Diagnosis: Calm Down, Boys

The words "attention-deficit hyperactivity disorder" may conjure images of a distracted, overenergetic little boy, but such preconceptions are often mistaken and can seriously mislead.

Two recent papers in the Journal of Consulting and Clinical Psychology suggest that clinicians sometimes don't recognize the symptoms of ADHD when they show up in girls and adolescents. A boy is twice as likely to be diagnosed with ADHD as a girl with the same symptoms, even if he does not fit all the diagnostic criteria. While there is a true gender disparity in the occurrence of ADHD, it is exaggerated by practitioners, says Stephen Hinshaw, a psychologist at the University of California at Berkeley.

Diagnosing ADHD in adolescents is also tricky, since teenagers with the disorder are impulsive, inattentive, and disorganized—but not necessarily hyperactive, explains Margaret Sibley, a psychologist at Florida International University. Different symptoms do not mean fewer problems. A 16-year-old girl who runs stop signs and can never find her homework might not be a rebel—she could just have ADHD.

Focus Up

Stimulant drugs, behavior therapy, and a combination of the two can all be effective in treating ADHD, but behavior therapy is crucial for long-term success. Three primary stakeholders need to be on board:

Families: Parents create structure by ignoring minor annoyances like fidgeting and encouraging good behavior through point systems and contracts ("you finish your homework, I'll leave you alone to watch TV").

Schools: Clinicians work with teachers to inculcate behaviors to which ADHD students aspire (e.g., staying in their seats). Games that involve the whole class—whichever side of the room is the best-behaved wins—take the focus off a single problem child.

Patients: Kids often show major improvement in behavior after residential summer programs that simulate school and social settings but enforce a rigid point system that rewards following directions and staying on task.