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Attention-Deficit/Hyperactivity Disorder and Women
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is most often diagnosed in boys and may be underdiagnosed in girls. This diagnostic gap can be partly explained by the fact that female symptoms are less evident than male disruptive behaviors. In childhood, the male-to-female ratio of ADHD is 3:1. In adulthood, however, this ratio is close to 1:1. Although the disorder is present since childhood, many women are diagnosed only as adults. Compared with their peers, girls with ADHD report increased anxiety, distress, and depressive symptoms. To some women, inattention, procrastination, and difficulty resuming a task after interruptions become more evident after they have children. If diagnosed late or not at all, ADHD is associated with lower levels of life satisfaction. Many women with ADHD make an effort to suppress disruptive, hyperactive, impulsive, and disorganized behavior because they understand that such symptoms violate norms of expected femininity. ADHD carries a strong social stigma, as do other mental disorders.
... ADHD often co-occurs with various conditions (3). The sex distribution in adulthood is close to 1:1, but girls and women with ADHD remain underdiagnosed and undertreated (4,5). ...
... Additional side effects were minimal to absent for all women. Premenstrual mood improved for all patients, with eight reporting reduced irritability (Pts 1,2, 3,5,6,7,8,9), seven describing improved energy levels (Pts 1,2,3,4,5,6,9), six experiencing decreased agitation ( Pts 1,2,4,6,8,9), and four reporting less anxiety (Pts 3,5,6,7). After dose increase, six women noted fewer mood swings or less impact thereof (Pts 1, 3,5,6,8,9) and four women explicitly reported feeling more in control of their emotional reactions (Pts 1,3,6,8). ...
... Premenstrual mood improved for all patients, with eight reporting reduced irritability (Pts 1,2, 3,5,6,7,8,9), seven describing improved energy levels (Pts 1,2,3,4,5,6,9), six experiencing decreased agitation ( Pts 1,2,4,6,8,9), and four reporting less anxiety (Pts 3,5,6,7). After dose increase, six women noted fewer mood swings or less impact thereof (Pts 1, 3,5,6,8,9) and four women explicitly reported feeling more in control of their emotional reactions (Pts 1,3,6,8). An additional six described being less emotionally volatile or "reactive" (Pts 2,4,6,7,8,9). ...
Objective
Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition which is underdiagnosed and undertreated in women. For decades, the ADHD field has called for more insight into female-specific therapy. Preliminary findings postulate that changes in sex hormones during the menstrual cycle may influence the effectiveness of psychostimulant medication. Yet, pharmacotherapeutic interventions tailored to women with ADHD remain scarce. Previously, our group showed an increase in mood symptoms in the premenstrual week in women with ADHD. Premenstrual worsening of depressive and ADHD symptoms represent a treatment challenge. In our adult ADHD clinic, we noted several women describing exacerbation of their ADHD and depressive symptoms in the premenstrual week and/or insufficient effect of their established dosage of psychostimulant. We responded to the need expressed by these women by increasing their stimulant dosage in the premenstrual week, while monitoring the response and side effects.
Methods
This community case study of nine consecutive women being treated for ADHD and co-occurring conditions (including depression and premenstrual dysphoric disorder), reports our local experience of increasing the individually prescribed psychostimulant dosage during the premenstrual period. We methodically monitored the effect of this increased dosage on ADHD symptoms, mood and somatic symptoms for the following 6–24 months.
Results
With premenstrual dose elevation, all nine women experienced improved ADHD and mood symptoms with minimal adverse events. Premenstrual inattention, irritability and energy levels improved, and now resembled the other non-premenstrual weeks more closely. All women decided to continue with the elevated premenstrual pharmacotherapy.
Discussion
Our preliminary results demonstrate potential benefits of increasing premenstrual psychostimulant dosage in women with ADHD, experiencing premenstrual worsening of ADHD and mood symptoms. The results concur with previous findings of diminished response to amphetamines in the late luteal phase. Increased dosage may help combat premenstrual worsening of cognitive and emotional symptoms in women with ADHD, with significant clinical implications. Better management of premenstrual ADHD and mood symptoms in vulnerable women can improve treatment outcome and meet an unmet need. However, implementation should be individually explored. Further investigation of luteal phase psychostimulant dose adjustment is required for safe, optimal and individualised treatment for women with ADHD.
