Monday, October 25, 2010

Girls, ADHD, and (Squirrel!) Under-Diagnosis

One of my nine-year-old daughters, the Pork Lo Maniac, has now been officially diagnosed with Attention Deficit Hyperactivity Disorder, Inattentive Type.  As with all the other diagnoses my kids have gotten, by the time the diagnosis was official, it was not a surprise.  Still, going to these kinds of appointments forces you to take a step back and see your child through someone else's eyes.

The psychiatrist asked questions like "Do you sometimes need instructions repeated to you several times before you can do them?"

Pork Lo Maniac: ::swivels in chair:: "Um, yes."
Psychiatrist: "Do you sometimes feel like it's hard to pay attention in school?"
PLM:  ::blank stare::
Psychiatrist: "Do you sometimes feel like it's hard to pay attention?"
PLM: "Are the flowers in that candle real?"
Me: ::bursts out laughing::
PLM: "Wait, what?"

Earlier in the day, she had been telling me about something that happened in school.  She stopped, mid-sentence, entranced by something outside the window.

"Look at that bird!" she exclaimed happily.



I feel like crap that we didn't have this diagnosed earlier.  She's been struggling in some areas of school, like math, since first grade.  Our child psychiatrist said that while boys are usually diagnosed between the ages of 7 and 8, girls are usually not diagnosed until age 12.

So I'm like, what the hell?

And also: oooh, shiny.

Because I'm 37 and just figuring out that I probably have ADHD, too.  (That there was a link to another post in my blog.  I might be hyper-focusing on links today.  It turns out that people with ADHD are sometimes actually able to hyper-focus on things to a degree that people with ADHD can't.  Which is totally my excuse for not getting the laundry done today.  I'm focused here, people.  And I find it supremely annoying when people spew medical "facts" without backing it up with, you know, facts.  So I'm going to keep linking.)

Wait, what the hell was I talking about?  Oh, right, the studies.

Studies have shown that ADHD in girls is consistently under-researched and under-diagnosed, despite the fact that girls with ADHD are at least as likely as boys to manifest with conduct disorder and are more likely than boys to engage in substance abuse.  (Here's one studyhere's anotherhere's anotherhere's yet another, I'll stop linking studies now.  Also? Maybe they should stop researching the under-researching and do some damn research now.)  Girls with ADHD are also just as likely as boys to have comorbid conditions such as anxiety, depression, and social impairments.

So why are these girls being missed?  The prevailing wisdom is that girls with ADHD are simply less annoying than boys with ADHD.  I'm paraphrasing here; "annoying" is not an actual medical diagnosis unless you're Caillou.  In which case?  Diagnosis:  Annoying.  Also, I'm *totally* not saying that your son with ADHD is annoying.  Unless he's the boy who shoved Little Dude in school the other day.  That kid is wicked annoying.

The deal is that boys with ADHD are more likely to have more annoying overt symptoms like spazzing out poor impulse control, which will irritate the hell out of his teacher prompt the school to recommend an evaluation.

Girls are more likely to present with spacing out inattentive type ADHD, which means they have a poor attention span and are easily distracted.  They are less likely to present with the spazzy hyperactive type of ADHD.  What do we call a girl who spaces out in math class? A space shot.  A dreamer.  We say that she's got her head in the clouds or that math just isn't her thing.  But we don't send her to the principal's office because she's not disrupting the class.

The squeaky wheel gets the grease.  At least that's the prevailing wisdom.  It's important to note that this study shows that there is no significant difference in the rate of conduct disorder in boys and girls with ADHD.  But this study shows that girls with ADHD are less impaired and show less impulsivity.  What does that mean? Just as many girls have these issues.  They're just less annoying about it.

Here's my thought: it's not just that they're less annoying about it.  It's that our society is not only okay with girls being "spacey," it actively encourages it.  As proof, I give you:

Umm, so I just made that graphic because I thought Paris Hilton personifies the most celebrated American space shot of all time.  But then I was like, hey, wait a minute.  So I Googled, "Does Paris Hilton have ADHD?" and holy crap, she does.  So that right there is proof that girls with ADHD need more support.  Ms. Hilton has been on ADHD medication since she was a child, and that was clearly not enough.


