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A recent study (by Alan J. Zametkin, M.D.) of a small group of 
adolescents found a difference in brain metabolic activity between girls 
with without ADD, but not between boys with and without ADD. 
Neuroimaging studies may lead to new important ways of understanding 
gender-related aspects of ADD and its treatment. 
What can be done now? Parents, teachers, physicians, and therapists should 
encourage the early and accurate identification and treatment of girls with 
ADD. ADD is largely an inherited condition. Girls (as well as boys) with a 
first-degree (biological) relative with ADD, and/or family members with 
disorders of anxiety, mood, learning, drug or alcohol use, and antisocial 
behavior are at increased risk of having ADD themselves. The incidence of 
ADD is also high in adopted children; thus, girls who have been adopted 
have an increased risk of ADD. 
All girls having substantial difficulty regulating activity level 
and/or attention, compared to other kids their age, deserve careful 
and thorough evaluation. ADD rarely occurs in isolation from other 
problems. It is important for girls to be adequately treated for their 
attention deficits as well as for the social, emotional, and learning 
difficulties which tend to come along with it. 
As far as we know, there is no essential difference between girls and 
boys in their response to treatment. Their response to stimulant 
medication is the same, though adolescent females with the disorder 
may experience an intensification of ADD symptoms premenstrually and 
need an adjustment in their medication regimen to alleviate this.
A comprehensive treatment effort, tailored to the needs of the 
individual girl and her family, is likely to be most effective. Girls 
with ADD deserve help in understanding ADD, its treatment, and 
themselves. 
What happened to those girls? Elizabeth, Cathy, Michele, Judith, 
Beth, and Eve responded well to either stimulant medication or a 
combination of medications. Other types of help, such as education 
about ADD for the family, and the development of social skills, 
stress management techniques, and learning strategies, were 
also beneficial. 
Elizabeth's parents planned for her to attend a kindergarten class 
in the fall which offered more structure and adult attention and 
support. Later, testing defined specific learning disabilities which 
had contributed to her avoidant behavior in preschool. 
Cathy's parents and teachers came to better understand her behavior 
once the diagnosis of ADD was made. They developed more reasonable 
expectations and provided the extra structure and consistency she 
needed. Her parents and teachers also learned to use behavioral 
techniques which fostered cooperation between Cathy and people 
in positions of authority. 
In family therapy, Michele and her parents learned to manage stress 
and conflict more adaptively. Judith changed schools so she could 
obtain more individualized instruction. She also utilized feedback 
and support in group therapy to develop better friendships. Counseling 
sessions helped her to express feelings more honestly. 
For Beth, individual and group therapy sessions offered emotional 
support and the chance to learn new, more effective skills and techniques 
to assert herself with peers. Math tutoring was also essential to Beth's 
academic progress.
Eve's grades dramatically improved, once the pieces of the treatment 
plan fell into place: an optimal medication plan, individual and 
family counseling, and changes in her high school curriculum. She 
became proud of her artistic talents, and her artwork has been 
entered in competition!
Soon after psychological testing was completed and psychotherapy 
started, Laurie regained better control of her eating. She more 
realistically faced her financial problems, and developed a plan 
to pay off her debts. She will be meeting with a physician to 
discuss a trial of medication to treat her ADD. 
All of these girls continue to struggle. They have not solved all 
of their problems, but each has found a better path. The 
individualized combination of treatments for each girl has provided 
relief, support, and opportunities to experience success. All know 
themselves a lot better, and all are feeling much better about 
themselves.    
*The girls described in this story are composites of patients, and 
all names have been changed to protect patient confidentiality.
Editor's note: Margaret S. Friedman, Psy.D. is a licensed 

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