anxiety disorder that people tend to miss.  With the others – Post Traumatic Stress Disorder, separation anxiety, and social phobia – it’s more obvious when you have it.  And, since GAD often comes along for the ride with depression, substance abuse, and other anxiety disorders, it may be relegated to a back seat in terms of recognition and treatment.

General Anxiety Disorder is characterized by 6 months or more of chronic, exaggerated worry and tension that is unfounded or much more severe than the normal anxiety most people experience.  People with GAD usually expect the worst.  They worry excessively about money, health, family, or work, even when there are no signs of trouble.  They are unable to relax and often suffer from insomnia.  Sometimes the source of the worry is hard to pinpoint.  Simply the thought of getting through the day can provoke anxiety.  General Anxiety Disorder may also grow worse with stress.  In addition to excessive anxiety and worry, people with GAD have at least 3 of the following symptoms:

  • Restlessness or feeling on edge
  • Fatigue
  • Difficulty concentrating or mind going blank
  • Irritability
  • Muscle tension
  • Difficulty sleeping

Separation Anxiety Disorder

About 10 times as many children with ADHD will have separation anxiety compared with the rate in the general population of 2.4%

Separation Anxiety Disorder develops in childhood and can persist into adulthood.  Basically this means a child is fearful of being separated from his or her safety net (familiar place or person).  The child may develop excessive worrying to the point of being reluctant or refusing to go to school, being alone, or sleeping alone.  The child may also experience repeated nightmares and complaints of physical symptoms such as headaches, stomachaches, nausea, or vomiting.

Social Phobia (a.k.a. Social Anxiety Disorder or SAD)

18% of people with ADHD will have a lifetime occurrence of Social Anxiety Disorder – half again as common as in the general population.

Social Anxiety Disorder is an intense fear of becoming humiliated in social situations, specifically of embarrassing yourself in front of other people.  It includes performance anxiety issues.  It often runs in families and may be accompanied by depression or alcoholism.  Social phobia often begins in early adolescence or even younger.  The person recognizes that the fear is excessive or unreasonable.  About 13% of the general population will experience social anxiety at some point in their lives.  Social Phobia is actually the third most common psychiatric disorder in the United States after depression and substance abuse.

Post Traumatic Stress Disorder or PTSD

Although there isn’t a lot of information on PTSD and ADHD specifically, there is some evidence that people with ADHD are more vulnerable to developing PTSD.  For more information consult Adler LA, Kunz M, Chua HC, Rotrosen J, Resnick SG. (2004). Attention-deficit/hyperactivity disorder in adult patients with posttraumatic stress disorder (PTSD): is ADHD a vulnerability factor?  Journal of Attention Disorders.  Aug; 8(1):11-6.

How to manage your anxiety

Anxiety disorders are highly treatable, but you have to recognize first that they exist.  If you think this might be you, seek the advice of a professional and find out what your options are.

An ADHD coach can also help you learn to identify your anxiety triggers and things you can do to keep your anxiety under control.

Watch for part 3 of our ADHD and Anxiety series where we will talk about some steps you can take to help you manage your anxiety.

Do you have ADHD and anxiety?  What have you done to keep it under control?  We invite you to share your story here and help others learn what you have to keep your edge! You don’t have to live with anxiety, sign up for an Edge Coach and start taking charge of your life today.


Treating ADHD with Exercise

Regular exercise has been shown to reduce the symptoms of ADHDAs the days grow shorter, it’s easy for all of us to get less active.  If you think about it, how much more time do you spend on-line or watching TV during the winter, when in the summer you would be out riding your bike or at the beach.

For people ADHD, keeping active year-round isn’t just a good idea, it’s key in reducing symptoms of anxiety and depression and is also known to help with symptoms of ADHD.  It’s no surprise that Michael Phelps is able to manage his ADHD without medication – the man’s life is built around exercise.

Studies reveal exercise treats ADHD

There are multiple studies that show exercise is critical to brain functioning:

Spark:  The Revolutionary New Science of Exercise and the Brain by John Ratey – was published earlier this year is filled with case studies which demonstrate the connection between exercise and brain functioning including ADHD.  (Click the link above to purchase the book and support the Edge Foundation.)

Inactive Teens More at Risk for Behavioral Problems,  Health Day, October 14, 2008.  A recent study of teenagers in Finland revealed that inactive boys and girls were more likely to have attention problems than their active peers.  It asserts that exercise is a highly effective method in easing depression and anxiety and urges teens to build regular exercise as a lifelong health habit.

ADHD Coaching Keeps Your Exercise Program on Track

It’s hard to start and exercise program, and even more difficult to make it a long-term habit.  ADHD coaching can help you stay on track with your exercise goals.  Checking in with someone about your weekly exercise goals, can be a way to set goals you can keep over time, stay on track and problem solve when you aren’t able to meet your goals.