It's a good thing we don't have Hilton Money because it seems that scads of dough plus ADHD can equal train wreck. I'd hate for my daughter to become a coke-snorting celebutante who sucks at lying to the police.  Plus, if you're distracted by shiny things and you have bajillions of dollars, it must be really difficult to get out of Tiffany's in under ten hours.

Despite the fact that there's a crapload of studies explaining why the Pork Lo Maniac hasn't been diagnosed until now, I still feel guilty.  Regardless, we're moving forward with the information we have now, and ADHD will not be a pass for bad behavior.  It will be a reason for me to try harder: to give the Pork Lo Maniac structure, support, consistency, and above all, love.

35 comments:

  1. Wow, does that photo of Paris show a nip slip?

    Maybe I have ADHD too!

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  2. Pork Lo Maniac is lucky, I wasn't diagnosed until I was 40. And yeah, I wasn't annoying in school. But I was annoyed a lot.

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  3. Awesome post! Don't blame yourself for not getting her diagnosed sooner--it's harder to diagnose in girls, and the hyper-focus thing is counter-intuitive.

    Partway through reading the post I started wondering if Sam should be tested...and then I started wondering about a classmate of his who has different issues....and then I googled the classmate's symptoms...and then I realized that I'd been hit by a squirrel and it was time to return to your post. Think it's time for my diagnosis.

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  4. I,too, feel guilty that my middle daughter was not diagnosed with her inattentive ADD until grade 7, even though she was clearly exhibiting symptoms by third grade. Everything you posted about these girls "not being annoying so therefore they can fall through the cracks", was true of her. She had a really rough time in school starting in 6th grade - I wish I hadn't let it go for so long. However, medication and accommodations in school have helped her and she's now a junior in high school, doing pretty well. I'm very proud of her! So don't beat yourself up too much - you have a lot on your plate.

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  5. I think as a Mother you tend to wonder why you missed stuff in retrospect. Find me a mother who is sitting in the Dr's office thinking to themselves "Why didn't I notice this earlier??!?!?! What kind of spaced out mother am I?!?"

    -before anyone yells - it's mostly Mothers who do this, maybe some Dad's do but I have yet to know one who sits with this much guilt about missing something that has to do with their child.

    I hope you don't let yourself worry about how you could have missed it too long - hindsight being 50-50 and all that.

    I'm glad your child got a diagnosis I know that you will try to find coping mechanisms for her to help her in school and in life.

    M

    ps- that description is so totally me. A friend of mine had a tee shirt that said A.D.D in huge letters with the following definition underneath - Attention, Deficit -Oh Look!! A squirrel! It was so me.. anything shiny some days and poof! I'm gone.

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  6. My husband has diagnosed me with S.O.S. Shiny Object Syndrome. I can sooooooo identify with this post for myself. Couple a lack of ability to focus with a perfectionist streak, and it is hard to get anything done around here!!!

    I think your kids are extremely lucky to have you as their mom, even if you are stark raving mad some days. :-)

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  7. As the mother of four kids with ADHD, I say welcome to the club! Kids with ADHD are wonderful out of the box thinkers, creative as all get out and often quite brilliant. They have amazingly different perspectives on common and simple things that are fascinating (when you are not in a hurry to get somewhere). So even though this is a diagnosis and will require treatment remember that it is also a blessing that requires nurturing.

    My favorite quote about ADHD (and I totally forget where I heard this so sorry original person!) is: Ready, FIRE! Aim.

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  8. I was never diagnosed as a child and have trouble getting adults to believe me. It took several psychs and docs to find one that believed me and didn't write it off to depression or mommy stress. I finally got appropriate medication and have never felt better in my life. All this time I wasn't DEPRESSED I was DISTRACTED. Sheesh.

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  9. How do clinicians tell the difference between ADHD and Asperger Syndrome in girls? It seems like there is so much overlap, with ADD/ADHD generally being an expected feature of ASD. If girls with ADHD are under-diagnosed, girls with Asperger Syndrome are WAY under-diagnosed. Is the difference that girls with Asperger Syndrome have highly focussed, obsessive interests (maybe not the math/science/Lego kind the boys have, but obsessive none the less) and the ADHD girls don't?

