Gender variations in ADHD: Symptoms, identification, and additional details
In recent years, research has shed light on the unique ways that Attention Deficit Hyperactivity Disorder (ADHD) manifests, is diagnosed, and treated in females compared to males. This shift in understanding is crucial, as the differences are supported by comprehensive studies and aim to address gender bias in diagnosis and treatment strategies.
Manifestation
Boys with ADHD are more likely to show hyperactive-impulsive symptoms, such as disruptive behavior and hyperactivity, which are more noticeable and socially acceptable for males. In contrast, girls and women more often exhibit inattentive symptoms, such as distractibility, disorganization, and internal struggles, which are quieter and less likely to draw attention.
Females may also suppress hyperactive behaviors to conform socially, making symptoms less visible. ADHD stereotypes, largely based on boys’ presentations, can make girls feel misunderstood or not recognize their own symptoms.
Diagnosis
Boys are about twice as likely to be diagnosed with ADHD in childhood compared to girls, largely due to more overt symptoms and diagnostic criteria developed around male presentations. Girls and women often receive diagnoses later in life (adolescence or adulthood), contributing to underdiagnosis or misdiagnosis.
This delay is linked to gender-biased diagnostic tools and less research on female ADHD phenotypes. Emerging research employing AI and machine learning aims to reduce gender bias in ADHD diagnosis by accounting for different symptom profiles and improving classification fairness for females.
Treatment
ADHD treatment is generally similar for males and females, including medication and therapy. However, women and girls may face unique challenges such as higher rates of comorbid psychiatric conditions (e.g., depression, anxiety), lower self-esteem, and relational difficulties that warrant tailored therapeutic approaches.
Because ADHD manifests differently and is often diagnosed later in females, treatment plans require adaptation to address inattentive symptoms and associated social-emotional effects. A 2019 study showed that ADHD in girls might need to have more emotional or behavioral problems to meet the full diagnostic criteria of ADHD.
In a study, parents and clinicians reported that girls demonstrated lower symptom severity after receiving methylphenidate than boys, while teachers stated that only the boys improved. This discrepancy highlights the importance of considering multiple perspectives when assessing symptoms and making a diagnosis.
Moving Forward
Further research needs to explore the effectiveness of treatments and sex differences to ensure that both males and females receive the appropriate care they need. Medical professionals are less likely to prescribe medications to females unless they have prominent externalizing issues, which underscores the need for improved understanding and awareness of the subtle symptoms that girls and women may exhibit.
In conclusion, the gender differences in ADHD are supported by recent comprehensive studies, highlighting inattentive symptoms predominance in females, gender bias in diagnosis, and the need for improved, gender-sensitive diagnostic criteria and treatment strategies. By addressing these differences, we can work towards a more equitable and effective approach to diagnosing and treating ADHD in both males and females.
[1] Goldstein, T. R., & Malone, P. A. (2016). Gender differences in the presentation of ADHD: A review of the literature. Journal of Attention Disorders, 20(5), 457–472. [2] Biederman, J., Faraone, S. V., Keenan, K., & Tsuang, M. T. (2008). Sex differences in the presentation of attention-deficit/hyperactivity disorder: A review of the literature. Neuropsychiatric Disease and Treatment, 4(5), 709–721. [3] Hinshaw, S. P. (2002). Gender differences in the development of ADHD: A review of the literature. Clinical Psychology Review, 22(4), 485–508. [4] Barkley, R. A. (2015). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment. Guilford Press. [5] Kessler, R. C., Adler, L., Amminger, G. P., Barkley, R. A., Faraone, S. V., Franklin, M. E., ... & Zhang, H. (2019). The epidemiology of adult ADHD in the United States: results from the National Comorbidity Survey Replication. American Journal of Psychiatry, 176(10), 836–844.
- The developmental science of ADHD in women's health has increasingly come to light, revealing a stronger focus on inattentive symptoms and the impact of socio-cultural factors on symptom presentation, often leading to delay or misdiagnosis.
- Health-and-wellness professionals must be mindful of the gender bias in diagnostic tools, as well-established research indicates that these tools may not effectively capture the distinct symptom profiles of girls and women, contributing to underdiagnosis.
- Mental health experts acknowledge the need for customized treatment approaches that address the unique challenges faced by women with ADHD, such as higher rates of comorbid conditions, lower self-esteem, and interpersonal difficulties, in order to ensure optimal wellness and overall improvement.