The Edge Foundation offers coaches who are specifically trained and experience in working with high school and college students.  Sign up and get your EDGE today!

And while your at it, consider exercising outdoors.  This week another study shows that a walk in the park is also highly beneficial to improving attention in children with ADHD.

Now it’s your turn, what do you do to keep on track with your exercise goals?  Leave a comment and share your success or struggles with other Edge readers.

One ADD/ADHD college student’s success story — part 1


[Note: This is part one of a two part story written by guest blogger, Shaina Humphries, University of Illinios — Editor]

Jesse is an average college student. He’s an engineering major at the University of Illinois, lives in a dorm room, goes to class during the week and goes to parties on the weekend. But there’s one thing about Jesse’s college experience that sets it apart from most others. He has ADHD.


Attention Deficit Hyperactive Disorder, or ADHD, is a neurobehavioral developmental disorder that can be especially debilitating to college students. College students who suffer from ADHD are more likely to drop out of college than students without the disorder.

According to Neil Peterson, the founder of the Edge Foundation, and father of two kids with ADHD, “Students with ADHD are 33 percent less likely to graduate from college.”

ADHD is characterized by symptoms of inattention, hyperactivity or impulsivity. The disorder, also commonly called ADD, can be present in three different ways. According to the USA Centers for Disease Control and Prevention, someone can either have the predominantly inattentive type of ADHD, the predominantly hyperactive-impulsive type, or the combined type.

People with the predominantly inattentive type of ADHD often do not pay close attention to details, are very forgetful and have a noticeably short attention span. While many people can attest to exhibiting at least one if not all of these symptoms from time to time, that doesn’t necessarily mean they have ADHD.

Peterson has a favorite analogy that he uses to distinguish people with ADHD and those without.

“Sometimes people will walk up the stairs, and when they finally get there, they can’t remember why they walked up in the first place,” Peterson said. “Plenty of people have had this experience before, but the difference is this: people who have ADHD experience this in a chronic fashion, rather than every once in a while.”

The case of the stairs is a perfect example of predominantly inattentive ADHD, but not necessarily the other types. A person with predominantly hyperactive-impulsive ADHD is usually very fidgety, has trouble waiting for his or her turn, blurts out answers to questions that have not been finished, and finally, talks excessively.

“Sometimes I’ll just talk, and not shut up, for like 10 minutes straight, and I don’t even really notice it,” Jesse says. “I just keep talking, and whoever I’m talking to obviously notices it, and probably gets offended, but I won’t even notice that I’ve been talking that long until after the fact.”

Jesse has the combined type of ADHD. This means he experiences various symptoms from both categories, inattentive and hyperactive-impulsive. However, like many people with ADHD, Jesse was diagnosed late in life. He was diagnosed just a year ago, during his freshman year of college.

Since many of the symptoms are thought to be simply bad behavior, extra energy, or just a part of a personality, many of the people in the U.S. with ADHD do not even know that they have it. According to Peterson, 50 percent of people with ADHD have never been diagnosed.

“I had a friend who had it [ADHD], and he was telling me about the things he was going through, and I thought ‘Hey, that sounds exactly like me,’” said Jesse. “So I went to get screened. After what ended up being a three-month-long process of tests and doctor visits, I was diagnosed.”

Jesse also said the biggest problem for college students probably isn’t the disorder itself, but the fact that so many people are unaware they have it. With all the academic demands, increased independence, and distracting environment, untreated ADHD students are likely to fail.

“If I wasn’t getting treatment , I can basically guarantee that I would have failed out by now,” Jesse said.

In fact, Jesse almost dropped out of school as recently as last semester. After being diagnosed, different medications were tested on him, but many of them had unbearable side effects.

Aside from depression and a strong urge to give up on school, Jesse said, “I had severe mood swings, one made me lose my appetite entirely, and one made me very angry and short-tempered. One even made me sweat.”

Even dorm life is greatly affected by Jesse’s ADHD. Anthony Perez, his roommate and close friend, said Jesse’s ADHD affects his life, too.

“A lot of times there will be tension in the room. He’ll have mood swings,” said Perez. “If he’s studying and I do something that distracts him, he’s completely screwed. He can’t just go right back to studying like most people. That leads to problems.”

Perez also said that the side effects from Jesse’s medications would cause fights and uncomfortable living conditions, so he was glad when Jesse eventually found the best one and stopped switching medications.

However, medicine is definitely not the only method Jesse uses to treat his ADHD. He receives treatment and special accommodations from U of I’s Disability Resources and Educational Services, or DRES.

With DRES, he is able to take his class exams in an environment conducive to people with ADHD. He takes his exams in a plain cubical with minimal noise and distractions. In this space, Jesse is able to concentrate, or “hyperfocus” as he calls it, on his exam, so he doesn’t make nervous mistakes that he would make in a normal classroom environment, filled with distractions and a time limit.

Next week:  How an ADHD Coach changed everything