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  10. Glad PLM was diagnosed and you are on your way to better living through chemistry. My 12 year old Sweet Pea was officially diagnosed as SQUIRELL-ISH at 5. Like you said, that was not a surprise, we were pretty sure. While he is a kind, sensitive human being, he has most of the *annoying* symptoms. It isn't easy being a super *annoying* person when you are also perceptive and sensitive and have no idea why everyone is so irritated with you all the time. Sometimes teachers and other parents would think his symptoms were intentional, and it was heartbreaking to see him so misunderstood. Good teachers have made ALL the difference for us, good luck to you at the beginning of this journey!!

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  11. My oldest boy was diagnosed at 5-turning-6 (the doc wanted to wait until he was older to tag him, but admitted he was "ADHD waiting to be diagnosed," and then number 2 was diagnosed at just-shy-of-5. (There was no ignoring that wall-writing, plus we already knew about his brother.) I still feel a little guilty...his first psych appt was the day he turned 5. "Happy Fifth Birthday, time to get your head shrinked!" DD was diagnosed at 5 1/2 - I think I would have probably missed it had we not already been down this road before. (And yup, we're just waiting on thing 4 to get the official diagnosis. He's worse at this age than number 2 was. Genetics suck.)

    I was finally diagnosed after no. 2 was. Thing 1 is more spacey, thing 2 is easily distracted and leaves a path of destruction in his wake. Let's just say I'm not the most diligent housekeeper. I'm not lazy, it's I get started on one thing, distracted by something else, and then that's it. I can be mopping the floor, the phone rings and I have to look at the calendar, so I leave the mop in the other room, and come back four hours later and find the mop still in the bucket. I started on meds and OMG it was like night and day. The problem is I got pregnant after that and had to stop. For some strange reason, they won't give you amphetamines when you're pregnant or nursing. I don't understand it. ;)

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  12. I am now dealing with a 22 year old MALE son who was not diagnosed as a kid just because he DID NOT act out in class. All I heard was "Oh he can't be ADHD, look how well he does in class" and "He hardly ever gets in trouble". He was doing that hyper-focusing you talked about (plus he was, and is, really smart so that helped tons). But now, as an adult, he has a really hard time staying focused and, in college, that is becoming a big problem. We joke about it all the time, but it really isn't a joke.

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  13. We have a child with ADHD and a child with Asperger's. We also have a dog and a cat. The similarities can be startling. My conclusion is that every dog has ADHD and every cat has Asperger's. We use the "squirrel" line all the time!

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  14. Girl - ditch the guilt. It's likely that the fact that she HASN'T been diagnosed and that you have been molding her and working with her and loving her all through this has given her coping skills she likely wouldn't get had she been diagnosed earlier. Look at the diagnosis as a window opening in her life; it's been great - and all she knows so far - and now there's some added fresh air.

    Hang in!

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  15. Great post!! I am almost 40 and recently had 2 doctors ask if I've been diagnosed with ADD. I am one of the lucky ones that my daughter was diagnosed at age 4. We had a wonderful doctor that sent us to a pediatric neurologist because she presented certain symptoms. She is highly intelligent. The neurologist worked with her for almost 4 hours. Then we got the write up for the school: ADD, inattentive with ODD tendencies. She is just about 13 now (3 weeks). She has not been on meds the whole time, just from age 4 until about age 8. We worked with the teacher, school and doctor to set up a plan. She does have a few problems, still, but mainly at home when she is loaded with homework/projects. She was part of a program at NIH to look at girls with ADD and if they present the same as boys (NO). I am grateful to her doctor (and his daughter who had it which was why he questioned it). I think he saved us a lot of questioning, guilt, etc.
    Glad you have finally had some progress. It sucks when you KNOW but no one is listening!!

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  16. The problem is that "everyone has ADD" because on the surface the symptoms are things that everyone does sometimes. Forget stuff, get distracted, etc. Most people don't believe it's a real problem because for them those things aren't a problem. But the reality is that those are just the tip of the iceberg, they are indicators of the actual disorder which can be described, in part, as a chronic disability to regulate and organize the thoughts and mind.
    My favorite quote about ADD is:
    Don't think of yourself as organizationally challenged.Think of yourself as disorganizationally gifted.

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  17. To Anonymous with the 22-year-old son: Has your son been evaluated for Asperger Syndrome? Very smart, hyper-focus on things he likes, trouble focussing on things he doesn't care about, generally good behavior in school, big struggles in college, etc. All very common for Asperger's. If he has obsessive interests (electronics, science, rocks, weather, etc.) and/or collections going back to childhood, and sensory sensitivities (picky eater, doesn't like certain clothes, bothered by noise), could be AS. Could also be ADD/ADHD, of course. As I posted above, there is a lot of overlap. But quite a few kids (especially if they were in elementary school ten years ago or more) are misdiagnosed as ADD/ADHD when they have AS instead.

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  18. Gee, I can't think why you didn't hop right on a behavior anomaly in one of your children. I mean, other than this, they are all exactly like average kiddos, with no major life events or changes in the last couple of years that might have distracted you or masked a different way of interacting with the world. What's that you say? Your home is a whirlwind of myriad competing (not to mention LOUDER) needs and awesomeness in which triage is not only necessary but the wisest, best course to pursue? And your work and fantastic parenting have so minimized the effect of this that it took a while for you or her teachers to pick up on it? Sounds like you have reasons to be proud of yourself, not guilty. Now knock that guilt crap off right now!

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  19. What a great post. My Girl Child is getting evaluated to ADHD - Inattentive, too, (she's 8) and we have the added bonus of trying to figure out if it's ADHD, Central Auditory Processing Disorder (common in kids with Unilateral Hearing Loss) or - jaysus - Both.

    I'm grateful that you put yourself out there and discuss things like this. It makes many of us feel less alone.

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  20. I am an 40 yr old female who wasn't officially diagnosed until my 20's with ADD. But we had our suspicions. When you look back at my report card comments it's pretty clear. But I was smart, developed coping mechanisms, and somehow survived. I also wasn't diagnosed as a child because a) I was a girl b) it was the 70's and 80's and c) I could sit and read for hours. And like you stated, with my ADD I could hyperfocus if something really captured my attention. So hang in there - my recommendation as someone who lived it and lives with it, start with coping mechanisms, structure and behavior modification (meaning find new ways to do things in a way that suits her) and see if that works. If not, then look at meds - the least dose for the maximum result. And yes, I do take Ritalin as an adult. And that being said, I think that meds should be the last resort with kids and you start thinking about meds when other stuff doesn't work and the ADHD is messing with who they are, who they can be, and what they could be capable of. Are meds the answer for some - yes; are meds the answer for others - no. "Driven to Distraction" by Edward Hollowell is a great book to read!! And if you truly think you might have it, look into it. My life is totally different for the better with my ADD meds. It's a process as an adult, but worth it. And personally, overall, I think ADD has a great many benefits. I am an outside of the box thinker & creative. And if you look at a list of DaVinci's life & Thomas Edison's life - they are poster boys of ADD/ADHD and look what they created!!! Hang in there. And good for you for getting your daughter help. You can be sure that I am watching out for my girls as well because I don't want them to go through what I did should it turn out that they inherited it. Good luck!!! If for some reason you'd like to compare notes or pick my brain (cuz again, I lived it - I am ADD) I am happy to share my thoughts and experiences. Just post and I'll send you my contact info.

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  21. Bravo. Entertaining and informative and ...shiny!

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  22. I can totally identify. I am also a 37 year old mom of a child with ADHD...and there is NO doubt which side of the family he inherited his "disorder" from. My brother has recently been diagnosed (at age 33) and my sister and I are both as spacey as they come, but all 3 of us excelled at standardized tests. My brother was able to succeed in spite of ADHD, but my sister and I both fell firmly into the ditzy underachiever camp.

    Sometimes I think I should pursue legitimate diagnosis and medical treatment, but at my age I wonder what would be the point. I survived the pursuit of 2 college degrees (that hyper-focus thing is true. I would sit and complete each assignment from start-to-finish...it was the only thing that worked). I've learned to compensate for my issues to some degree.

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  23. I'm still stuck on the picture of Caillou and am just glad I'm not the only one who thinks he's incredibly annoying.

    We all feel guilty for what we perceive as "missed opportunities" for helping our kids - no matter what age they are diagnosed. But we have to knock that guilt right back on its head. With all the things going on in our lives...ah, who am I kidding. I'm still on a guilt trip about our son's ASD diagnosis and it's almost a year later. I think guilt is just part of the game.
    Now, back to Caillou...

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  24. Hey, I'm right there with you! I, too, have a kid w/ ADD w/o the H component, although he's a boy. And I know all too well what he's going through because I have figured out that I have a whopping dose of ADD myself.

    Although no one caught it because I was a bright hyper-focuser who was good at compensating. But not THAT good since I'm a classic underachiever - brain the size of Texas, but no college degree (130+ credits, but no completed major).

    And, Ethan's issues often slip under the radar because his twin brother is on the autism spectrum and has so much bigger issues. So there is plenty of guilt to dish around in my house, too. But I try not to, because it really does no one any good.

    And also... Ooooh, shiny... what was I saying?

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  25. Really interesting and entertaining post. The diagnosis is informative to both of you, but you are lucky to have each other!

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  26. @Kirsten- Even with the coping skills you've developed, trust me, getting treatment is so worth it. I was dx'd with adhd when my oldest (who we now know is an Aspie) was diagnosed adhd at 3. He'd run into walls/furniture/people, bounce off, get up, shake himself off, and do it again! That's when we decided to have him evaluated. In evaluating him, my then-therapist asked if I was. I didn't think so, but he ran some simplified tests on me, and we decided I was. Tried behavior modification, but trying to modify behaviors at 23 wasn't that easy, so once I had my daughter, we tried meds. Now I'm wondering if I was mis-diagnosed, because the meds for adhd don't do ANYTHING for me (stimulants make me stupid, really!), and I've had a primary care ask me if I'd been evaluated for Aspergers. Then recommend it.

    SRMM, don't feel guilty for it taking so long to get PLM diagnosed. At least you did! She didn't find out as an adult, and when she told you about it, you tell her that she's just trying to get attention. She's still young enough that behavior mod and meds can help her be a successful, productive member of society.

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  27. I just spent the afternoon writing a calm email as to why lattice math and my 11 year old mechanical pencil maniac child with auditory spectrum disorder and the attention span of a 3 year old. Is failing math tests where she is forced to use a highly distracting lattice form when she already can do traditional math... Oh and why did the Teacher actually email me about her scores Oh because Her ARD is Next week and it has to look like she is actually following my dd's IEP.. grrrr Your blog made me laugh out loud today!!!

    and My squirrel moment is I found your blog by searching Texas water bugs.. ROFL!!! but then I was diagnosed with Hyperactivity in 3rd grade Dyslexia and a serious lack of short term memory issues did no t come till 7th grade! A great math teacher finally noticed if you flipped the numbers on my math homework you would get he answers I was writing down... So don't let the guilt get you :-)

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  28. My son is diagnosed ADHD with a mood disorder (which mood disorder is undiagnosed at this point since he's only 7 but our strong suspicion is Bipolar). He was always off the wall, crazy, insane hyper. He is also scarily impulsive, we found him one day where he climbed the shed in the backyard and was hanging from the phone lines with no fear what so ever! He is a math whiz, he can do math that my 12 year old has trouble with, numbers click for him, when it comes to reading and spelling, he completely shuts down. I'm having issues with the school not wanting to help him in any way because they say it is a home issue and he needs more structure in the home. Not true, we are very structured in our home but the school does not see him acting out because when he gets overwhelmed he shuts down. He may be present in class and it may look like he's paying attention but he is mentally turned off. When he comes home from school all of the frustration and overwhelming feelings from the entire day come flooding out of him, making home life very difficult. We are now in the process of trying to force the school into action by using an advocate and the threat of putting him in another school at his current schools expense. He has the knowledge, he has the ability to learn what they are teaching him and he actually has a higher than average IQ and vocabulary, the problem is, as the neuropsychologist explained it, his brain is like a library without a card catalog. Check out "Executive Dysfunction". The information is in his brain, he just can't pull it out and put it on paper. I'm not exactly sure where I'm going with all of this except to say that I've been there and it is a long road to find the medication and modifications that work for your child but you will get there. The biggest thing you can do for her is to keep boosting her self esteem in anyway you can. It's a difficult issue with these kids as they get older and realize that they don't learn the same way as other kids do and they are different. Hang tough, you both will get through this and come out on the other side even stronger.

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  29. Whoa momma - it's a tough & sensitive issue! You did the right thing in your own time. Can't look back or we'd all be past SRM. My son is 8, has ADHD. Like another mom, mine is intelligent, sweet, sensitive & I want to wring the necks of people who make him feel bad for things he can't control. That said, in the last month alone, as we ride bikes in our new neighborhood and he's chatting along & I am trying to stay attentive myself, he goes "squirrel!" Seriously. And although I didn't realize it till researching info to make his/mine/everyone's life easier - I'm a chicky with ADD too. Girls are SO different. I was the dreamer. And thankfully still am.

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  30. Holy shit woman, I was laughing so loud I may have broken the first commandment of our marriage: Thou Shalt Not Wake Me Up LOLing in the Wee Hours. (Yeah, it's a problem. Dave Barry has been forever banned from my nightstand.)

    Just this morning I was trying to explain my controversial Caillou Theory of Mom Coolness to my husband, because there is a startling correlation between these demographic segments:

    - Prissy Uptight Moms and Moms Who Love Caillou

    - Cool Moms I'd Love To Hang With and Moms Who Want to Smack That Annoying Little Whiner

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  31. yeah I know this post is old, but those little links at the bottom of posts totally get me off on tangents of reading not just one, but like 10 blogs before I get back on track :)

    Just wanted to point out though, the link to substance abuse is not a link to the disorder itself, but to the medication that is often prescribed to young children for it. Small example, but my husband and I were both diagnosed in elementary school. Both of us were soon after given drugs for it. I only tried them for a year or so then went for more natural methods where my husband continued to take them all the way through college. We are now early 30s and guess which one of us has a tendency towards substance abuse? I don't easily addict to anything, not even caffeine. My husband on the other hand has gone through addictions to alcohol, pain medicine, antidepressants, and of course, Adderall. Both of us have the same amount of family history of substance abuse. Medicating kids at an early age with a highly addictive drug is what makes them more prone to it, not having ADD or ADHD itself.

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  32. Um, yeah. After reading your post, I do believe I might just fall into the ADD realm. Just a little... Ooh, look! Shiny!

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  33. My little girl aka "Tornado in a Tutu" is only 4 and we are starting the process of figuring out what is going on with her. So far we have "Possible Early ADHD" but not official. I am having a HARD time because she is so young getting anyone to listen but if it was their home that was literally being vandalized and ripped to shreds everyday they would be right on top of that. I really am trying to go the diet and natural route right now to see if this helps..does anyone have any suggestions?

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  34. Your post just made me realize that I probably make my own mother feel pretty guilty sometimes. I wasn't diagnosed until I was 22 and almost finished with college. In fact, I wasn't diagnosed until I sought out an answer to the question "What the hell is wrong with me?" myself because I was failing miserably at all aspects of making a life for myself. At 22, I was finally mature enough to admit that my lifelong struggles where a sign of something more fundamental then just being an "air-head" or "spaz".

    Thanks for the post from a mother's perspective. I'm going to have to find a way to tell my own mother that I know its not her fault I slipped under the radar all those years.

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  35. Um. I love you.

    My daughter has ADHD and actually so do I (was recently diagnosed).
    However I saw a psychiatrist the other day that said that judging by my kid's report cards this was not a child with ADHD (as ADHD is thought to only be a disorder if it presents itself in more than one setting ie: school and/or home and/or sociably) and although my daughter "clearly has a LD (does she?) she isn't presenting ADHD in school".

    Now, this psychiatrist did not bother to look at the SWAN rating scale I brought that the teacher had filled out, nor did she know what it was....so....

    And she also went on and on about how ADHD is over diagnosed and how she doesn't believe in diagnosis (um aren't you a psychiatrist? WTF?) but then proceeded to insist I have my child "diagnosed" for a LD before it was too late.

    My kid has a more typical type of ADHD in the home (impulsivity, hyperactive, inattention to anything but what she loves - at which point she has been described even by her teacher as "obsessive", mood swings, trouble sleeping...) and even at school (at least by the SWAN rating scale the teacher filled out) she presents many of these attributes - but because it is on a much smaller scale than that of a boy the teacher does not consider my daughter to have ADHD - and apparently neither does this wacky psychiatrist!

    Anyways - I think it's high time people realize and understand that this disorder is different for each gender and that if left untreated - even if only by diet and therapy and resources such as ADHD specific parenting courses - it can be detrimental to the young women who go through life thinking they are just "dumb" or "lazy", and who ultimately have many issues with employment and/or relationships.

    http://www.additudemag.com/adhd/article/740-2.html

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