ABSTRACT
OBJECTIVE: To describe the clinical presentation of attention-deficit/hyperactivity disorder (ADHD) in women and girls and factors influencing proper diagnosis and treatment. DATA SOURCES: A PubMed search was conducted in April 9, 2012 for English-language publications from the previous 10 years. 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. STUDY SELECTION/DATA EXTRACTION: A total of 41 articles were reviewed for relevance. Reference lists from relevant articles were reviewed for additional publications; sources known to the authors were also included. RESULTS: Attitudes about ADHD among individuals with ADHD and knowledgeable informants (families, teachers, colleagues) vary on the basis of the diagnosed individual's gender. The ADHD prevalence rates are higher among boys than girls. A low index of clinical suspicion exists for girls; their presentation is considered "subthreshold" because inattentiveness is more prominent than hyperactivity/impulsivity. Females with ADHD may develop better coping strategies than males to mask their symptoms. Lastly, anxiety and depression, common comorbidities in female patients with ADHD, can lead to missed or misdiagnosis. If not properly diagnosed and treated, girls with ADHD experience the same negative consequences as boys, including poor academic performance and behavioral problems. Unique issues related to hormonal effects on ADHD expression and treatment response are also experienced by women and girls. CONCLUSIONS: Accurate ADHD diagnosis in women and girls requires establishing a symptom history and an understanding of its gender-specific presentation. Coexisting anxiety and depression are prominent in female patients with ADHD; satisfactory academic achievement should not rule out an ADHD diagnosis.
ABSTRACT
Despite the increasing recognition of attention-deficit/hyperactivity disorder (ADHD) in females, gender-sensitive comorbidity profiles have been slow to develop. In this article, I focus on coexisting conditions in females with ADHD and highlight significant differences that deserve greater attention. For some time, it has been held that women with ADHD are more likely to internalize symptoms and become anxious and depressed and to suffer emotional dysregulation than males with the disorder. Recent evidence confirms that girls with ADHD are 5.4 times more likely to be diagnosed with major depression and three times more likely to be treated for depression before their ADHD diagnosis. I also discuss eating disorders (particularly binge eating and bulimia) that recently have been linked to ADHD in girls and women. The disordered eating/ADHD connection is not difficult to understand but has important clinical and therapeutic implications that must not be overlooked.
Subject(s)
Attention Deficit Disorder with Hyperactivity/epidemiology , Adolescent , Adult , Anxiety Disorders/diagnosis , Anxiety Disorders/epidemiology , Anxiety Disorders/therapy , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/therapy , Attention Deficit and Disruptive Behavior Disorders/diagnosis , Attention Deficit and Disruptive Behavior Disorders/epidemiology , Attention Deficit and Disruptive Behavior Disorders/therapy , Bulimia Nervosa/diagnosis , Bulimia Nervosa/epidemiology , Bulimia Nervosa/therapy , Child , Comorbidity , Cross-Sectional Studies , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/epidemiology , Depressive Disorder, Major/therapy , Female , Follow-Up Studies , Humans , Sex Factors , Young AdultABSTRACT
Attention deficit hyperactivity disorder (ADHD), commonly diagnosed in males, is often a "hidden disorder" in girls and women. This lack of recognition can be partially explained because the symptoms are less overt in females. In addition, coexisting disorders in females are often different from those seen in males who have ADHD. Higher rates of anxiety, mood, and substance disorders, as well as learning disabilities, often complicate the picture. Thus, clinicians are challenged with disentangling the symptoms of ADHD from symptoms of these coexisting conditions. In addition, fluctuating hormone levels may affect ADHD symptoms and treatment in females. Only with gender-sensitive diagnosis and treatment will the public health concern posed by the underdiagnosis of ADHD in females be addressed. This case report of a 23-year-old female illustrates the specific difficulties with the gender-sensitive aspects of the diagnosis and treatment of ADHD in females.
