ADHD affects males and females, but research suggests an increased prevalence in males. This discrepancy may be due to differences in how ADHD manifests, referral bias, and misdiagnosis or delays in diagnosis.
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by developmentally atypical levels of:
This article explores the differences in ADHD symptoms and presentation, diagnosis, and treatment between males and females.
A note about sex and gender
Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.
According to the
Due to this discrepancy in the prevalence of ADHD among males and females, researchers have undertaken studies to explore the sex differences in ADHD and the possible cause of the discrepancy.
Sex differences in ADHD remain poorly understood because most previous studies relied on subjective measures of ADHD, a methodology prone to bias. These studies also included a limited proportion of girls.
A 2019 study aimed to explore the sex differences in subjective and objective measures of ADHD among children referred to clinics.
The study’s researchers found that certain subjective and objective measures of ADHD may capture different symptoms in males and females. Parents and teachers report that girls have more inattention problems, but objective measures reveal that boys have more serious impulsivity problems.
A 2018 study found that the higher male-to-female diagnosis ratio is seen in clinical samples but not in population samples, suggesting a possible sex bias in the diagnostic process of ADHD.
This research shows that people with ADHD are more likely to receive a diagnosis and treatment when they show prominent externalizing symptoms. This includes females.
Males and females also show different patterns of comorbidity, which is when another condition occurs alongside ADHD. Males are
Meanwhile, females are more likely to have internalizing disorders, such as:
Hormones can also worsen ADHD symptoms in females. These changes in symptoms may delay diagnosis.
As males tend to exhibit hyperactive symptoms that may be bothersome and disruptive to others, they tend to receive a diagnosis earlier than females.
Meanwhile, females may not display this inattentive behavior prominently so doctors may miss the condition.
Additionally, inattention symptoms in females with ADHD are more likely to occur in structured educational environments, such as college, which may delay the diagnosis. And females may develop better coping strategies to compensate for their ADHD-related difficulties.
As ADHD symptoms are less overt in females, experts are
There is no single test to diagnose ADHD. Instead, a doctor will make a diagnosis after a detailed assessment. This assessment typically involves collecting information from relevant informants, such as parents, caregivers, and teachers.
To receive a diagnosis of ADHD, a child or teenager must have six or more symptoms of inattention or 6 or more symptoms of hyperactivity and impulsivity. These should be present continuously for at least 6 months. They should also be present in two or more settings, such as the child’s home and school. Several symptoms should also manifest before the age of 12 years.
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.
The same study found that parents may also underestimate the severity and impairment of hyperactivity and impulsiveness in girls while overrating these symptoms in boys.
Medical professionals commonly treat a person with ADHD with
Stimulants are the mainstay treatment for ADHD and include amphetamines and methylphenidate. Doctors prescribe nonstimulants to children who cannot tolerate stimulants or have anxiety. These medications include antidepressants and alpha agonists.
Treatments and sex differences
Treatment recommendations only vary by age but
There has been a
Are medications effective?
These findings suggest that the effectiveness of methylphenidate may vary in different settings, but it also may be a result of gender bias.
Further research needs to explore the effectiveness of treatments and sex differences.
ADHD affects both males and females. There is a high discrepancy in the prevalence of the condition among males and females.
Many factors can contribute to this, including referral bias, differences in how symptoms manifest in males and females, the effects of hormonal changes, and differences in comorbidity patterns.
These may cause underdiagnosis or misdiagnosis of ADHD in females, leading to a lack of or delayed treatment.
Better awareness and recognition of these differences can help parents, teachers, and medical professionals detect ADHD in girls, allowing them to receive the proper diagnosis and treatment earlier.