... Attention-Deficit Hyperactivity Disorder (ADHD) in women, its characteristics and development across the lifespan remain insufficiently studied [2][3][4]. This is remarkable, taking into account that the sex distribution in adulthood is close to 1:1 [5,6]. As a result, treatment for women with ADHD remains suboptimal [7] in terms of identifying (all) the associated symptoms. ...
... (www.preprints.org) | NOT PEER-REVIEWED | Posted: 21 March 2024 doi:10.20944/preprints202403.1267.v16 ...
Diagnosis and treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in women remain insufficient. Fluctuations of reproductive hormones during the premenstrual period, postpartum period and (peri)menopause are neglected, even though they impact ADHD symptoms and as-sociated mood disorders [1]. Therefore, we created a female-specific treatment group for women with ADHD and premenstrual worsening of ADHD and/or mood symptoms. We describe the group programme and underlying rationale, offering a qualitative analysis of the participants’ evaluation. The 7 two-weekly sessions foreground the menstrual cycle and address several ADHD-specific topics in relation to this cyclical pattern: emotional regulation; impulsivity; setting boundaries, and triggers. Concurrently, women track their menstrual cycle and (fluctuating) ADHD and mood symptoms with an adjusted premenstrual calendar. In total, 18 women (25-47yrs) participated in three consecutive groups. We analysed the evaluation of the last group. Participants experienced the group as a safe and welcoming space. Recognition was valued by all. The topics discussed were deemed valuable and the structure suited them well. Completing the premenstrual calendar augmented awareness and recognition of individual cyclical symptoms. Discussing ADHD throughout the lifespan increased self-understanding. Participants took their menstrual cycle more seriously, prioritising self-acceptance and self-care in the luteal phase of the cycle. Exploring a cyclical approach in a group setting seems to be a positive addition to treatment for female ADHD.
... Typically, boys more commonly suffer from neurodevelopmental disorders such as ADHD or autism that are also associated with ACEs (Bölte et al., 2023). In childhood, the male-to-female ratio of ADHD prevalence is 3:1, but approaches 1:1 in adulthood (Bölte et al., 2023;da Silva et al., 2020). In this study, 5CSRTT attention testing is performed during adulthood, suggesting that in both males and females, there are lasting attention deficits in our ELVS model. ...
Adverse childhood experiences have been associated with many neurodevelopmental and affective disorders including attention deficit hyperactivity disorder and generalized anxiety disorder, with more exposures increasing negative risk. Sex and genetic background are biological variables involved in adverse psychiatric outcomes due to early life trauma. Females in general have an increased prevalence of stress-related psychopathologies beginning after adolescence, indicative of adolescence being a female-specific sensitive period. To understand the underlying neuronal mechanisms potentially responsible for this relationship between genetic background, sex, stress/trauma, and cognitive/affective behaviors, we assessed behavioral and neuronal changes in a novel animal model of early life stress exposure. Male and female BALB/cJ mice that express elevated basal anxiety-like behaviors and differences in monoamine signaling-associated genes, were exposed to an early life variable stress protocol that combined deprivation in early life with unpredictability in adolescence. Stress exposure produced hyperlocomotion and attention deficits (5-choice serial reaction time task) in male and female mice along with female-specific increased anxiety-like behavior. These behavioral changes were paralleled by reduced excitability of locus coeruleus (LC) neurons, due to resting membrane potential hyperpolarization in males and a female-specific increase in action potential delay time. These data describe a novel interaction between sex, genetic background, and early life stress that results in behavioral changes in clinically relevant domains and potential underlying mechanistic lasting changes in physiological properties of neurons in the LC.
