UF Study: Girls With Attention Deficit Disorder Frequently Not Treated

September 12, 1996

GAINESVILLE— Picture a hyperactive child.

Do you first think of a boy or girl?

If your answer is boy, that’s not surprising–three times as many boys as girls have attention deficit hyperactivity disorder. But considering ADHD as just a “boy’s problem” may cause trouble for girls because University of Florida research indicates that girls with the disorder are much less likely than boys to be diagnosed and treated.

“Faced with signs of hyperactivity in a girl, doctors and parents may be saying, ‘no, it can’t be ADHD because it’s so rare in girls,’” said Dr. Regina Bussing, the study’s author and associate professor of child psychiatry at UF’s College of Medicine.

An estimated 3 to 12 percent of U.S. children have ADHD. Children with the disorder show signs of inattention, hyperactivity or impulsiveness over a prolonged period. The symptoms must be severe enough that they seem out of line with a child’s developmental level.

Bussing studied special education students in second through fourth grades in one Florida county. She gave parents and teachers questionnaires to elicit signs of hyperactivity. Bussing followed up with diagnostic interviews, using guidelines from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.

Through her interviews, Bussing found that certain categories of children who met the criteria for ADHD were much less likely than others to have their treatment needs met. Girls were four times less likely than boys to have received treatment before the study. Minorities were almost two times less likely than whites and children enrolled in health maintenance organizations were two times less likely than those in other insurance plans to have received care. Bussing presented her findings in May at a meeting of the American Psychiatric Association.

“It’s important to understand why children may not be getting into treatment,” Bussing said. “Are parents not bringing their daughters to the attention of health-care providers? Or are health-care providers less likely to think care is needed when it’s a girl because ADHD is more frequently found in boys?” She hopes continued research will provide the answers.

Minorities may be undertreated because blacks, more so than whites, blame hyperactive behavior on sugar, Bussing said. Study after study, however, has shown no link between eating sugary foods and boisterous behavior.

Children insured through HMOs are at increased risk for unmet treatment needs, Bussing theorizes, because the providers of such health plans are under great pressure to reduce costs.

“That is worrisome since increasing numbers of children are being insured through HMOs,” Bussing said.

ADHD has been debated intensely in academic circles and the popular press amid concerns that doctors too frequently are diagnosing the disorder and prescribing drugs for treatment.

“We don’t want to start labeling kids with ADHD when that label isn’t warranted,” Bussing said, “but it’s important for children who truly have the disorder to get help. Children with ADHD are more likely than others to have problems in school, to drop out and to abuse drugs. Treatment, which can include medication therapy and counseling, can improve their chances of completing their education and doing well in life.”