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LOST AND UNIDENTIFIED: The Plight of the ADHD Inattentive Female

Presented to: CHADD’s 24th Annual Conference on ADHD November 9, 2012 San Francisco, CA Joan K Teach, Ph.D.

IDENTIFYING THE ADHD INATTENTIVE ADOLESCENT

FEMALE

  Inattentive females are often under-identified due to their intense desire to please and conform.

  Inattentive symptoms are under appreciated, and under studied

  2.2 times more girls than boys are Inattentive

  Teachers refer ADHD males due to externalizing and impulsive symptoms twice as often as females

  Girls are thought to be slow or intellectually and learning impaired

  Staller, Farone 2006

WHY IS IT IMPORTANT TO FIND HER?

  1 Million women and girls in the US are diagnosed with ADHD

  32 million ADHD females are identified world wide

  Impact of ADHD in girls is a major international health concern

  70-80% of identified ADHD children will have persistent symptoms and impairment that extends into adolescence and adulthood

  Diagnostic criteria have traditionally focused upon male behavioral symptoms

  Inattentive ADHD must be more scrutinized and understood

  Staller, Farone 2006

WHAT DOES SHE LOOK LIKE?

  Inattentive, with poor attention to detail

  Limited attention span, often forgetful

  Distractibility, fails to finish assigned activities

  Less disruptive, less obvious

  Largely goes unnoticed

  Struggles to avoid school failure

  Low self-esteem, feelings of being wrong, not worthy

  Quinn, Nadeau

HOW DOES SHE FEEL ABOUT HERSELF?

  High anxiety; wants to please

  Perfectionistic; pulls all nighters to finish

  Unwanted; never lives up to expectations

  Always wrong; but she doesn't’t know why!

  Doesn‘t have friends; has poor social skills

  Compulsively checks; rechecks, trying to get it right

  Feels depressed

  Often diagnosed with Depression before gaining her ADHD identification

Neurobiological Disorders

ADHD - I

  A hidden disorder due to unique neurological hookup and transmission creating a working mechanism without smooth seamless transmission desired for optimal function

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Of Course, if she’d only try!

  DAYDREAMER? SHY!

  DON’T DRAW ATTENTION TO YOURSELF!

  WORRIED?

  OVERWHELMED!

  YOUR THOUGHTS MILES AWAY?

  MIND RACING?

  IF ONLY!!!!!!!!!!!!!!!!!!!!!

She would if she could!

  She doesn't’t attend like other adolescents

  Frantic about wanting to be liked and have attention

  Sabotages her own success

  Wounded by earlier social failures

  Can’t meet societies expectations for females

  Victim of long time social abuse, can’t stop the pain

  Low self esteem avoids social interaction

  Shuts down   Hartmann

If she’s struggling, Why isn’t she identified?

  Teachers refer boys for help because are squeaking the classroom wheel

  Teachers assume her poor academic levels are due to a lowered IQ

  Her lack of language and cognitive clarity, enhances the idea that she is slow and non-productive

  Social difficulties are ignored as if they are just part of her shyness

  Gifted ADHD fake it until middle or high school , then the overload hits and the tragedy begins

She does anything to hide her pain

  Isolate herself from social events

  Stay up all night, studying and still only maintains average grades or lower

  Stops eating Binge eating

  Spends hours on internet or other lonely endeavors

  Believes everyone knows how stupid she is and how incompetent

  Fears revealing her creative mind, as she must be crazy

Lack of identification leads to:

  Need for tutoring   Special classes   Repeated grades   Language disorders   Anxiety and depression   Panic, OCD, Acting out   Alcohol or Drug dependency,

cigarette smoking   Sexual promiscuity

How can we help?

  Optimal treatment includes:   Stimulant medication   Behavioral therapy   Structure in life and environment   Organizational skill development   Social skill building   Psychological support, counseling   Treatment for co-morbidities

  Hinshaw 2006

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Learning Coping Strategies makes all the difference

"   She must learn to perform by using new strategies, often not attained by taking the road most usually traveled

"   She will search to learn more about herself, what her own strengths and weaknesses entail in order to create a new and better solution

"   She becomes mindful of her reaction to others and learns to develop a positive reactions from them

Step One Who am I?

What do I need?

  Support for developing my self-esteem

  Medication to balance my mood, focus and efficiency

  Technology to make work more efficient – An App for that!

  Social Skill training to develop mindfulness

  Organization skills, strategies for survival

  People to believe in ME!