... Moreover, this ability may be particularly important for children who are perceived as girls because discrimination makes it more likely that their perspectives and experiences will be omitted from teaching and research (e.g., Geller et al., 2018;Mansukhani et al., 2016;Prakash et al., 2018;Scott et al., 2018;Woitowich et al., 2020). For instance, much of existing research on attention-deficit/hyperactivity disorder is based on studies of boys and men (Da Silva et al., 2020;Hinshaw et al., 2022;Quinn & Madhoo, 2014). As a result, diagnostic criteria for attention-deficit/hyperactivity disorder have historically overlooked the symptoms of girls, who now must independently explore and advocate for diagnoses (Williamson & Johnston, 2015). ...
Teaching is the primary way children learn about the world. However, successful learning involves recognizing when teaching is ineffective, even in the absence of overt cues, and divesting from ineffective teaching to explore novel solutions. Across three experiments, we investigated 7- to 10-year-old children’s ability to recognize ineffective teaching; we tested the hypothesis that girls may be less likely than boys to divest by exploring new solutions, given documented gender differences in socialization toward conformity and obedience. Overall, we demonstrate that children independently tested taught solutions and, upon learning that the solutions were ineffective, rationally traded off between instruction and exploration. Simultaneously, gender differences in divestment emerged. On average, girls demonstrated greater persistence in applying the taught solution, while boys tended to explore their own ideas, leading to differences in solving and learning. Importantly, these differences were observable across both masculine- and feminine-stereotyped tasks. These results have important implications for children’s learning and the development of leadership.
... Attention-deficit hyperactivity disorder (ADHD) in women, its characteristics, and its development across the lifespan remain insufficiently studied [1][2][3]. This is remarkable, taking into account that the sex distribution in adulthood is close to 1:1 [4,5]. As a result, treatment for women with ADHD remains suboptimal [6]. ...
Background: The diagnostics and treatment of attention-deficit/hyperactivity disorder (ADHD) in women remain insufficient. Fluctuations of reproductive hormones during the premenstrual period, postpartum period, and (peri)menopause are neglected, even though they impact ADHD symptoms and associated mood disorders. Therefore, we created a female-specific treatment group for women with ADHD and premenstrual worsening of ADHD and/or mood symptoms. Methods: We describe the group programme and underlying rationale, offering a qualitative analysis of the participants’ evaluation. Results: The seven bi-weekly sessions foreground the menstrual cycle and address several ADHD-specific topics in relation to this cyclical pattern. Concurrently, women track their menstrual cycle and (fluctuating) ADHD and mood symptoms with an adjusted premenstrual calendar. In total, 18 women (25–47 years) participated in three consecutive groups. We analysed the evaluation of the last group. Participants experienced the group as a safe and welcoming space. Recognition was valued by all. The topics discussed were deemed valuable, and the structure suited them well. Completing the premenstrual calendar augmented the awareness and recognition of individual cyclical symptoms. A lifespan approach increased self-understanding. Participants took their menstrual cycle more seriously, prioritising self-acceptance and self-care. Conclusions: Exploring a cyclical approach in a group setting seems to be a positive addition to treatment for female ADHD.
Attention deficit hyperactivity disorder (ADHD) is a widely prevalent neurodevelopmental disorder that affects millions of children and adolescents in the U.S. Despite the growing number of diagnoses, the maternal exacerbating and protective factors influencing ADHD symptom severity in offspring remain largely understudied. This narrative review examines the interplay between genetic and epigenetic factors, focusing on specific single nucleotide polymorphisms, polygenic risk scores for ADHD and comorbidities, mitochondrial DNA haplotypes, and X-linked inheritance. Key epigenetic influences include maternal gestational weight gain, young parental age, parental gene–psychopathology interactions, shared genetic loci between maternal educational attainment and ADHD, maternal prenatal stress, maternal hostility and maltreatment, postnatal household chaos, and parenting styles, all which shape ADHD symptom severity in the context of genetic predispositions. Importantly, the positive effects of elevated socioeconomic status and positive parenting on symptom severity may also be influenced by maternal genetic factors, representing an avenue for further research. The maternal environmental factors associated with ADHD in offspring, such as in utero acetaminophen exposure, maternal diet, vitamin D deficiency, and exposure to toxins, particularly from maternal smoking, are highlighted. Ultimately, this review seeks to uncover the combined impact of maternal environmental and existing factors on underlying parental genetics—a critical aspect often overlooked in existing studies. Clinical implications are also addressed, particularly concerning differences in beta and theta wave activity and variations in cerebral blood flow in the dorsolateral prefrontal cortex between children with ADHD and those with comorbid autism spectrum disorder (ASD). By understanding these multifaceted factors, especially maternal contributions, alongside emerging clinical diagnostic strategies, better targeted interventions can be aimed at enhancing treatment efficacy and improving long-term outcomes for children with ADHD.
