Question:

I have an 8 year old daughter in the third grade. Her teacher has suggested that she might have ADD and the school psychologist thinks she should be evaluated. She's definitely not hyperactive - in fact, according to them she just sits in class and stares out the window. Every year she's been in school since kindergarten this has come up. I don't get it. How can such a quiet kid have ADD?

. . . A concerned father

Dear dad, Believe it or not, it is possible that your daughter might have attention deficit disorder or "AD/HD" as it is currently abbreviated. ADHD is often written with a slash, as in AD/HD because the term refers to several types of disorders: Attention Deficit Disorder, Predominantly Hyperactive-Impulsive; Attention Deficit Disorder, Predominantly Inattentive; and Attention Deficit Disorder, Combined Type. In other words, attention deficits can occur with or without the "H" - or "hyperactivity."

Inattentive ADHD is the type most commonly diagnosed in girls before puberty. Girls with this disorder tend to be daydreamers, shy, and easily overwhelmed. Research studies about ADHD children's self perceptions have shown that boys with ADHD are often not even aware that their behaviors annoy others. In contrast, girls with ADHD tend to withdraw and are often painfully aware of their differences. Rather than being overactive, girls with inattentive type ADHD can be lethargic. They are easily discouraged and often have difficulty expressing themselves verbally.

If you decide to have your daughter assessed, be sure to have her tested to rule out a learning disability, as learning disabilities are often confused with ADHD, Inattentive type. Children with learning disabilities can withdraw in class because they do not know how to complete assigned schoolwork and may not understand concepts discussed in class. ADHD has historically been under-diagnosed in girls. Some authorities speculate that this is because these children aren't disruptive like many ADHD boys. The few girls whose behavior meets the criteria for ADHD, Hyperactive Impulsive and Combined types are often identified at a younger age and are sometimes seen as "difficult" by age 3 to 4 years. These girls often demonstrate temper tantrums, willfulness and emotional intensity. According to Dr. Patricia Quinn, MD, there is a higher incidence of learning problems in girls with this type. They are also at a high risk for low self-esteem as their high activity level and tendency to take risks is considered undesirable in girls.

The Combined Type is most commonly diagnosed after puberty. Many of these girls are overly talkative and "hyper-social." They can be restless and fidgety. Though many are charismatic because of their social activity level, they can be bossy. When they have difficulty managing the demands of daily life, they often blame others.

If your daughter is diagnosed with ADHD, you should be aware of the fact that many of these girls develop symptoms of depression and anxiety in adolescence. Although you probably won't need to manage her behavior as intensely as you would a boy's, you will need to be careful of her fragile self-esteem. Girls often develop shame and guilt about their awkward behaviors. Mothers of these girls need to guard against a tendency to be critical. As she enters adolescence, issues with peer relationships can become extremely intense. Your daughter may need to spend more time than others on learning social skills. Be sure to catch her being good. Recognize her talents and help her to develop islands of competence that will foster self-esteem. And don't forget to celebrate the gifts of ADHD. A few of these: