Forever Distracted: The Impact of ADHD on Middle School Girls

Forever Distracted: The Impact of ADHD on Middle School Students

Hannah Zontine Mr. Zontine Honors Senior Thesis May 26, 2013

“Ben! I told you to stop talking and sit down!” It was another day in Mrs. Clark’s 7th grade math class. She was teaching her students how to use the Pythagorean theorem to find the third side of a triangle. Most of her students had aced the simple pop quiz she had just given, except for Ben and Ashley. Ben never paid attention in her class, which led Mrs. Clark to suspect that Ben could have ADHD. He was always bouncing in his seat and rarely completed worksheets and tests.

Ashley, however, was different; she was quiet. She, like Ben, had trouble focusing in class.

Ashley sat by the window, played with her hair, and daydreamed all throughout class. Mrs. Clark couldn’t figure out why Ashley wouldn’t apply herself to the material. Since Ashley wasn’t loud and disruptive like Ben, Mrs. Clark, like many others, assumed that she could not have ADHD. So why is Ashley struggling academically and socially like Ben is?

Attention Deficit Hyperactivity Disorder is a mental disorder that causes those affected to have trouble focusing on school. Both Ashley and Ben suffer from ADHD, but their symptoms differ. Most understand ADHD to cause kids to be disruptive and loud; they understand ADHD the way it affects boys. Boys like Ben exhibit behaviors that others easily label as ADHD. As a result, Ben is more likely to receive the help and attention he needs, once referred to a clinician.

Ashley, on the other hand, may not be as fortunate. Her disorder, like many other girls, goes unnoticed by adults due to its passive presentation. Girls tend to be quiet and reserved, and yet they have difficulty paying attention. Therefore, Ashley is left to significantly struggle in both school and her social life.

Attention deficit is a psychological disorder that requires a diagnosis, treatment, and the support of parents and teachers in order to properly help a child succeed. The effects of ADHD upon middle school girls and boys are distinctive throughout their academic and social lives.

Adults need to be educated on these different effects so that they are able to discern a spunky, rambunctious child from one bearing ADHD; by just suspecting the disorder, one adult could make a child’s life incredibly different.

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History “‘What we know about ADHD is that it's been with us a long time,’ says Dr. Peter Jensen, director of the Center for the Advancement of Children's Mental Health and Ruane Professor of Child Psychiatry at Columbia University College of Physicians and Surgeons. ‘As far back as 100-150 years ago, people gave clinical descriptions of what we know as ADHD today.’” The terminology of the disorder has constantly been altered; however, the children affected have always struggled the same way (Tsuchiya).

Prior to usage of the term ADHD, the same cluster of symptoms was referred to as attention deficit disorder with hyperactivity (ADD-H) or without hyperactivity (ADD). The label first appeared in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, third edition, published in 1980. Before then, what is now known as ADHD was known as “minimal brain damage or minimal drain dysfunction” (Pender and Smith).

One of the first references to a child with ADHD was in the “poetry of the German physician Heinrich Hoffman in 1865, who penned poems about many of the childhood maladies he saw in his medical practice” (Barkley 3). In particular, he wrote about a poem called “The Story of Fidgety Phil.”

‘Let me see if Philip can be a little gentleman; let me see if he is able to sit still for once at table.’ Thus spoke, in earnest tone, the father to his son; and the mother looked very grave to see Philip so misbehave. But Philip he did not mind; his father who was so kind … See the naughty, restless child, growing still more rude and wild, till his chair falls over quite. Philip screams with all his might, catches at the cloth, but then, that makes matters worse again. Down upon the ground they fall, glasses, bread, knives forks and all … Poor Papa and poor Mamma look quite cross, and wonder how they shall make their dinner now. (Hoffman) This 150-year-old tale captures ADHD in its own glory. The actions of Philip describe the typical undiagnosed child struggling with ADHD. His parents have no idea how to help him or

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what to do because ADHD was not declared as a disorder until much later on. Hoffman is admired for making such a keen observation, years before ADHD is even labeled (Barkley 3).

The first theories about this unidentified problem started to sprout in the early 1900s. At first, investigators attributed a child’s restlessness to be an effect of the defects in the brain; however, they had not evidence to support the theory. Later on, researchers would find much evidence to authenticate this theory. Bad parenting, also, became a popular theory. People believed that spoiling a child or raising them in an unpleasant family environment could cause forms of hyperactivity in a child’s brain (Barkley 6).

Over the next decade, the concept of the “brain-injured child” was created. Many children, who had little to no evidence of brain pathology, were being wrongly labeled as such. It was “fashionable to consider most children hospitalized in psychiatric facilities with this symptom picture to have suffered from some type of brain damage (such as encephalitis or pre/perinatal trauma), whether or not the clinical history of the case contained evidence of such” (Barkley 6).

In the 1940s, dedicated researchers Alfred Strauss and Laura Lehtinen stressed that the “psychological disturbances alone were de facto evidence of brain injury as the etiology” (Barkley 6). After extensive research, we concluded that restless behavior and inattention was a result of brain damage. They argued that children were “thought to have sustained brain injuries, which caused the resultant behaviors of inattention and restlessness” (Pender and Smith 64). This concept later evolved into the notion of ‘minimal brain damage’ and eventually ‘minimal brain dysfunction’ by the 1950s and 1960s. Strauss and Lehtinen proposed that these children be put in smaller classrooms and have the amount of distractions be reduced. Furthermore, they say that teachers should not wear jewelry or bright colored clothing and only few pictures should be hung

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on the wall. By minimizing distractions, the classroom can be the perfect environment for a child with attention deficit to focus (Barkley 7).

In the late 1980s, the disorder was renamed Attention Deficit Hyperactivity Disorder, for the purpose that hyperactivity was now considered one of the main features. In 1994, the DSM definition was revised, sorting children according to the degree of their attention deficit into three categories: primarily attention deficits (ADHD-I), hyperactivity/impulsivity (ADHD-H/I), or a combination of both (ADHD-C) (Pender and Smith 64).

The history of interest in ADHD in North America can be traced to the outbreak of an encephalitis epidemic in 1917–1918, when “clinicians were presented with a number of children who survived this brain infection but were left with significant behavioral and cognitive sequelae. Numerous papers reported these sequelae, and they included many of the characteristics we now incorporate into the concept of ADHD” (Barkley 5). These children were described as exhibiting impaired attention and memory abilities as well as increased impulsivity; they were known to be socially disruptive. The association of a brain disease with behavioral pathology led researchers to look at other potential causes of brain injury, such as birth trauma, measles, lead toxicity, epilepsy, or head injury (Barkley 6). All of these causes allowed investigators to conclude the injuries led to ADHD like symptoms. Many of the children seen in these samples also had mental retardation or more serious behavioral disorders, other than what is today called ADHD. It would be “several decades before investigators would attempt to parse out the separate contributions of intellectual delay, learning disabilities, or other neuropsychological deficits from those of the behavioral deficits to the maladjustment of these children” (Barkley 6).

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Apart from Heinstein Hoffman’s observations in 1865, scientific credit is “typically awarded to George Still for being the first author to focus serious clinical attention on the behavior and condition in children that most closely approximates what is today known as ADHD” (Barkley 4). Still came to correct conclusions about ADHD, disproving most all other theories. George Still was a hard-working English pediatrician and author of numerous medical textbooks and articles. He is most commonly known as the ‘Father of British Pediatrics.’ In a series of three published lectures to the Royal College of Physicians, George Still described forty-three children of his patients, of who had problems with sustained attention. “Most were also quite overactive. Many were often aggressive, defiant, resistant to discipline, and excessively emotional or ‘passionate.’ These children showed little ‘inhibitory volition’ over their behavior, and they also manifested ‘lawlessness,’ spitefulness, cruelty, and dishonesty” (Barkley 4).

As he explored his curiosity, Still took interest in the way the kids “would be punished (even physically), yet would engage in the same infraction within a matter of hours.” He accredited that to be insensitivity for punishment. He noticed that the children displayed a major defect in moral control in their behavior that could perhaps be explained as a “syndrome secondary to an acute brain disease” (Barkley 4).

In addition, Still recorded a greater risk for ADHD kids to perform criminal acts later on in life. However, although this “defect could be associated with intellectual retardation, as it was in 23 of the cases, it could also arise in children of near-normal intelligence, as it seemed to do in the remaining 20” (Barkley 4). Just like what researchers witness today, Still saw a “greater proportion of males than females (3:1) in his sample, and he observed that the disorder appeared to arise in most cases before eight years of age (typically in early childhood)” (Barkley 5).

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Though Still did mostly observe and conclude the physical effect ADHD has on children, he did agree with one of the earlier theories about ADHD. Specifically he believed that a poor household environment could attribute to hyperactivity. Many of his subjects were reported to have a chaotic family life; however, others had a seemingly adequate upbringing (Barkley 5). He believed that any child submerged in a bad household environment should be exempt from the category of lack of moral control. As a result, Still “proposed a biological predisposition to this behavioral condition that was probably hereditary in some children but the result of pre- or postnatal injury in others” (Barkley 5).

Throughout history, researchers have slowly developed a concept of what attention deficit is and its effects on children and adults. Through the conduction of many different studies, the most accurate information about attention deficit has been discovered and later educated to society. Though theories are still changing, psychologists have a steady plan of action to help those diagnosed deal with their disorder.

What is ADHD? Many people believe ADD is the most common term, and ADHD only comes into play when a child is dealing with hyperactivity as well. However, the belief has now been clarified.

“By the current DSM-IV definition, ADD technically does not exist [. . .] the term ADHD includes both ADHD with hyperactivity and ADHD without hyperactivity.” Therefore, this means a child can have ADHD with no symptoms of hyperactivity, giving no use to the term ADD. Interestingly, having “ADHD without hyperactivity or impulsivity is more common among females” (Hallowell and Ratey 5).

It is still unclear what the direct and immediate causes of ADHD are “although scientific and technological advances in the field of neurological imaging techniques and genetics promise to clarify this issue in the near future” (“Identifying”). Many researchers suspect the cause of 7

ADHD to be biological and genetic; nevertheless, they acknowledge the different ways that environment can a factor in developing ADHD. A study conducted in 1996 at the National Institute for Mental Health found that the “right prefrontal cortex (part of the cerebellum) and at least two of the clusters of nerve cells known collectively as the basal ganglia are significantly smaller in children with ADHD” (“Identifying”). These specific areas of the brain are responsible for the regulation of attention. This research, nevertheless, showed that the difference in size was not permanent; as the children grew up, the brain developed a normal level of thickness (Attention Deficit Hyperactivity Disorder 4). It is unknown why children with ADHD have smaller parts of their brain, but investigators believe that mutations may play a role.

Genetics can also be a major contribution to kids developing ADHD. Inherited from our parents, genes are the blueprints of who we are. Several international studies performed on twins show that ADHD does linger through the family. Follow-up research is being done in order to pinpoint which genes cause people to be more likely to develop this disorder, and perhaps even one day prevent it from happening before the symptoms develop (Attention Deficit Hyperactivity Disorder 3).

Besides biological and genetic roots, scientists have looked to the environment as being an outside cause toward one developing ADHD. “Like many traits of behavior and temperament, ADHD is genetically influenced, but not genetically determined” (Hallowell and Ratey 7). There are many factors, occurring at a young age, that researchers believe causes ADHD in children.

This list includes a lack of oxygen at birth, head injury, elevated lead levels, or watching too much television. Researchers also think that the mother smoking or drinking during pregnancy could have some effect; studies suggest a connection between those activities and ADHD in a child. However, there are many other reasons of which we are still unclear. “Children who have

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suffered a brain injury may show some behaviors similar to those of ADHD. However, only a small percentage of children with ADHD have suffered a traumatic brain injury” (Attention Deficit Hyperactivity Disorder 4).

Some investigators claim that refined sugar can worsen or cause ADHD, but there isn’t enough research to support the theory; in fact, most research disproves it. There was a study conducted where “investigators gave children foods containing either sugar or a sugar substitute every other day. The children who received sugar showed no different behavior or learning capabilities than those who received the sugar substitute. Another study in which children were given higher than average amounts or sugar or sugar substitutes showed similar results.” Another experiment came to different results. Children who were “considered sugar-sensitive by their mothers were given the sugar substitute aspartame, also known as NutraSweet. Although all the children got aspartame, half their mothers were told their children were given sugar, and the other half was given aspartame. The mothers who though their children had gotten sugar rated them as more hyperactive than the other children and were more critical of their behavior, compared to mothers who though their children received aspartame.” As a result, the sugar theory is has neither proved nor disproved; researchers continue to look into the effect of refined sugar on children (Attention Deficit Hyperactivity Disorder 4).

Recent British research shows a connection between consumption of certain food additives and increase in hyperactivity. These food additives include specifics like artificial colors or preservatives. Research is continuing to confirm the findings and to learn more about the possible link between diet and development of ADHD symptoms (Attention Deficit Hyperactivity Disorder 4).

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Since the cause of ADHD could be a result of internal or external forces, researchers are always improving their experiments and searching for information to further understand the many causes of ADHD. It is important to minimize the outside factors as much as possible during infancy and later youth. As a result, less people may become affected by the disorder.

Diagnosis Attention deficit affects 8-12% of children throughout the world. The controversy about the diagnosis of ADHD is demonstrated by the differences between US diagnostic criteria for the disorder, as defined by the “Diagnostic and Statistical Manual of the American Psychiatric Association (4th edition; DSM-IV), and the European diagnostic criteria for hyperkinetic disorder (HKD), as defined by the International Classification of Diseases (10th edition; ICD10).” Both classifications “include children displaying developmentally inappropriate levels of inattention, hyperactivity, and impulsivity that begin in childhood and cause impairment to school performance, intellectual functioning, social skills, driving, and occupational functioning” (Biederman). However, HKD criteria are more restraining than the DSM-IV diagnosis of ADHD because it requires that the patient exhibit a greater number of symptoms (Table 1).

Table 1. Differences between US and European criteria of ADHD and HKD. (Biederman) DSM-IV ADHD

ICD-10 HKD

Symptoms

Either or both of the following: All of the following: At least 6 of 9 inattentive symptoms At least 6 of 8 inattentive symptoms At least 6 of 9 hyperactive of impulsive At least 1 of 4 impulsive symptoms symptoms At least 3 of 5 hyperactive symptoms Pervasiveness Some impairment from symptoms is Criteria are met for more than one present in more than one setting setting Both DSM-IV and ICD-10, although well structured, actually have several weaknesses.

“The diagnostic items, although well-described, do not have developmentally sensitive definitions to help doctors differentiate ADHD symptoms from developmentally healthy levels 10

of inattention, hyperactivity, and impulsivity.” Clinicians often obtain data from several sources, that being parent, teacher, and child, but the DSM-IV and ICD-10 provide no procedures to integrate this information (Biederman).

No single test can diagnose a child with ADHD. It requires both the parents’ support, and frequent visits to a doctor; both procedures can properly help a child through his/her struggle.

First, a parent must begin to suspect their child has ADHD; in doing so, many can remember early symptoms like “awkwardness, clumsiness, poor balance, and delayed skills development” – which could be attributed “to deficits in communication between the two hemispheres of the brain” (Dunkin). These types of deficits are at the heart of ADHD. Researcher Robert Melillo noticed his son’s problem with concentration on the soccer field. “He had a difficult time with sports and coordinating things together, following multiple steps,” Melillo says. “On the soccer field, he just didn't get the game” (Dunkin).

Once a parent has suspicions, it is both common, and necessary, that the child be taken to see a doctor in order for a proper diagnosis. Though there is not one specific test to diagnose a child, a licensed professional may make an assessment based upon gathered information about the child, and their behavior and environment. They can also refer the family to a mental health specialist with experience in child mental disorders. In order to properly diagnosis a child, the pediatrician and mental health specialist will first try to rule out all other possibilities of symptoms; for instance, certain situations, events, or health conditions could have temporarily caused ADHD-like behaviors. These other possibilities could include undetected seizures from another medical condition, a middle ear infection hindering hearing, or any unidentified hearing or vision problems. The referring pediatrician and specialist will determine if a child has any medical problems influencing behavior and/or thinking, other learning disabilities, anxiety or

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depression, or even any other psychiatric problems producing ADHD-like symptoms. Significant and sudden events, like the death of a family member, a divorce, or a parent’s job loss, are also analyzed for their effect on the child in suspicion. As a result, caring physicians and specialist can weed out other possible causes before correctly diagnosing a child with attention deficit (Attention Deficit Hyperactivity Disorder 6).

Statistically, more boys are likely to be diagnosed than girls; in particular the ratio is three boys to every girl. Marjorie Montague, PhD, a professor at University of Miami, says, “No one knows if it is more common in boys or just more likely to be diagnosed in them. It may just be that boys are referred more commonly by teachers.� His research focuses on learning disabilities and emotional/behavioral disorders. Girls with ADHD may be more likely to be inattentive than hyperactive or impulsive, which may mean they are more likely to be under diagnosed with the disorder (Dunkin).

Treatment Once a child has been diagnosed, a doctor begins to find the proper treatment. The purpose, of course, is to prevent the child from struggling through the academic and social aspects of their life. Current available treatments include medication, various types of psychotherapy, education or training, or a combination of treatments.

The medication prescribed to those with attention deficit is called a central nervous system stimulant drug because it increases mental alertness and wakefulness. The most common drugs stimulating the central nervous system include caffeine, dextroamphetamine, methylphenidate, and pemoline. Methylphenidate specifically is used to improve attention span.

Central nervous system stimulants improve concentration by acting on a part of the brain that

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regulates mental awareness. They promote the “release of neurotransmitters to increase nerve activity in that part of the brain” (“Central nervous system stimulant drugs”).

As a result, central nervous system stimulants (table 2) have a soothing affect, minimizing a child’s hyperactivity and impulsivity. At the same time, they improve an ADHD child’s ability to focus, work, and learn. Some medication works for some, and not for others; one type may give side effects to users, and none to others. A child may have to test out many before finding the most effective one.

Table 2. List of medications used to treat attention deficit. (“How is ADHD Treated?”)

Trade Name Adderall Adderall XR Concerta Daytrana Desoxyn Dexedrine Dextrostat Focalin Focalin XR Metadate ER Metadate CD Methylin Ritalin Ritalin SR Ritalin LA Strattera Vyvanse

Generic Name amphetamine amphetamine (extended release) methylphenidate (long acting) methylphenidate patch methamphetamine hydrochloride dextroamphetamine dextroamphetamine dexmethylphenidate dexmethylphenidate (extended release) methylphenidate (extended release) methylphenidate (extended release) methylphenidate (oral and chewable tablets) methylphenidate methylphenidate (extended release) methylphenidate (long acting) atomoxetine lisdexamfetamine dimesylate

Approved Age 3 and older 6 and older 6 and older 6 and older 6 and older 3 and older 3 and older 6 and older 6 and older 6 and older 6 and older 6 and older 6 and older 6 and older 6 and older 6 and older 6 and older

Specifically, stimulant medications can come in many different forms, such as a pill, capsule, liquid, or skin patch. Medications can be short acting, long acting, or extended release varieties (table 3), allowing children to take it once for the day or make a daily trip to the school nurse (“How is ADHD Treated?”).

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Table 3. Duration of action of stimulant drugs. (Biederman) Stimulant Drug Methylphenidate Ritalin, methylin, focalin Concerta Ritalin LA Metadate CD Amphetamine Dexedrine Adderall Adderall XR

Duration of action 3 hours 10-12 hours 8-9 hours 8-9 hours 3 hours 6 hours 10-12 hours

While the stimulant medication is incredibly useful, there are many commonly reported side effects that come along with it. Side effects include “reduced appetite, tremor, and palpitations.” These drugs can also cause “restlessness, sleeplessness, anxiety, shaking, and sweating.” Along with “mild stomachaches, headaches, rashes and allergies,” all the side effects are minor and disappear over time. If stimulants are taken long term, “stopping [one] may cause withdrawal symptoms, including lethargy, depression, and increased appetite” (“Central nervous system stimulant drugs”). Parents are encouraged to cook good, healthy meals for their children.

If a child has trouble sleeping as a result, a doctor will subscribe a lower dose or suggest the medication be taken at a different time (“How is ADHD Treated?”).

It’s not yes or no to drugs. It is more complicated. Like, it’s okay to give a child who needs pain medication some pain medication because he is in pain. It is not okay to give him pain medication so you don’t have to read him a bedtime story before he can go to sleep. I was given Ritalin as a kid so that I would sit down at my desk more often in school. (Mooney and Cole 53) Regardless of when a diagnosis is made, it helps parents understand the reasons for their child's behavior and how they can aid their kids. Melillo says, “There is help for ADHD.” That can include ADHD medications, therapy, and changes at school and at home. “With medication, behavior modification, and an individualized program he devised to help his son develop skills, Melillo says his once-inattentive second-grader is now a successful college freshman” (Dunkin).

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Misconceptions There are many misconceptions and assumptions about a child with ADHD. Though overlooked, researchers find many benefits in having attention deficit. The official definition defines ADHD as a set of eighteen symptoms, of which in order to qualify for the diagnosis, you need six.

Diagnostic Criteria for the three subtypes of Attention-Deficit/Hyperactivity Disorder according to DSM-IV: A. “Persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and is more severe than is typically observed in individuals at comparable level of development.” Individual must meet criteria for either (1) or (2): (1) Six (or more) of the following symptoms of inattention have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level: Inattention (a) often fails to give close attention to details or makes careless mistakes in schoolwork, work or other activities (b) often has difficulty sustaining attention in tasks or play activity (c) often does not seem to listen when spoken to directly (d) often does not follow through on instructions and fails to finish schoolwork, chores or duties in the workplace (not due to oppositional behavior or failure to understand instructions) (e) often has difficulty organizing tasks and activities (f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework) (g) often looses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books or tools) (h) is often easily distracted by extraneous stimuli (i) is often forgetful in daily activities (2) Six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level: Hyperactivity (a) often fidgets with hands or feet or squirms in seat (b) often leaves seat in classroom or in other situations in which remaining seated is expected (c) often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness) (d) often has difficulty playing or engaging in leisure activities quietly (e) is often “on the go” or often acts as if “driven by a motor” (f) often talks 15

excessively Impulsivity (g) often blurts out answers before questions have been completed (h) often has difficulty awaiting turn (i) often interrupts or intrudes on others (e.g., butts into conversations or games) B. Some hyperactive-impulsive or inattentive symptoms must have been present before age 7 years.

C. Some impairment from the symptoms is present in at least two settings (e.g., at school [or work] and at home).

D. There must be clear evidence of interference with developmentally appropriate social, academic or occupational functioning.

E. The disturbance does not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorders and is not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder). (Aupperlee et al.)

“The pathology of ADD—its disorderly side—represents only one part of its total picture.

The other part, the part that the DSM-IV and other catalogs of pathology leave out, is the zesty side of ADD. People with ADD have special gifts, even if they are hidden.” The most common gifts include “originality, creativity, charisma, energy, liveliness, and unusual sense of humor, areas of intellectual brilliance, and spunk.” The creativity that compliments ADHD brings about some of the world’s best “entrepreneurs and actors, along with writers, doctors, scientists, attorneys, architects, athletes, and dynamic people in the walks of life” (Hallowell and Ratey 4).

People make many misconceptions based upon a child’s actions when it comes to ADHD. For example, a parent may claim their child is just lazy and unmotivated, instead of having a disorder. However “a child who finds it almost impossible to stay focused at school or complete long tasks may try to ‘save face’ by acting as if he or she doesn’t care or doesn’t want to do the task” (“Hidden in Plain Sight”). This way he is able to mask the serious difficulty in his ability to function. Another instance occurs when a parent says that “He’s a handful (or ‘She’s a daydreamer…’), but that’s normal. They just don’t let kids be kids.” It is true that all children can be impulsive, active, and inattentive; yet, a child with ADHD will have a problem fitting into

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“family routines, keeping friends, avoiding injuries, and following rules” (“Hidden in Plain Sight”).

One of the most common assumptions parents can make is that since their child can focus on video games for hours on end they can’t have ADHD. In reality, though, the child is staying focused “on the stimulating visuals, sounds, and physical activity of video games, [he/she] ha[s] real problems dealing with situations where [his/her] senses aren’t as stimulated.” Some example of this include sitting in a classroom for long periods, organizing projects, and dealing with people in ways that require frequent and subtle changes (“Hidden in Plain Sight”). David Cole, a high school dropout and later Brown graduate, writes in his book, Learning Outside the Lines, about his experiences dealing with ADHD. What is that about, anyway? ‘He can pay attention to what he likes/wants to.’ It is definitely about living in discomfort. I used to be afraid to get my head wet. I would panic; it would overwhelm me. And in the pool at Storres Pool—my chest tightening right now—and my frustrated mom. And uncomfortable, because other people are staring at her. . . It’s my fault, my fault, that all of the people are disapproving of her. I just don’t want to get my head wet. “So does that mean that kids should only have to do what they enjoy?” Maybe. But I had to get my head wet if I was going to swim. (Mooney and Cole 52) Once a child has been taken to the doctors in order to be diagnosed or not, there are still many misconceptions about how to continue on the right path for the child. For one, if a child does not receive a diagnosis, they still need help. Even if they do not meet the clinical requirements, a child may still need the extra help and counseling. “ADHD can manifest itself in different ways over many years. The key is to continue helping your child learn to function better at every age.” It is common to believe that when one’s child is diagnosed with ADHD, that poor parenting is at fault; however, it most definitely has no effect (“Hidden in Plain Sight”).

Finally, when a child starts to take their medication, many parents assume that the meds will treat the disorder and the goal is to get off of it as soon as possible. Unfortunately, ADHD is

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a chronic condition that does not just go away. “From childhood to adolescence to adulthood, ADHD evolves and treatment may need to evolve with it. Getting off ADHD medications is not the goal; dealing with the problem effectively is” (“Hidden in Plain Sight”).

Why Focus On Middle School Students?

Attention deficit affects each stage of human development differently, resulting in an impact of symptoms and treatment that vary by age. “Although about ten percent of infants appear to have difficult temperaments characterized by irritability, hyper arousal, over activity and inability to be easily calmed, clinicians do not diagnose ADHD in infancy.” When children reach a preschool age, it is customary for them to be overactive and impulsive. Adults expect a toddler that cries and throws temper tantrums, because their attention can only be captured for a short period of time. Clinicians have to be cautious in sorting out the normal from over-the-top ADHD-like behaviors. For example, if a child experiences a language delay, they may exhibit hyperactive behavior out of frustration arising from their inability to communicate. The common methods of discipline, like time-outs, refused to have any impact. However, the majority of inattentive preschool children show improvement in these areas as they mature; consequently, children with symptoms lasting longer than a year have a stronger chance of being diagnosed (“ADHD Across the Lifespan”).

Some children will be diagnosed as they are turning nine or ten years old. If a child leaves a trail of uncompleted tasks, like a messy room, uncompleted games, and mixed homework, he/she is primarily inattentive. If hyperactivity and impulsivity are also present, the scenario at home becomes more chaotic; for example, the child may color the walls, disrupt meals, or break toys. “Patterns of academic frustration and failure, social rejection and criticism from parents and teachers build in elementary school to the point where other disorders associated with ADHD

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begin to appear.” Over half of these children actually develop another disorder, characterized by defiant and non-compliant behavior (“ADHD Across the Lifespan”).

At this time, most children are referred for an assessment, after which a diagnosis and treatment is then started. Those with hyperactive/impulsive ADHD are more likely to be noticed by a teacher or parent because of their disruptive behavior in the classroom and the home, respectively. On the other hand, an inattentive child may go unnoticed, yet still struggle with schoolwork and focusing (“ADHD Across the Lifespan”).

School-related problems often suddenly escalate when ADHD kids hit middle school. The “transition can be stressful for the best of students, but for a child with an ‘invisible’ disability such as ADHD, it can be traumatic unless parents, teachers and the students themselves team up to address problems before they escalate” (Tsuchiya). The middle school setting sets an undiagnosed child up to fail. Not only are the academic challenges harder than those in grade school, but also the students in middle school begin to develop more “complex social relationships, trying to gain independence and find more and more demands and responsibilities placed on them” (Bailey).

Grade school is vastly different than middle school; in it, students stay in one classroom all day with one teacher who covers a majority of subjects. Each student has a desk where all books and supplies are kept and left. However, everything changes once a child reaches middle school. All of a sudden, students must move from classroom to classroom, receiving a different teacher for each subject. Children must carry books, pens, and pencils to each class and keep a surplus of handouts and homework together. Greater demands are placed on students in secondary schools with more teachers, more work, and less supervision. “The ADHD adolescent

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starts middle school with several teachers each of whom probably has two hundred or more students to teach. It is easy to get lost in the shuffle” (“ADHD Across the Lifespan”).

Once in middle school, students are expected to stay organized, pay attention, and make friends; for a child with ADHD, all three are a frustrating challenge. “Staying organized is a pipe dream for the ADHD student in a school setting with multiple classes” (Tsuchiya). The necessary skills—“keeping planners, filing papers, and remembering whatever books, binders and implements are needed for class or homework”—don't develop naturally. In ADHD kids, these are skills that must be taught and worked at. Students with attention deficit are easily distracted.

I get frustrated by getting distracted. (That is a sane way of saying it; the better way would be: ‘badsitdownnonotgoodagainalwaysneverdoitnotdoingitwhatareyousupposedtodonowwhatswrongwithyouwhodoyouthinkyouare.’) (Mooney and Cole 52) ADHD kids struggle keeping track of time, paying attention in class, and getting work entirely completed. Arriving to every class of the school day on time can be particularly challenging (Tsuchiya).

Lastly, there are lots of new faces throughout the hallways of the middle school. Instead of spending the day with the same kids in the same classroom, middle school students must navigate through the school to different class, encountering many new faces each day. “Behaving impulsively and missing social cues—both common among ADHD students—often land them in the principal's office or make them targets of ridicule.” The skills needed to succeed in middle school are the skills many children with ADHD struggle with, leaving middle school to be the primal age with which ADHD proves to be the most threatening (Tsuchiya).

In addition, during the middle school, a child’s self image and how he/she is viewed by peers often centers on school performance. If a child succeeds in school, they may be well liked;

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consequently, if a child struggles or fails a class, they might be thought of as “stupid.” Social relationships change at this age as well. Belonging to a group becomes extremely important and when a child with ADHD feels he/she doesn’t fit in, it can be devastating (Bailey).

Into high school and adulthood, ADHD may either persist or calm down. Limited research has been conducted up until the last fifteen years on the effects of attention deficit in adults. Dr. Sam Goldstein explains that ADHD can be very variable. He categorizes adults with histories of ADHD into three categories: 1) “those who seem to function fairly normally as adults although they have had childhood ADHD; (2) those who continue to have significant problems with ADHD as well as life difficulty involving work, interpersonal relations, selfesteem, anxiety and emotional liability; and (3) those who develop serious psychiatric and antisocial problems and are quite dysfunctional” (“ADHD Across the Lifespan”).

As a result, the middle school/adolescent age proves to be the primary stage of life to track the effect attention deficit has. Because of the new atmosphere and more freedom, children entering middle school suffer to a greater extent on the academic and social level than had previously and thereafter. It is known that on account of the new environment ADHD is discovered easier and treated quicker than in earlier academic years.

Academic Issues As a pre-teen struggling with attention deficit, there are many accounts in which a disorder may separate he/she from the rest of his/her peers. More specifically, children and their parents identify both the academic and social scene to be the most effected during the middle school age. For that reason, researchers focus on helping students with ADHD in these areas by educating their parents and teachers with numerous methods.

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Chris Dendy advocates against the common tendency to address the social/behavioral issues a child with ADHD possesses. Instead, she believes in addressing the child’s academic struggles first. “Succeeding in school is one of the most therapeutic things for a child. For the ADHD child, academic interventions improve behavior, but the converse is not true,” she states.

Attention deficit can cause students to have more challenging school experience than the rest of their peers. William Bennginer, Ph.D., cites that 90%+ of ADHD students have a poor school performance as a result. Studies found that students with ADHD, compared to students without ADHD, had persistent academic difficulties that resulted in the following: “lower average marks, more failed grades, more expulsions, increased dropout rates, and a lower rate of college undergraduate completion” (“How Does ADHD Affect School Performance?”).

In order to prevent many failed grades and dropouts, two federal laws have been created specifically to protect public-school students with ADHD, the Individuals with Disabilities Education Act (IDEA) and the Vocational Rehabilitation Act, Amendments of 1973 (Section 504). Under IDEA, ADHD students qualify for special education. Schools and parents jointly produce an Individualized Education Program (IEP) for the child, which recognizes needs and services to be issued and expected outcomes. A student can choose to remain in the regular classroom or be put into a special-education environment.

Section 504 is a civil-rights law that “essentially seeks to ‘level the playing field’ for people with disabilities— everything from constructing ramps to overcoming access issues to modifying teaching or evaluation methods” (Tsuchiya). ADHD students typically stay in the normal classroom but take advantage of accommodations provided, like sitting in front, having duplicate textbooks for school and home, continuous communication between teachers and parents, having assignments modified, and taking longer on tests.

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Starting either an IEP or a 504 plan requires a referral by a teacher, other school staff, parent, doctor, or tutor. The school must then consider whether or not to perform their own evaluation on the child, or accept a doctor’s ADHD diagnosis. If a child is denied an evaluation or thought of as not eligible, parents may challenge the verdict starting with the school principal, school-district's 504 coordinator, then the district superintendent, then the U.S. Dept of Education. If no agreement is reached, parents may take the case to court (Tushiya).

ADHD negatively effects the academic portion of a child’s middle school career. School can start bad, and get worse. “With failure rates double to triple those of other children, about 50 percent repeat a grade by adolescence.” Roughly thirty-five percent of ADHD teenagers typically drop out of school at some point and shockingly, a mere 5 percent are recorded to have completed college. One study recorded that by eleven, most are two years at least behind in reading, writing, spelling, and math (“ADHD: Building Academic Success”).

Studies have found that students with ADHD, compared to students without ADHD, had persistent academic difficulties that resulted in the following: “lower average marks, more failed grades, more expulsions, increased dropout rates, and a lower rate of college undergraduate completion.” This disruptive behavior may make students with ADHD more susceptible to suspensions and expulsions. “A study by Barkley and colleagues found that 46 percent of their student study group with ADHD had been suspended and 11 percent had been expelled” (“Identifying”).

The three main characteristics of ADHD—inattention, impulsivity, and hyperactivity— can certainly interfere with academic performance. Children with ADHD pay attention to what is stimulating yet may have trouble focusing on the important information. Instead, they become caught up in the background noise or irrelevant details. Students with ADHD may be unable to

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sustain attention. At times, the school environment is not an ideal place to hold their attention.

Adults unless they recognize the ADHD, will see the hyperactivity side, both motor and verbal, as misbehavior when children are expected to sit quietly. “Deficiencies in executive brain functions tied to motivation, analysis, goal setting, and problem solving can seriously impair academic performance among children with ADHD. In addition, up to 50 percent of children with ADHD have coexisting learning disabilities, especially in spelling, reading, writing, and math” (“ADHD: Building Academic Success”).

Organization tends to be a continuous struggle for students with attention deficit. In particular, those problems are shown to escalate following the transition to middle school on account of the numerous environmental changes. Students face a greater number of teachers, increased demands for independence, and larger workloads as they make the transition from fifth to sixth grade. Middle school children with ADHD frequently “lose homework assignments or fail to turn them in on time; misplace school materials such as books, pencils, and class work; and procrastinate and fail to adequately prepare for tests” (Langberg et al).

Since there is a need for organization in the academic life, psychosocial interventions have been developed. Considering the medication does not normalize these problems, organizational skill interventions have typically focused on academic aspects of organization, such as classroom preparation, homework management, and managing time during and after school, in addition to the physical organization of school materials. “Organizational skills training has been included as part of a number of multicomponent interventions for children with ADHD, which are considered multicomponent because in addition to targeting organization and time management, they often target behavior problems, social skills, and other

educational

skills.” As a result, these interventions have led to significant improvements in organization for

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kids with ADHD (Langberg et al).

Tips To Surviving Middle School Considering how tough the transition into middle school is for students with ADHD, researchers over the many years have come up with several pieces of advice to cope with the change. Though ADHD is a difficult disorder to strive academically with, hard work and communication between the child, parents, and teachers can make the journey much easier.

The first step between parents and their children is to get on the same page. A strong family support team gives a child the best chance to succeed at school. It isn’t until both parents have accepted their child as having attention deficit will the child’s needs have a greater likelihood of being met. Tom Dendy spoke about his experiences at a conference; he had trouble accepting his son Steven’s ADHD and constantly argued with his wife about the matter. When she suggested counseling for their son on account of his poor academics, Tom recalls remarking, “You want me to pay someone $100 an hour because our son's too lazy to do his homework?" It was only when Steven attempted suicide did Dendy accept that his son needed professional help and from then on, was completely supportive (Tsuchiya).

Not only do parents need to reach the same page, but also the child must weigh in on the discussion. The next step is educating the child on what attention deficit is and the way that it works. “Students with ADHD need to be able to advocate for themselves. In order to do this, they must understand ADHD and its impact on learning” (Tsuchiya). Drawing up a contract with the child is a recipe for success. “Based on what has worked well in the past. You might want to work on school-relayed behaviors that need improvement, and offer new rewards for success” (Schwartz).

Another crucial step is to establish a consistent home routine for the child including

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everything from bedtime customs to history homework. “Starting and finishing tasks is so difficult for people with ADHD, routines are a good way to teach the critical cognitive skills needed for school success: organizing, starting and finishing work, and planning” (Tsuchiya). By creating little habits, students with ADHD can become not only more organized, but more successful. These habits include:  

 



“Making sure assignments come home every night and all the materials needed.”

“Working with the child to decide what he needs in his locker—and get rid of unnecessary items. Make the space more efficient with additional shelves, hooks for a gym bag, and a hanging organizer.”

“Keeping a “to-do” list [so that] a child can prioritize his/her time by dividing tasks into categories of important (do it now!) and less important (do it anytime).”

“Posting sticky notes, with reminders, on mirrors, doors, and elsewhere, keep cheerleading for the child while reminding him of his responsibilities [, and] encourage the child to post reminders to himself.”

Setting the child up with a “portable computer with a built-in keyboard, like Alpha Smart, to write reports and take notes” (Schwartz).

If such tasks start to become part of a child’s regular routine, he/she stands the best chance of controlling his/her ADHD. Considering teachers interact the most with the students on the academic level, they “must be adequately prepared to teach adolescents and to meet the individual needs of all students.” Children with attention deficit struggle most when they are “expected to follow rules, act in socially proper ways, participate in academic activities, and not interrupt the learning development or activities of others” (Guerra and Brown 1).

A study was conduct to examine middle school teachers’ level of knowledge regarding attention deficit hyperactivity disorder. The study questions tested the teachers general knowledge of ADHD including the diagnosis and treatment plans (Guerra and Brown 2). The study targeted five public middle schools in three different districts in South Texas (Guerra and Brown 3).“The data analysis indicated that the levels of knowledge of ADHD among middle 26

school teachers in South Texas are low, with scale knowledge scores ranging from 46% to 66%.”

These findings emphasize that educators have not been successful prepared to deal with special education (Guerra and Brown 5). Educating teachers to a greater extent about ADHD may influence how they interact with and instruct children. By providing educators with a higher understanding of the effect of ADHD, they may become less negative toward students and work to help them succeed in school. Past studies have established that teachers continue to provide incorrect recommendations to parents of ADHD children and those parents have followed that mistaken advice (Guerra and Brown 6).

As a start, many families with ADHD children are encouraged to establish a relationship and provide knowledge pertaining to their child’s ADHD, by establishing meetings with each new teacher at the start of the year. However, “by the time the child reaches high school, many parents of ADHD kids can be burned out on meetings with teachers, but it's important to keep renewing the commitment to the child's success” (Tsuchiya). Monica Pardee, mother of a 12 year old, Chris, who has ADHD, prepares a success pack for each of Chris' teachers at the start of the semester. She constructs a letter introducing her son and explains that “his ADHD is not an excuse and that he's capable of behaving and performing as expected. She then provides all her contact details and asks to be notified immediately of any problems at school” (Tsuchiya).

Through all of these tips researchers have posed, much of the middle school experience proves to be bearable and worthwhile. Developing the little habits such as making a “to-do” list of priorities, students with attention deficit can carry with them to high school and their job.

When they don’t have parents to write letters to their teachers or post sticky notes around the house, most students can struggle and fall into a rut. However, knowing that they can succeed, even if it was in 7th grade math, can boost themselves up enough to get them back on their feet.

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Social Issues Many children with ADHD have trouble in social environments, understanding the typical social cues and predicted behavior. Especially in the middle school, students are surrounded by their peers, all desperately trying to fit in. At this time, being social feels more important than anything; consequently, being on the bottom half of the social pyramid could come as a result of bullying or lack of acceptance by others. Therefore, attention deficit proves to be a liability for children in comparison to those of their peers without the disorder.

Dr. Ken Dodge of Duke University studied the way people react to any particular situation by constructing a list of the series of events that go through one’s mind as they decided on a response to a scenario. First, he/she has to read and comprehend the social cues present. For an example, in a situation with a boy getting bumped by a peer, the offended child may read into the “peer’s facial expression (i.e. does he look contrite or provocative?), the expression of any witnesses, and the tone of voice the peer uses when he apologizes (i.e. does he sound sincere or sarcastic?).” Depending on all those factors will the child decide on an appropriate reaction.

Dodge believes that there are many social cues to be interpreted from just one scene. The better one can comprehend those cues, the more “accurate picture” of the circumstances one may come to (“Social Problem Solving”).

Next, after reading all the cues, it is necessary to analyze them properly. Determining the intentions of others is a difficult task; they are not always specific and defined, but can be confusing and unclear. As a result, it is easy to decode an event multiple, different ways. Back to the bumped child, he could assume the incident was an accident and not be upset, or he could believe it to be a personal insult and get angry. Then, a person is expected to produce several ways to respond, weighing the good and bad of each. Problems can occur, however, if a “child

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[is] not . . . able to generate many alternatives, and thus has a limited range of options to choose from . . . or a child might consistently select options that are problematic.” For example, an aggressive child would be quicker to choose a hostile response. It is key to understand the complications that can arise if a child struggles to correctly read cues from the first stage, causing them to respond unnecessarily toward another peer (“Social Problem Solving”).

In the study conducted by Dr. Dodge, children with and without attention deficit watched several short videos of children in different problematic social situations. For example, a child lets another play with his plastic airplane and the kid breaks the toy. The results of the study showed that in comparison to those without ADHD, those with ADHD picked up “significantly fewer cues and . . . also generate[d] less alternative strategies for dealing with the different problematic situations.” As a result, children with ADHD are known to not be as equipped in dealing with social situations because they are unable to understand the entire picture (“Social Problem Solving”).

A child with ADHD is known to have unstable relationships with others, causing them to be unhappy (“Attention Deficit Hyperactivity Disorder (ADHD)”). Typically, they struggle more socially than students without attention deficit. They may have difficulty keeping their behavior and emotions in control. Children with ADHD tend to be very physical and aggressive and react angrily when upset. As a result, the average ADHD child can have trouble making and getting along with friends, because others may not deal well with their hyperactive or impulsive behavior (McAuley et al.). The impulsivity can cause kids to take “chances before thinking them through, putting them in situations where the consequences become clear only after the action has been taken.” Children with ADHD have a greater chance of getting into felonious behavior in their teenage years and then criminal activity in adulthood (“Attention Deficit Hyperactivity

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Disorder (ADHD)”).

Proactive measures (i.e. social skills training, cognitive therapy, and medication) can be taken to help ADHD children understand and smooth out difficult social behaviors. Social skills training uses reinforcement tactics and rewards for correct behavior; furthermore, it helps adolescents learn to evaluate social situations and adjust their behavior accordingly. Nonetheless, teenagers with ADHD may continue to have problems with socialization, causing misery for an adolescent seeking peer acceptance (Pruitt).

Children with attention deficit are often considered to be several years below their peers in emotional maturity. Middle school students with ADHD, furthermore, are said to have the emotional maturity of a fourth or fifth grader, while trying to fit in with peers their own age. This immaturity may lead to greater frustration as well as feelings of isolation. The average teenager may want to be left home alone or to go the movies by themselves; however, since attention deficit causes kid’s to be less mature than their peers, it isn’t plausible to give them the freedom that others receive. This can greatly affect a child’s self-esteem (Bailey).

Boys with Attention Deficit Tuesday was a rough day for Ben. He had two tests and a quiz back to back. He had dedicated the previous night to non-stop studying, but when he arrived at school, he felt unprepared and distracted. As each class passed, Ben, fidgeting in his seat, found himself staring out the window.

Half of the tests weren’t even completed when the bell rang. He knew the material, he told himself, what went wrong? The next day, he saw the big, red C’s and D’s written atop his tests.

The effect attention deficit has on boys is different than its effect on girls. A middle school boy is the typical rambunctious, unfocused pre-teen who forgets his homework and talks in class. When the average person recalls what they know ADHD to be, that stereotype is the first image to pop into their head. However, many don’t understand the different effect attention deficit may have on girls. Instead of being loud and talkative, girls may be quiet and keep to

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themselves. As a result, girls with ADHD may go unnoticed; realizing the symptoms and paying careful attention to each individual can be beneficial in the long run.

Most boys with ADHD struggle with inattention, impulsivity, hyperactivity, or all three.

Consequently, it impedes their academic performance and can lead them into trouble. When it comes to inattention, adolescent males have a hard time focusing in school. They would rather be flirting with the girl in science class than concentrating on the quiz. Teen boys find it extremely difficult to stay focused on tasks that don't hold their interest. They make careless mistakes, don't follow through on homework and chores, and lose things on a regular basis. Typically, one would have a disorganized room, locker and backpack, causing him to misplace things such as his keys, cell phone and homework (Bolyn). ADHD causes students to become forgetful and careless. “An adolescent male might forget he's supposed to go to a doctor's appointment after school and goes skateboarding with his friends, or doesn't remember he has an upcoming history test and never studies. This can lead to constant arguments at home and poor or failing grades” (Bolyn).

The teen population is known for making impulsive decisions; however, adolescent males with ADD/ADHD have an even harder time than their peers reigning in their impulses. As a result, they’ll mostly make both significant and meager decisions without putting any thought into the matter. For example, “a teen boy with ADD/ADHD might try drugs with his friends before thinking about the consequences or have unprotected sex without considering that he might get a sexually transmitted disease or become a father” (Bolyn). When it pertains to school, a teenage boy with ADHD is more likely to blurt out answers and interrupt his peers and teachers.

Hyperactivity causes teenage boys to have a hard time sitting still and focusing all day at

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school; however, that's exactly what the middle-school setting expects them to do. Over time, as their energy builds up, they may start to talk back to teachers, become irritable and get into physical fights with peers. It could lead to them getting detention or suspended more often than their peers (Bolyn).

Ben and his friend, Tim, were wrestling in the hallway. It started out as funny, typical boy behavior. However, the fighting turned quickly from playful to forceful. Ben didn’t understand Tim’s scared response to his sudden over-aggression. Once the English teacher broke up the scuffle, confused Ben couldn’t understand why Tim left and later refused to talk to him. Ben and Tim didn’t talk for several weeks.

In the social scene, an ADHD boy struggles the most with the issues mentioned previously. However different from girls, boys tend to be standoffish; they are described to be very intense people, more interested in subjects and facts than the people around them. In addition, “boys tend to make friends with people older or younger than themselves. Thus placing themselves in relationships where their role is clearly defined” (Hefley).

Boys in general are less likely to show empathy toward others in difficult situations.

However, when boys with attention deficit hurt someone, they may either completely deny it or blame themselves greatly. “As ostracism, fear, and ridicule from peers persist from year to year, the unstable behavior, originally neurologic, becomes emotionally based. Unless this cycle is broken, serious adult problems can evolve” (“Attention Deficit Hyperactivity Disorder (ADHD)”).

For a boy with ADHD, it is important to find an outlet to channel his energy toward, such as playing sports (Bolyn). Specifically, the activities are to build their self-confidence, so it should be one he can excel at. Most importantly, that activity should use “less motor coordination while running and minimal eye-hand coordination (i.e. martial arts, swimming, wrestling, horseback riding, bowling, or golf)” (Silver).

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Girls with Attention Deficit Many people assume attention deficit to be a disorder for boys. However, “ADHD is not gender-linked,” says Dr. Patricia Quinn, director of the Center for Gender Issues and ADHD (Adams). Many understand ADHD to be a disorder that causes children to be loud and unfocused; therefore, since boys demonstrate those external symptoms of behavior and girls tend to be more internal with their ADHD, many people don’t comprehend the quiet effect the disorder has on girls, leaving them without a diagnosis. Studies guesstimate six more boys are refered to the doctor to every one girl; yet, estimated, the actual ratio of ADHD in boys to girls is 3:1 (“Understanding Girls with ADHD”). Furthermore, Dr. Quinn goes on to say, “The diagnosis should be 50-50 between boys and girls” (Adams). This leaves many girls without a diagnosis or a clue. Since many more boys fit the typical description, they are much easier to spot. Girls, who are hyperactive and impulsive, are rare and are typically labeled tomboys or social butterflies (“Understanding Girls with ADHD”).

“All Ashley needs to do is copy the words off of the board,” said Mr. Jeffery, the 7th grade history teacher, to his colleague. “She has trouble doing that. She’s either slow or refusing to put forth any effort. She always seems bored and unfocused, but she isn’t disruptive or talkative.

She keeps to herself. I don’t know what to do at this point. I guess she could be sent to the resource room for extra help.”

At school, girls with ADHD may not be interrupting the teacher as he/she speaks, but that doesn’t mean that they are paying attention and taking notes. Instead, girls are known to spend class excessively daydreaming. Therefore, girls typically receive bad grades, even though they are much smarter. A girl may be considered a lazy or slow student who doesn’t work hard, even though ADHD doesn’t affect lack of effort. The hyperactivity side of girls might give them the ‘Chatty Cathy’ label on account of constant talking (Tartakovsky).

Most people assume attention deficit has the same effect on both boys and girls; however, that is not the case. The first common mistake is the thought that if a girl has ADHD, she must 33

only be inattentive. While it is more common for girls to be that type, it doesn’t mean there aren’t girls with hyperactivity. Instead of being diagnosed with ADHD, those battling with ADHD hyperactivity may be known as tomboys. Stephanie Starkis Ph.D, a psychotherapist and author, accredits girls with ADHD not being hyperactive in class to socialization. “It is thought that one reason girls exhibit less hyperactivity in class may not have to do with the disorder itself – rather, girls may have been socially conditioned to speak out less in class and be less disruptive,” she said. Another myth is that girls with the inattentive type of ADHD don’t need stimulants, because they only treat hyperactivity, yet stimulants make inattention and distractibility easier to control. “Treating any disorder with medication requires careful consideration. But it’s important for parents and practitioners to know that stimulants can successfully treat these very disruptive symptoms of ADHD” (Tartakovsky).

Many people make many incorrect statements about the effect ADHD has on girls in comparison to what they know about boys. This leaves many girls alone and without proper help.

Once educated, an adult can make a huge difference in a child’s life just by identifying the disorder.

‘It’s all my fault,’ Ashley thought to herself. ‘If I had just remembered the stupid formula, I could have aced that math quiz. Why can’t I just focus and get it together? My mother is going to kill me. And why did Katie make that rude comment about my skirt today? All my friends are turning against me. Even Stacey didn’t say hi to me in history.’

Socially, a pre-teenage/teenage girl with ADHD goes through similar symptoms as a boy does; yet many believe the disorder impairs their social relationships to a greater extent. Janet Giler, Ph.D., points out that “males and females, in general, operate by different social rules . . .

Female social rules place a greater value on cooperation, listening, care-taking, and relationship maintaining activities . . . [Thus] it would make sense that the traits of ADHD might make females seem less cooperative." As a result, girls may be rejected by their peers. Girls often get

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distracted when someone is talking, miss social cues, and don't respond well. Since boys are more direct to each other and quickly resolve conflicts, they don’t need the same set of cues as girls (“Understanding Girls with ADHD”). ADHD girls typically have few friends and are labeled as loners. As a result, they succumb to more emotional outbursts than others. Girls continue to constantly “feel overwhelmed and internalize that into anxiety and fears” (Tartakovsky). The bossy and domineering or inattentive and shy attitude ADHD girls have stems from having trouble keeping pace with the verbal give-and-take conversations with others.

As a result, since they don't understand and can’t keep up, they seek to either control the verbal flow or not to be noticed (Hefley).

Attention deficit is difficult to detect in girls until they have reached puberty when their hormones cause “dramatic mood swings and disruptive behavior.” Suddenly, once middle school takes its course, a girl with an unknown disorder often appears to explode on account of the female hormones. Unfortunately, those girls whose attention deficit isn’t treated until now are at a greater risk for developing anxiety and/or depression; furthermore, most have spent their “lives suffering, struggling, and blaming themselves for poor academic performance and peer rejection.” Girls may even feel such rejection from those that are supposed to be closest to them.

“Mothers often expect their daughters to conform to the standards of society by being especially thoughtful, polite and compliant.” If a girl has ADHD, this can be a challenging goal to attain.

As a result, a strain can be placed on the mother-daughter relationship; while the mother has trouble understanding her daughter’s inappropriate behavior, the daughter can be left feeling angry and upset at herself (“Understanding Girls with ADHD”).

As they mature, girls tend to internalize their feelings, leaving them to suffer without comfort from loved ones. Girls with untreated ADHD have a greater chance than their non-

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affected peers of being addicted to behaviors like “over-eating, smoking, alcohol abuse and sexual promiscuity.” Specifically, studies demonstrate the likelihood of girls with ADHD to become overweight and have low self-esteem (“Understanding Girls with ADHD”).

Depression is a common struggle many girls face as a result of their disorder. New findings from a study at UC Berkeley caution that girls with ADHD are more “prone to internalize their struggles and feelings of failure, a development that can manifest itself in selfinjury and even attempted suicide.” The experiment resulted in data showing high rates of girls cutting and using other forms of self-injury, even several suicide attempts. Researchers found that into adulthood, the outcomes of ADHD in females are unimaginable (Anwar).

Suffering from attention deficit is a tough feat for a middle school girl, especially if it goes untreated. She is left without success in school or many friendships to rely on. As a result, it is crucial to be educated and driven to identify girls with the disorder.

Conclusion Two years later, Ashley and Ben enter high school. Ben is no longer getting out of his seat and interrupting the lectures; he is focusing and turning in his homework. One year ago, Ben was diagnosed with ADHD. He started taking medications every night and follows a morning and night routine. His friends do their best to help him stay organized and bring home his homework. Ben is overcoming the effects of ADHD; though the disorder may never completely wither away, he has developed the best possible strategies to stay on top of his schoolwork and keep his actions in check.

Ashley’s scenario turned out to be a happy ending after all. After many failed tests, lectures from frustrated parents and fights with friends, Ashley’s mother recalled a seminar she had heard about ADHD. She suspected some form of disorder keeping her daughter from excelling through life. She took Ashley to the clinician with the hopes of helping her daughter towards the end of Ashley’s eighth grade year. Once diagnosed, both of her parents and her teachers worked together to help Ashley finish off the year. She enters high school confident and excited to be challenged. Ashley is no longer depressed and enjoys hanging out with her friends.

By just suspecting the disorder, Ashley’s mother made Ashley’s life incredibly different.

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Annotated Bibliography Adams, Caralee. "Girls and ADHD: Are You Missing the Signs?" Scholastic Teachers. N.p., n.d. Web. 19 Dec. 2012.

This source focuses on preteen girls developing ADHD. As stated in the source, the world needs to recognize just how few girls get diagnosed with ADHD out of the many suffering from it. It is much harder to differentiate girls with ADHD against girls without; therefore, this source gives many scenarios in order to educate teachers and others the ways in which ADHD affects girls.

Anwar, Yasmin. "Girls with ADHD More Prone to Self-injury, Suicide as They Enter Adulthood." UC Berkeley NewsCenter. N.p., 14 Aug. 2012. Web. 19 Dec. 2012.

This article looks at the way in which ADHD affects the social aspect of a young girl’s life. Girls pick up social cues easier than boys and are left having trouble acting on them. As a result, this article, through means of experiments, proves that on account of this defect girls are more prone to self-injury. The article has many quotes from educated researchers to make it even more beneficial.

"ADHD Across the Lifespan." ADHD Across the Lifespan. N.p., n.d. Web. 25 Mar. 2013.

This article comes from a website targeted toward parents and teachers of children with ADHD. Specifically, it in detail describes the different effect ADHD has on the different stages of life. Since one section covered the importance of attention deficit in the middle school, this source was incredibly helpful.

“ADHD: Building Academic Success.” LD OnLine: The World's Leading Website on Learning Disabilities and ADHD. N.p., n.d. Web. 15 Apr. 2013.

This site focuses mainly on the academic impairments that ADHD causes. Most students with the disorder struggle to finish high school and few actually complete college. The source had useful statistics.

The source gave useful tips for parents and teachers to accommodate the kids.

"Attention Deficit Hyperactivity Disorder (ADHD)." The New York Times. N.p., 27 Feb. 2012. Web. 29 Apr. 2013.

This resource covers all aspects of attention deficit in depth. From background to causes, and diagnosis to social problems, this article has it all. I particularly used the information on the social and emotional problems to expand my knowledge of the struggles socially that both girls and boys with ADHD face.

Attention Deficit Hyperactivity Disorder. National Institute of Mental Health: U.S. Department of Health and Human Services. 2008. Web. This source provides detailed information as to what ADHD actually is and how to diagnosis it. It is presented in the form of a pamphlet expressing everything one needs to know about ADHD. This source has provided useful in educating me on the causes of ADHD and how it is treated. It is particularly valuable because it will tell me ways in which parents can help their ADHD affected children.

Aupperlee, Jana, Marianne Swank, My Lien, and Andrea Ripinski. "DSM-IV Diagnosis of ADHD." Attention Deficit Hyperactivity Disorder. N.p., n.d. Web. 04 Apr. 2013.

This website covers all the different aspects of ADHD; however, I explicitly used it for its DSM-IV

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diagnosis definition. The DSM-IV diagnosis holds the specific criteria that one must have in order to be diagnosed. It is a lengthy definition with specific symptoms for each type of ADHD. I placed the entire definition in my paper in order to convey to the reader its exclusive standards.

Bailey, Eileen. "ADHD in Middle School." ADHD in Middle School. N.p., n.d. Web. 25 Mar. 2013.

This article discusses the difficult transition that students with ADHD encounter when they transition from grade school to middle school. It explains that in grade school, students travel less places, encounter less people, and have less freedom, but as soon as they reach middle school, so much more it expected of them. As a result, many kids with ADHD suffer greatly both academically and socially.

Barkley, Russell A. Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment.

3rd ed. New York: Guilford Publications, 2006. Web. This educational journal goes into much detail about the history and origins of ADHD. It covers many of the original theories by researchers about children we now know to have ADHD. The history of ADHD is one of the major topics of the thesis, so this source proves valuable. It also has several experiments done by researchers to further prove my points.

Bass, Sarah-Jayne. “Types of ADD/ADHD in the form of the characters from Winnie the Pooh.” Healthy Place: America’s Mental Heath Channel. N.p. 30 Dec 2008. Web. 9 Dec 2012.

This source was an excellent in understanding the different types of ADHD. Specifically, one could tell the different effects ADHD can have on a person, causing them to be loud and obnoxious or shy and quiet. The source related ADHD to each Winnie the Pooh characters, making the connection personal and more clear.

Benninger, William B. ADHD in the Middle School Student. N.d.

This source is written in the form of a PowerPoint by a professor at Ohio State University. I did not extract much from the source on account that it was not incredibly detailed. However, the statistics about academic impairments were key to clinching my point about academic issues.

Biederman, Joseph., Faraone, Stephen V.. "Attention-deficit hyperactivity disorder." Lancet 9481(2005):237. eLibrary. Web. 04 Apr. 2013.

This source provided two detailed tables that pertain to particular sections in the paper. The first compared the differences in criteria between ADHD in the United States and ADHD in Europe. The second table looked at the different durations of action of each different stimulant drug used to help students with ADHD. Bolyn, Michelle. "Symptoms of ADD in Adolescent Males." Livestrong. N.p., 4 May 2011. Web. 11 Apr. 2013.

This article focused on the different symptoms of ADHD in teenage boys, whether they expressed inattention, hyperactivity, and impulsivity ADHD. It gave many examples and scenarios of boys dealing with their disorder both at home and at school. The source improved the content of the portions of my paper about teenage males.

"Central nervous system stimulant drugs." Complete Home Medical Guide. 2004. eLibrary. Web. 04 Apr. 2013.

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This source describes in detail how the medications for ADHD work. They are known as central nervous system stimulant drugs because they improve concentration in specific parts of the brain. They advance the escape of neurotransmitters to increase activity.

Dunkin, Mary. "ADHD Symptoms in Boys and Girls: How They Differ." WebMD. WebMD, n.d. Web. 03 Jan. 2013.

This article covers the three different types of ADHD and compares the symptoms of boys with ADHD to girls. The three different types of ADHD are Hyperactivity-Impulsivity ADHD, Inattention ADHD, and Combined ADHD. The source has quotes from pediatricians and other doctors with PhD that relate the different forms of ADHD to people. The source also gives treatment options that parents and students can undergo.

Guerra, Fred R., and Michelle S. Brown. "Teacher Knowledge of Attention Deficit Hyperactivity Disorder Among Middle School Students in South Texas." Ed. Karen W. Swanson. Research in Middle Level Education 36.3 (2012): 1-7. Web. 11 Dec. 2012.

This source provides scientific insight and research about the lack of knowledge teachers have about ADHD. Since middle school is the prime age to identify if one has ADHD, the scientists asked many middle school teachers in Texas about ADHD. Surprisingly, the results implied many teachers knew near to nothing about the disorder. As a result, researchers can assume that students may not be getting the help in school they need and concurrently, suffering due to undiscovered ADHD. Hallowell, Edward M., and John J. Ratey. Delivered from Distraction: Getting the Most out of Life with Attention Deficit Disorder. New York: Ballantine, 2005. Print.

This book is written to people who think they may have ADHD. It consists of self-assessment quizzes, detailed explanations of what ADHD is, and information on what to do about your ADHD. This book also starts about basic and is very informational; it has done wonders in teaching me about ADHD. Hefley, Glenn. "ADHD and Social Interactions." ADHD and Social Interactions. N.p., n.d. Web. 29 Apr. 2013.

This article discusses the impact ADHD has on the social aspects of a child’s life. It describes how many kids act, both girl and boy, as a result of their ADHD. The author writes about his experiences with his son, of who has the disorder. This source was useful and beneficial to my research.

"Hidden in Plain Sight: Girls and ADHD." HealthyChildren.org. N.p., 27 Nov. 2011. Web. 19 Dec. 2012.

This source further proves how girls get missed in the search for kids with ADHD. It also gives important information that I have not come across yet. This source covers myths and misconceptions that the average adult would believe to be true about ADHD. This information will fit nicely either in my introduction or help me to further educate parents to know when their child has ADHD. Hoffman, Heinrich. The Story of Fidgety Phil. Philadelphia: n.p., 1884. Print.

This poem was one of the first accounts that we know of about the symptoms of ADHD. Hoffman wrote about a boy named Philip not being able to sit at the table. Philip caused his parents a lot of stress and trouble. They couldn’t understand what Philip was suffering from because the idea of the disorder had not yet been introduced.

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"How Does ADHD Affect School Performance?" Education.com. U.S. Department of Education, n.d.

Web. 27 Mar. 2013.

This article describes the effects ADHD has on a child’s academic environment. It became incredibly useful by providing several tips to make the academic issues less of a problem for kids. Parents are encouraged to set up routines for their child which can include getting ready for school and going to bed.

"How is ADHD Treated?” NIMH RSS. N.p., n.d. Web. 04 Mar. 2013.

This article was useful in order appropriately cover the treatment aspect of the diagnosis process of ADHD. It discussed the different medications that can be used, as well as provided a table with all of them. The source also talked about the side effects that the medications may cause and how to decrease their effect.

“Identifying and Treating Attention Deficit Hyperactivity Disorder: A Resource for School and Home.”

Washington DC: U.S. Department of Education Contract, 2003. Web. This source excellently defines ADHD and ways to approach treatment. It also explains the ways in which ADHD affects school performance. Along with that, the source gives many hints and ways for children to live with their ADHD. It particularly focuses on tips to improve school and home life. Since ADHD’s affect on education is one of the main points I want to hit in my thesis, this source proves valuable.

Jamison, Lesley. "Gender Differences in ADHD Children." N.p., n.d. Web. 3 Jan. 2013.

This source is a short essay comparing ADHD in girls and boys. It looks at the differences between girls and boy including the societal aspects of the disorder. Parents attended training groups to deal with the behavior of their ADHD kids. These sessions help parents deal with the aggressive behavior of boys and improve the interactions with ADHD teenage daughters.

Kvist, Anette P., Helena S. Nielsen, and Marianne Simonsen. "The Effects of Children’s ADHD on Parents’ Relationship Dissolution and Labor Supply." Discussion Paper Series 6092 (2011): 134. IZA. Web. 29 Dec. 2012. <http://ftp.iza.org/dp6092.pdf>.

This source speaks not as much about kids with ADHD but to parents and especially the effect having a kid with ADHD can have on them. This source is a perfect fit for the section about parents I want to cover. That section will include ways in which parents can help, tips, and the impact ADHD can have on the home. Since the end of my thesis will be speaking to teachers, parents, and finally kids, this piece will do wonders in helping me educate parents.

Langberg, Joshua, Jeffery Epstein, Stephen Becker, Erin Girio-Herrera, and Aaron Vaughn. "Evaluation of the homework, organization, and planning skills (hops) intervention for middle school students with attention deficit hyperactivity disorder as implemented by school mental health providers."

School Psychology Review Sept. 2012: 342+. Gale Power Search. Web. 6 Jan. 2013.

This source is a very informative and scientific journal evaluating the issue that ADHD students have when it comes to homework and organization. The paper argues for the disorganization of kids with ADHD and how to fix it. The source mainly focuses on the middle school, which is my intended age range to study. The journal also included many experiments done by other scientists to further prove the theory.

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McAuley, Tara, Peter Chaban, and Rosemary Tannock. "ADHD and Social-Emotional Abilities." About Kids Health. N.p., 14 Oct. 2009. Web. 29 Apr. 2013.

This source presented many specific examples about the social issues children with ADHD face. For example, kids with ADHD may behave aggressively, seem quiet, or be depressed. This source helped me convey the struggles that those with ADHD continuously suffer from. It also provides several ways in which both teachers and parents can help the kid socially.

Pender, Carolyn, and Bradley Smith. "Attention Deficit/Hyperactivity Disorder." Mental Health Care Issues in America. Ed. Michael Shally-Jensen. Vol. 1. Santa Barbara: ABC-CLIO, CA. 62-70.

Print.

This source discusses all the many aspects of ADHD throughout its article. Specifically, I used the source to understand the complete history of ADHD. From when the disorder used to be thought of as minimal brain dysfunction to being now known as ADHD, this source talks about the long history of ADHD. Pruitt, David B. Your Adolescent: Emotional, Behavioral, and Cognitive Development from Early Adolescence through the Teen Years. New York: HarperCollins, 1999. Print.

This book talks about the effect ADHD has on teenagers. It explains how many develop an eating disorder, struggle with substance abuse, or fall into depression. It is geared to help those children get through their adolescent years in their social lives by explaining the good and the bad.

Schwartz, Susan. "ADHD in Middle School Survival Guide." Additude: Living with Attention Deficit.

N.p., n.d. Web. 6 Jan. 2013.

This article is apart of a very helpful website educating children and parents on ADHD. The entire website is key in making my thesis more personal for my readers instead of informative. In particular, this article offers many tip and tricks for such students to live with their ADHD and even excel. I would like to end my thesis with these sort of tips and tricks for students, as well as their parents and teachers.

Silver, Larry. "Why Boys with ADHD Need Their Dads." ADDitude Magazine. N.p., n.d. Web. 03 May 2013.

This source described why boys with ADHD need their fatherâ&#x20AC;&#x2122;s care and support throughout childhood and into adulthood. I used this source, however, to discuss ways in which a boy with ADHD can suppress his symptoms through sports and other activities. Dr. Silver strongly believes that it is important to build a childâ&#x20AC;&#x2122;s confidence through activities he can excel at.

"Social Problem Solving in Boys with ADHD." ADD Treatment Center. N.p., 2005. Web. 29 Apr. 2013.

This website discusses the struggles that boys with ADHD face when it comes to social problem solving.

It starts out by discussing the steps one (without a disorder) goes through when encountering a social problem, which includes reading social cues. Later, the site explains how boys with ADHD struggle with comprehending social cues and other steps of the process. As a result, they have poor social problems solving skills.

Tartakovsky, Margarita. "The Biggest Myths About Girls with ADHD | World of Psychology." Psych Central.com. N.p., n.d. Web. 15 Apr. 2013.

This source was extremely beneficial in my understanding of the effect ADHD has on girls. Specifically,

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it explains how most girls go with unrecognized and untreated ADHD. It also covers many misconceptions that society has about girls with ADHD. Tsuchiya, Melinda. "Kids with ADD/ADHD Can Have a Tough Transition to Middle School." The Seattle Times: Health. N.p., n.d. Web. 25 Mar. 2013.

This article adequately portrays the difficulty kids with ADHD can have as they enter the middle school.

The author explains that addressing the academic problems a child faces before the social is crucial. The source has many tips and ways for parents to help their children in the academic environment.

"Understanding Girls with ADHD: Symptoms and Strategies." GreatSchools. N.p., n.d. Web. 15 Apr. 2013.

This source starts out with an excellent story about unnoticed children in classrooms. I want to insert into various parts of my thesis short stories from the studentâ&#x20AC;&#x2122;s perspective about their struggles. This is one example of how getting treatment for ADHD significantly improves the classroom performance over not receiving treatment. This source also talks about the social aspect that kids with ADHD suffer not having.

Image Bibliography http://www.advancedsportmed.com/wp-content/uploads/2010/08/quick_facts_about_ADHD.jpg

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