Introduction: Autism Spectrum Disorder (ASD) is a neurological disorder characterized by social communication disorders, repetitive behaviors that affect cognition. Children with ASD have the potential to experience nutritional status disorders. Children who experience sleep disorders affect the thinking process and affect negative behavior, and behaviors like children with ASD. Parenting helps deal with emotional instability, and compromise on potentially harmful actions in children with ASD. The purpose of this study is to determine the relationship between nutritional status, parenting style and sleep disorders in children with ASD. Methods: This research method is a descriptive- cross-sectional design with purposive sampling techniques. M-CHAT Screening questionnaire used to diagnose autism. Sleep disorders were measured using the Pittsburgh Sleep Quality Index (PSQI) questionnaire, the implementation of parenting was measured by the Parenting Styles and Dimensions Questionnaire (PSDQ) and height and weight measurements to determine nutritional status. Results: The results of the study were obtained: 1) poor nutritional status (5%) has sleep disturbance with authoritarian parenting; 2) normal nutritional status (84%) has sleep disturbance (62%) with from parents who apply permissive parenting (50%), democratic (31.25%), authoritarian (18.75%); 3) Excess nutritional status comes from permissive parenting and has sleep disturbances (50%). Conclusions: There was no relation between nutritional status, parenting style and sleep disturbances in children with ASD.
Neurodiversity encompasses the natural wiring of the mind, shaping how individuals think, behave, communicate, and perceive the world. While society largely caters to the neurotypical majority, neurodivergent individuals, who represent a minority, experience the world differently and face unique challenges. Stigma persists surrounding neurodivergent people, and they are consistently marginalized. Family law professionals often work with neurodivergent individuals but need improved awareness and knowledge of neurodivergent traits and client presentation. Recognizing neurodivergence and providing inclusive support and access to services is crucial. This article defines relevant concepts and definitions and provides scenarios and examples that illustrate how neurodivergence may show up in day‐to‐day family law practice. Tips are provided for increasing awareness for professionals, along with practical suggestions for working with neurodivergent individuals.
Background
Sleep problems are common in adults with ADHD and may be bidirectionally associated with ADHD severity and other psychiatric symptoms. We investigated the prevalence of positive screenings for various sleep disorders, and their association with psychiatric comorbidities in a large sample of adults with ADHD from a specialized outpatient clinic.
Methods
We included data of 3,691 adult patients diagnosed with ADHD, who had filled out a screener for sleep disorders (Holland Sleep Disorders Questionnaire (HSDQ)) as part of routine diagnostic assessment. The HSDQ screens for the sleep disorders insomnia, parasomnia, hypersomnia, circadian rhythm sleep disorders (CRSD), restless legs syndrome (RLS)/periodic limb movement disorder (PLMD), and sleep-related breathing disorders (SBD). As delayed sleep phase syndrome (DSPS) is very frequent in ADHD, we additionally screened for DSPS. Psychiatric comorbidities were diagnosed through clinical assessment and the Mini International Neuropsychiatric Interview (M.I.N.I.) Plus, which assesses 26 psychiatric disorders following the classification of the DSM-5. All data were retrieved from the electronic patient files.
