Taken together, the disparity in diagnosis of ADHD between sexes, the bias in treatment referral, and the reduced use of medication in female patients contribute to the underdiagnosis and undertreatment of ADHD in this population. Multiple factors may contribute to the lack of ADHD diagnosis in girls during childhood, including differences in predominant symptoms (internalizing rather than externalizing) and subtype (inattentive rather than hyperactive) 7 the presence of comorbid psychiatric disorders, including depression and anxiety, 8, 9 which are linked to internalizing ADHD symptoms the presence of comorbid obsessive-compulsive disorder, often accompanied by perfectionistic behaviors, 10 that might mitigate symptoms and delay diagnosis the need for referral by others (parents and teachers) for treatment 11 and the fact that referrals are made more often for boys than for girls 12 and the tendency for relational (covert) aggression to be more prominent than overt aggression in girls 13 and for physical aggression in girls with ADHD to be less prominent than in boys with ADHD. 6 It behooves us, therefore, to understand whether the prevalence data from adult ADHD is incorrect or if childhood symptoms of ADHD are being missed in girls. 5 In addition to differences in rates of diagnosis, the prevalence of ADHD medication use is lower in girls and women compared with boys and men. The prevalence of ADHD in adulthood appears to be more comparable between sexes than in childhood, with the estimated prevalence of adult ADHD being less than 2-fold higher in men versus women (5.4% vs 3.2%, respectively) 4 however, women tend to be older than men when diagnosed with ADHD. 2 These findings are consistent with the 3- to 16-fold higher prevalence of ADHD in boys than in girls across European countries as well. Gender differences have been reported in the prevalence rates of ADHD, with the published literature indicating that the prevalence of ADHD in boys is 2- to 9-fold higher than in girls in clinical samples and 2- to 3-fold higher in epidemiologic samples. 1 In the majority of cases, symptoms begin in childhood and continue to affect a person’s functioning well into adulthood. ■ Greater awareness on the part of health care professionals regarding the specific symptom profile of ADHD in women and girls is necessary for proper diagnosis and treatment.Īttention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioral disorder characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity. Coexisting anxiety and depression are prominent in female patients with ADHD satisfactory academic achievement should not rule out an ADHD diagnosis. Unique issues related to hormonal effects on ADHD expression and treatment response are also experienced by women and girls.Ĭonclusions: Accurate ADHD diagnosis in women and girls requires establishing a symptom history and an understanding of its gender-specific presentation. If not properly diagnosed and treated, girls with ADHD experience the same negative consequences as boys, including poor academic performance and behavioral problems. Lastly, anxiety and depression, common comorbidities in female patients with ADHD, can lead to missed or misdiagnosis. Females with ADHD may develop better coping strategies than males to mask their symptoms. A low index of clinical suspicion exists for girls their presentation is considered “subthreshold” because inattentiveness is more prominent than hyperactivity/impulsivity. The ADHD prevalence rates are higher among boys than girls. Results: Attitudes about ADHD among individuals with ADHD and knowledgeable informants (families, teachers, colleagues) vary on the basis of the diagnosed individual’s gender. Reference lists from relevant articles were reviewed for additional publications sources known to the authors were also included. Study Selection/Data Extraction: A total of 41 articles were reviewed for relevance. Search terms included attention deficit hyperactivity disorder, attention deficit/hyperactivity disorder, ADHD, and AD/HD combined with gender, girls, females, women, continuity, discontinuity, gap, treatment, untreated, and lack of treatment. Objective: To describe the clinical presentation of attention-deficit/hyperactivity disorder (ADHD) in women and girls and factors influencing proper diagnosis and treatment.ĭata Sources: A PubMed search was conducted in Apfor English-language publications from the previous 10 years.
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