Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women

Abstract

Background There is evidence to suggest that the broad discrepancy in the ratio of males to females with diagnosed ADHD is due, at least in part, to lack of recognition and/or referral bias in females. Studies suggest that females with ADHD present with differences in their profile of symptoms, comorbidity and associated functioning compared with males. This consensus aims to provide a better understanding of females with ADHD in order to improve recognition and referral. Comprehensive assessment and appropriate treatment is hoped to enhance longer-term clinical outcomes and patient wellbeing for females with ADHD. Methods The United Kingdom ADHD Partnership hosted a meeting of experts to discuss symptom presentation, triggers for referral, assessment, treatment and multi-agency liaison for females with ADHD across the lifespan. Results A consensus was reached offering practical guidance to support medical and mental health practitioners working with females with ADHD. The potential challenges of working with this patient group were identified, as well as specific barriers that may hinder recognition. These included symptomatic differences, gender biases, comorbidities and the compensatory strategies that may mask or overshadow underlying symptoms of ADHD. Furthermore, we determined the broader needs of these patients and considered how multi-agency liaison may provide the support to meet them. Conclusions This practical approach based upon expert consensus will inform effective identification, treatment and support of girls and women with ADHD. It is important to move away from the prevalent perspective that ADHD is a behavioural disorder and attend to the more subtle and/or internalised presentation that is common in females. It is essential to adopt a lifespan model of care to support the complex transitions experienced by females that occur in parallel to change in clinical presentation and social circumstances. Treatment with pharmacological and psychological interventions is expected to have a positive impact leading to increased productivity, decreased resource utilization and most importantly, improved long-term outcomes for girls and women.

The neurodevelopmental nature of attention-deficit hyperactivity disorder in adults

“…Furthermore, our findings support the hypothesis that women are diagnosed later than men. 30 Late-onset trajectories obtained from self-reported information were similar to those derived from parent-reports. These findings suggest that undetected ADHD symptoms in women might not be a determinant cause of false late-onset ADHD cases.…”

Failure of Healthcare Provision for Attention-Deficit/Hyperactivity Disorder in the United Kingdom: A Consensus Statement

“…Expectations that ADHD expresses only as hyperactive, restless, and disruptive behavior may limit detection of the many more subtle presentations. Although more subtle inattentive problems can present across both sexes, they may disproportionately affect detection of ADHD in girls and women ( 58 ). Furthermore, lower rates of detection have been reported among minority racial/ethnic groups in the United States ( 59 ) and more research is required to examine for biases in operation for ADHD treatment in relation to ethnic and racial status in the UK.…”

Behavioural Measures of Infant Activity but Not Attention Associate with Later Preschool ADHD Traits

“…Such study design decisions may affect ADHD prevalence rates and associated difficulties in the recruited sample. We considered the inclusion of females in our sample as important, given that females with ADHD have often been underrepresented both in research and clinically [ 94 ]. However, the transmission of familial likelihood may be different in female, compared to male samples [ 95 ].…”