Support for developing my self-esteem

  DOVE -Self Esteem Discussion Guide

  1-1 Activities Girls 13-18   Self Esteem Activity Guide

  The Art of Extreme Self-Care   My Daily Affirmation Cards   Cheryl Richardson

  Growing Great Girls: a gender-responsive Life-Skills Curriculum   Denise Bray, Wendy Dougherty

Medication for Efficiency

  Medication is available only from a licensed provider

  Each individual responds differently to medication

  70 -80% of individuals respond positively to medical intervention

  Medication requires careful monitoring and needs a positive interaction between provider and client

  The choice of medication is an individual preference

Technology to make me more efficient

  i.AM Search – an APP to search for those apps that meet your needs as provided by the profile you submit

  App-le tools for reading

  Voice activation programs – Dragon –write for me

  Text to speech programs – read to me

  Comprehension reinforcement

  Assistive Technology workup

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Social Skills Training

  Developing Mindfulness

  Initial awareness   Eye contact

  Proximity   Interactive Awareness   Balance in Dialogue

  Social Skills for active listening

  Social Role Play

������SOCIAL SKILL INTERVENTION GUIDE SN ELLIOTT, FM GRESHAM, 1991

The Internet as a Social Media

  Student Activities Directory +++

  http://www.cccoe.net/social/SAdirectory.htm

  Agame.com - - - - -

  http://www.agame.com/games/dating/dating.html

A Girl’s Guide to the Digital World –How to log-off of digital drama Dove

  Online friendship: Friend or Frenemy

  Privacy: Do you want everyone to know?

  Rumors: Controlling the conversation about you

  Self Image: Painting a Positive Picture

  Mobile Conversations: Think before you Text

Social Skill Activities

  Building Social Skills through Activities

  Danny Wayne Pettry II

  Four Steps of Communication

  Social Skill Activities

  Sue Watson

  ADHD Mindfulness and Making Decisions

  Marla Cummings

  Zing! Snappy Comebacks to Thoughtless Comments

  ADDitudeMag.com

Building social skills

  “I” STATEMENTS   I don’t want to   I prefer not to   I am not interested   I don’t think that would be best for me   I’d rather not   I won’t allow it   I feel it would be best if   What I really want to do is   I think it would be better if   I do not like that idea   I don’t appreciate that

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Tips for using “I” statements

  Be sure to use an “I” statement

  Speak clear and firm

  Do not curse or call the other person a bad name

  Do not talk hateful to the other person

  You have the right to stand up for yourself

  If someone won’t take “NO” for an answer – walk away, tell

  Pettry

Self-Esteem Scavenger Hunt

  Find a photo of when you were happy, silly

  Clip a headline about a woman making news

  Unearth a favorite birthday card

  Write a thank you note to someone special

  Call a relative you haven’t spoken to recently

  Give someone a compliment

  Discover an interesting fact about your parents

  Ask an elder to describe their life   Dove self esteem

Four Steps of Communication Synergy of mind, body, eyes and

language

  Think about others and what they are thinking about you

  Establish a physical presence

  Think with your eyes

  Use language to relate to others

  Make yourself a better communicator

Playing to Win

Getting a Handle on Yourself Addressing Your Self-Worth

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Organizational Skills

  G QUEUES

  ONE STOP Calendars

  Backplanning

  Color coding

  Bins Bags and Baskets

  Timers, Apps and Appliances

Strategizing for Survival

  Acquisition of skills   Overt = rehearsing behavior   Covert = imagining behavior   Verbal = saying behavioral strategies

  Modeling   Telling   Showing   Rehearsing

  Feedback   Evaluate   Inform   Reinforce   Positive affirmation

Blessing of Coaching

  Non-judgmental

  Supportive

  Successful with those who understand rewards and consequences

  Ongoing support for management strategies

  Teens become a part of the selection and structure building

  Contracts guide expectations, frequency, progress

Self-Esteem comes by

  Developing a Positive Self Image

  Avoiding Negative Press

  Catching your own rainbow of skills

  Allowing yourself to be different

  Journaling

  Getting help: it’s not that bad

Self-Revitalization means

  Allowing yourself to enjoy

  Find time alone daily

  De-stress your environment   Less is more

  Comfort Corner

  Do one creative, enlightening, enhancing thing a day

  Surround yourself with music, art, joy

Build a Bridge to Tomorrow

  Building Bridges   www.buildingbridgestherapy.com

  Social Responsibility Training   Resilience   Social and problem solving skills   Work readiness   Improves school success

  www.characterdevelopmentsystems.com

  Power Social Skills   www.powersocialskills.com YOU ARE YOUR OWN SUCCESS