Results
Mean age was 35.4 and 49.4% of the patients were female. About 60% of the adults with ADHD screened positive for any sleep disorder. Highest prevalences were found for symptoms of DSPS (36%), insomnia (30%), and RLS/PLMD (29%). Sleep problems in adults with ADHD were associated with comorbid depression, anxiety, substance use disorder, personality disorder, and post-traumatic stress disorder.
Conclusion
Adults with ADHD often report sleep problems, which are associated with specific psychiatric comorbidities. Systematic screening for sleep disorders in adult patients with ADHD can contribute to a better understanding of their complaints and may aid improved and integrated treatment for the sleep and psychiatric problems.
Adults with ADHD maintain some success in higher education but underperform their non-ADHD peers despite having normal intelligence. This study explored the essence of the lived experiences of female graduate students with ADHD navigating their academic journeys in graduate school. Using a phenomenological approach through the lens of Merleau-Ponty's concepts of world, body, others, and time, with open-ended questions via Zoom interviews, nine female graduate students with ADHD participated in the study. Three themes emerged: A little bit extra, I always felt I was going to fail, and they don’t understand. Findings revealed unknown struggles about what it's like to be a female graduate student with ADHD, including that graduate school overloads their ability to cope, causing emotional distress, educational impairment, poor life quality, and fears of seeking support and understanding for their holistic wellbeing. Implications illustrate for higher education how adult learners with ADHD can complete graduate education.
Background
We examined whether increased risk for adolescent tobacco and marijuana problems associated with childhood ADHD is explained by key intermediary influences during adolescence and differs by gender.
Methods
Longitudinal structural equation models examined mediating effects on problems with both substances (or each substance separately) through age‐14 peer impairment, internalizing, and adolescent ADHD symptoms in two twin samples, prospectively assessed since age 11 (N = 2,164). Whether these mediators contributed beyond mediating effects of early‐adolescent substance use was also considered. Twin difference analyses further illuminated which mediators might be potentially causal.
Results
Direct effects of childhood ADHD on age‐17 tobacco and marijuana problems (i.e., independent of included mediators) as well as effects of adolescent ADHD symptoms were significant only for females. By contrast, mediation by peer impairment, evident particularly for marijuana, was relatively stronger for males than females. Depression and anxiety were not prospectively associated with age‐17 substance problems when earlier substance problems were considered. Consistent with causal influence of early substance use on later problems, monozygotic twins with more severe tobacco or marijuana problems at age 14 than their co‐twins were also more likely to have substance problems later in adolescence.
Conclusions
Mediation through peer impairment, continued presence of ADHD symptoms, and early substance use may alter development so that childhood ADHD indirectly contributes to problems with tobacco and marijuana. Targeting gender‐sensitive interventions prior to mid‐adolescence, before these patterns become established, is essential.
The use of attention-deficit/hyperactivity disorder (ADHD) medications during pregnancy has increased in recent years. An earlier article in this column examined whether psychostimulant medications, used to treated ADHD and related disorders, increase the risk of major congenital malformations in pregnancies with first trimester exposure to these drugs. This article examines whether amphetamines, methylphenidate, and atomoxetine exposure during early and late pregnancy are associated with other adverse gestational outcomes. One large and 4 small studies provided data relevant to the inquiry. In unadjusted analyses, amphetamines and methylphenidate were associated with an increased risk of most of the adverse outcomes under study. However, in analyses adjusted for potential confounds, amphetamine exposure during early pregnancy was associated only with an increased risk of preeclampsia; otherwise, amphetamine and methylphenidate exposure was not associated with the risk of preeclampsia, placental abruption, small for gestational age, or preterm birth. Late gestational exposure to psychostimulants was associated with an increased risk of preterm birth but not with the other adverse outcomes. In sensitivity analyses, such as one that examined exposure during weeks 8-18 of gestation, amphetamines were associated with an increased risk of preeclampsia, placental abruption, and preterm birth, and methylphenidate, with an increased risk of preeclampsia. For reasons explained in the text, it may be prudent to err on the side of caution, but in the worst case scenario, the number needed to harm is about 63 for amphetamines exposure and preeclampsia and larger (eg, > 500, indicating less risk) for other adverse outcomes. Atomoxetine was not associated with any adverse gestational outcome, but it is not clear whether this is a true finding or a result of underpowered analyses. In conclusion, women need to weigh the benefits of the ADHD medication that they are using against potential gestational risks when deciding whether or not to continue treatment during pregnancy.
Introduction:
Attention deficit/hyperactivity disorder (ADHD) is a neurobehavioral problem found in 2-5% of adults. Stimulants and drugs that affect the dopaminergic, noradrenergic and/or serotonergic systems are effective treatment and are increasingly prescribed to women at child bearing age. It is consequently important that reliable information on the safety of these drugs in pregnancy is available so that appropriate therapeutic choices can be made.
Results:
The data on stimulants (methylphenidate and amphetamines) are generally showing that there is no increase in the rate of major congenital anomalies. There are very little data on the use of atomoxetine and guanfacine in pregnancy. There are no data on the use of clonidine for ADHD but the data on its use as an antihypertensive drug have not revealed any serious adverse effect. Bupropion, when used as an antidepressant, does not seem to increase the rate of congenital anomalies. There are practically no data on the possible long-term neurodevelopmental effects of any of these drugs. Most of them are secreted in human milk, but the concentrations in infant's blood, except for clonidine and amphetamines, have been very low. Breast feeding with clonidine and amphetamines is therefore contraindicated, but there seems to be no safety concerns for the other drugs.
Conclusion:
The drugs used for the treatment of ADHD are apparently not teratogenic, but due to paucity of data, especially on the long-term neurodevelopmental outcome, the treating physician should reconsider the need of treatment during pregnancy. If needed, methylphenidate, amphetamines and bupropion are preferred drugs.
The objective of the study was to aid an understanding of women’s experiences of living with attention deficit hyperactivity disorder (ADHD), with special consideration of the role of stigma and gender-specific issues. Semistructured in-depth interviews were conducted with five women aged 32 to 50 years, all diagnosed with ADHD as adults. The interviews were analyzed in accordance with thematic analysis. The data analyses were centered around five core themes: (a) from unidentified childhood ADHD to adult diagnosis, (b) present main symptoms and challenges, (c) conflict between ADHD symptoms and gender norms and expectations, (d) stigma of ADHD: “People think it’s a fake disease,” and (e) managing ADHD symptoms and identifying strengths. Despite their difficulties, all participants are highly educated and employed, and differ from common portrayals of individuals with ADHD as observably hyperactive, disruptive, or globally impaired. The participants are reluctant about disclosure of their diagnosis, due to fear of negative judgment and lack of understanding from others. The findings highlight the importance of recognizing and targeting ADHD as a serious disorder that yields continuing, and even increasing, impairment in multiple areas into adulthood. Gender-specific issues of ADHD need to be examined further, particularly challenges associated with motherhood. Stigma and the conflict between ADHD symptoms and gender norms complicate women’s experiences of living with ADHD, and should be essential areas of focus in research, educational settings, and the media.
Objective: Comorbidity in adult ADHD (aADHD) has been investigated in a large number of studies using varying research approaches with divergent results. In contrast, there is limited information about sex- or subtype-related differences from studies with small sample size. Method: A large sample of 910 individuals (458 males, 452 females) affected with aADHD was recruited at a tertiary referral center. All probands underwent a four-step procedure for diagnosing aADHD, including the Structured Clinical Interview of Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) Axis I disorders to assess comorbidity. This study will provide additional information regarding the co-morbidity of Axis I disorders in the currently largest clinical referral sample. However, the main objective of this study is to gain information about sex- or subtype-related differences. Results: Affected females show higher rates of mood (61% vs. 49%), anxiety (32% vs. 22%), and eating disorders (16% vs. 1%) than affected males, while substance use disorders were more frequent in affected males (45% vs. 29%), which mirrors sex differences in prevalence in the general population. There were hardly any relevant differences in comorbidities between subtypes, with the exception of the inattentive subtype having an especially low prevalence of panic disorder. Comorbidity in general and substance use disorders in particular, but not sex or subtype, were highly predictive of lower psychosocial status. Conclusion: Sex-related differences in the comorbidity of aADHD are more pronounced than subtype-related differences.
Objective: To study the quality of life in adults aged 50+ with ADHD. Method: An anonymous questionnaire survey was performed on 148 adults aged 50+ with ADHD. Quality of life was assessed with EuroQol and the Satisfaction With Life Scale. Age-matched Norwegian and Danish population samples served as reference groups. Results: Mean age of participants was 55.7 years, and mean age when diagnosed with ADHD was 50.2 years, while mean Adult ADHD Self-Report Scale Screener score was 15.2. Adults with ADHD reported significantly reduced health-related quality of life and reduced satisfaction with life compared with population norms. Nonemployment and severe ADHD were associated with poor quality of life. Conclusion: Adults aged 50+ with ADHD diagnosed in late adulthood reported significantly reduced quality of life when compared with population norms. The negative impact of ADHD persists into late adulthood.
Objective:
We performed a 10-year prospective follow-up of a childhood-ascertained (6-12 years), ethnically and socioeconomically diverse sample of girls with attention-deficit/hyperactivity disorder (ADHD; N = 140: combined type [ADHD-C] n = 93; inattentive type [ADHD-I] n = 47) plus a matched comparison group (N = 88). Girls were recruited from schools, mental health centers, pediatric practices, and via advertisements; extensive evaluations confirmed ADHD versus comparison status.
Method:
Ten-year outcomes (age range 17-24 years; retention rate = 95%) included symptoms (ADHD, externalizing, internalizing), substance use, eating pathology, self-perceptions, functional impairment (global, academic, service utilization), self-harm (suicide attempts, self-injury), and driving behavior.
Results:
Participants with childhood-diagnosed ADHD continued to display higher rates of ADHD and comorbid symptoms, showed more serious impairment (both global and specific), and had higher rates of suicide attempts and self-injury than the comparison sample, with effect sizes from medium to very large; yet the groups did not differ significantly in terms of eating pathology, substance use, or driving behavior. ADHD-C and ADHD-I types rarely differed significantly, except for suicide attempts and self-injury, which were highly concentrated in ADHD-C. Domains of externalizing behavior, global impairment, service utilization, and self-harm (self-injury and suicide attempts) survived stringent control of crucial childhood covariates (age, demographics, comorbidities, IQ).
Conclusions:
Girls with childhood ADHD maintain marked impairment by early adulthood, spreading from symptoms to risk for serious self-harm. Our future research addresses the viability of different diagnostic conceptions of adult ADHD and their linkages with core life impairments.
ADHD was once thought of as a predominantly male disorder. While this may be true for ADHD in childhood, extant research suggests that the number of women with ADHD may be nearly equal to that of men with the disorder (Faraone et al., 2000). There is accumulating research which clearly indicates subtle but important sex differences exist in the symptom profile, neuropathology and clinical course of ADHD. Compared to males with ADHD, females with ADHD are more prone to have difficulties with inattentive symptoms than hyperactive and impulsive symptoms, and females often receive a diagnosis of ADHD significantly later than do males (Gaub & Carlson, 1997; Gershon, 2002a, 2002b). Emerging evidence suggests differences exist in the neuropathology of ADHD, and there are hormonal factors which may play an important role in understanding ADHD in females. Although research demonstrates females with ADHD differ from males in important ways, little research exists that evaluates differences in treatment response. Given the subtle but important differences in presentation and developmental course of ADHD, it is essential that both clinical practice and research be informed by awareness of these differences in order to better identify and promote improved quality of care to girls and women with ADHD.
