SPED 501 Synthesis Essay

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1 Girl Unseen: Referral Bias in Girls with ADHD CJ Craig Educational Leadership Department SPED 501: Survey of Exceptional Learners Dr. Sam Arnold March 19, 2023

2 Girl Unseen: Referral Bias in Girls with ADHD Alex 1 stopped napping at eighteen months. Alex struggled to fall asleep at night throughout elementary school. Teachers found Alex sweet but aloof, smart but scattered, and highly sensitive. Alex’s parents struggled to understand Alex’s big feelings that came with bigger tantrums, the struggle to follow age appropriate, multi-step directions, and the hyperfocus that combined to make Alex a “difficult child.” After struggling at home and at school despite having supportive parents and access to health care, Alex’s exceptionality was not diagnosed until age 13. Alex was one of many children who would eventually be diagnosed with attention- deficit, hyperactive disorder or ADHD. ADHD, although not a category of disability in IDEA, is a neurological disorder that is diagnosed through the compilation of a set of specified symptoms. (Friend 2018) Alex, a girl, exhibited behaviors that did not conform to the expected symptoms of ADHD. ADDitude Magazine , an online magazine whose goal is to provide suggestions and support for people living with ADHD, recently published an article titled, “ADHD in girls: The symptoms that are ignored in females.” The International Journal of Special Education published “Understanding ADHD in girls: Identification and social characteristics,” a study written by Janice A. Grskovic from Indiana University Northwest and Sydney S. Zentall from Purdue University in 2010. And in 2020, the National Library of Medicine published guidelines for diagnosing girls and women with ADHD. ADHD in girls quite often hides in plain sight. According to Connolly, girls with ADHD, especially if the ADHD manifests as the formerly labeled ADD, attention-deficit disorder (ie inattentive attention-deficit disorder) are often mislabeled because they don’t exhibit the stereotypical traits that boys with ADHD more often display. When teachers picture the typical student who has ADHD, more often than not, the 1 Alex is based an actual student, but the student’s name has been changed to protect the child’s privacy. Permission to use Alex’s story was granted by a parent.

3 teacher will recall the boy who is constantly disrupting class, repeatedly out of his seat, lacking inhibitory control, blurting out answers or extraneous comments. Frequently, ADHD in boys manifests as external hyperactivity. Girls with ADHD, on the other hand, are more likely to exhibit internal or mental hyperactivity. They may be seen as “chatty Cathys,” ditzy daydreamers, or unorganized “hot messes.” These behaviors, which can be mixed in with a perfectionist mindset and low self-esteem, are often misinterpreted by teachers and parents. Current research indicates that girls with untreated ADHD struggle as much, if not more, than boys with ADHD, particularly in peer relationships. Studies confirm that female friendships are more complex and sophisticated than male friendships. Consequently, girls who have ADHD have a more difficult time maintaining friendships than other girls. (2023) A study conducted by Grskovic and Zentall in 2010 was designed to investigate the reasons that teachers typically failed to recognize girls with ADHD symptoms. Research showed that teachers typically focus on the external manifestations of ADHD, physical hyperactivity, lack of inhibitory control in the form of large body movements, running around the classroom, tackling peers on the playground, climbing and jumping on furniture. Therefore, girls who more likely to display inattentive symptoms of ADHD, staring into space, disorganization, inability to start or finish a multi-step task, were less likely to be recommended for assessment for ADHD. An online article published by the National Center for Biotechnical Information in 2020 echoes the conclusions of Grskovic and Zentall regarding the “referral bias” that parents, teachers, and physicians. According to Young et. al, “[s] tudies suggest that females with ADHD present with differences in their profile of symptoms, comorbidity and associated functioning compared with males.” (2020) Conclusions

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4 In Teh et al ( 2022), the Center for Disease Control ‘s (CDC) conclusions about the under diagnosis of ADHD in girls and women corroborate previous studies as shown in Figure 1, which shows the percentage of boys and girls who were diagnosed with ADHD from 1997-2016 Figure 1 The CDC’s study concluded that girls and women were consistently under diagnosed as having ADHD is because parents and teachers failed to connect the symptoms to the disorder in girls. One reason is the “cultural tendency to label boys as ‘more energetic’ than girls. So many…may attribute ADHD symptoms [in girls] to other problems. What does all this mean for teachers? First, we will need to acknowledge our implicit bias toward boys having ADHD. Second, we can recognize that ADHD is not a male-centric diagnosis, Finally, we can familiarize ourselves with all the symptoms of ADHD, not just the symptoms that disrupt our classrooms, in order to better serve our female students and their families.

5 References Connolly, M. (2023, January 20). ADHD in girls: the symptoms that are ignored in females. ADDitude . https://www.additudemag.com/adhd-in-girls-women/ Friend, M. (2018). Special education: contemporary perspectives for school professionals . Pearson. Grskovic, J. A., & Zentall, S. S. (2010). Understanding ADHD in girls: identification and social characteristics. International Journal of Special Education , 25 (1), 171–184. http://files.eric.ed.gov/fulltext/EJ890576.pdf Teh, D. (2022, September 2). Adult women can have ADHD - why are they not getting diagnosed? HealthMatch . https://healthmatch.io/blog/adult-women-can-have-adhd-too- but-why-are-they-not-getting-diagnosed Young, S., Adamo, N., Asgeirsdottir, B. B., Branney, P., Beckett, M., Colley, W., Cubbin, S., Deeley, Q., Farrag, E., Gudjonsson, G. H., Hill, P. S., Hollingdale, J., Kilic, O., Lloyd, T., Mason, P. W., Paliokosta, E., Perecherla, S., Sedgwick, J., Skirrow, C., . . . Woodhouse, E. (2020, August 12). Females with ADHD: an expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women. BMC Psychiatry , 20 (1). https://doi.org/10.1186/s12888-020-02707-9

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