Attention deficit hyperactivity disorder (ADHD) comprises a deficit in behavioral inhibition. A theoretical model is constructed that links inhibition to 4 executive neuropsychological functions that appear to depend on it for their effective execution: (a) working memory, (b) self-regulation of affect-motivation-arousal, (c) internalization of speech, and (d) reconstitution (behavioral analysis and synthesis). Extended to ADHD, the model predicts that ADHD should be associated with secondary impairments in these 4 executive abilities and the motor control they afford. The author reviews evidence for each of these domains of functioning and finds it to be strongest for deficits in behavioral inhibition, working memory, regulation of motivation, and motor control in those with ADHD. Although the model is promising as a potential theory of self-control and ADHD, far more research is required to evaluate its merits and the many predictions it makes about ADHD.
The authors performed 5-year prospective follow-up (retention rate = 92%) with an ethnically diverse sample of girls, aged 11-18 years, who had been diagnosed in childhood with attention-deficit/ hyperactivity disorder (ADHD; N = 140) and a matched comparison group (N = 88). Hyperactive-impulsive symptoms were more likely to abate than inattentive symptoms. Across multiple domains of symptoms and functional impairment, girls with ADHD continued to display deficits of moderate to large effect size in relation to the comparison girls, but few differences emerged between the inattentive versus combined types. Follow-up effects withstood statistical control of crucial covariates for most outcomes, meaning that there were specific effects of childhood ADHD on follow-up status; in other instances, baseline disruptive disorders accounted for adolescent effects. For outcomes identical at baseline and follow-up, girls with ADHD showed more improvement across time than comparison girls (except for math achievement). Overall, ADHD in girls portends continuing impairment 5 years after childhood ascertainment.
Objective:
To investigate suicidal ideation (SI) in patients with adult ADHD (aADHD), and its association with gender and psychopathology.
Methods:
Case-control study with 206 participants (patients = 103/healthy controls = 103; matched on gender, age, and education). SI was assessed by the Beck-I Depression-Inventory. The Conners' Adult ADHD Rating Scale (CAARS) was used to characterize the ADHD symptom-domains.
Results:
Compared to controls, the likelihood of SI was significantly higher in females with ADHD (odds ratio[OR] = 25.0 (95%CI:2.98-200.0); the difference was not significant in males (OR = 2.09 (95%CI:0.75-5.81). In females, "Problems with Self-Concept" scores on the CAARS showed the closest association with SI (OR = 5.60,95%CI:2.34-13.41]), while in males it was "Impulsivity" scores (OR = 3.01,95%CI:1.50-6.06).
Conclusion:
Our findings extend previously described transdiagnostic associations of specific psychopathological risk factors to aADHD, including problems with self-concept and impulsivity, which are robustly associated with suicidality across diagnostic boundaries. In addition, they indicate that these associations exhibit pronounced gender-specificity in aADHD.
Background:
To develop a sociodemographic and health profile of women with self-reported attention deficit/hyperactivity disorder (ADHD) in comparison to women without.
Methods:
Chi-square tests and logistic regression analyses were conducted on data from the nationally representative Canadian Community Health Survey-Mental Health (2012) comparing 107 women aged 20 to 39 years (inclusive) with ADHD to 3801 without ADHD. Depression, generalized anxiety disorder and substance abuse were measured using the WHO-CIDI.
Results:
Women with ADHD had triple the prevalence of insomnia, chronic pain, suicidal ideation, childhood sexual abuse and generalized anxiety disorder and double the prevalence of substance abuse, current smoking, depressive disorders, severe poverty and childhood physical abuse in comparison with women without ADHD (all P < 0.001). Even after adjustments for age, race, education and income, women with ADHD had substantially higher odds of a wide range of problems.
Conclusion:
Our results suggest that women with ADHD are particularly vulnerable to early adversities, health and mental health problems.
To understand the low utilization rates of child and adolescent mental health services, it is necessary to recognize the kinds of professional and institutional stigma that may produce barriers to care. We address the large literature on the stigmatization of mental illness, linkages between such literature and children's mental health services use, and the kinds of professional and institutional attitudes and practices that communicate shame and low expectations to youth and their families. It will take recognition of such stigmatizing practices-including overcoming resistance to the messages presented herein-to make real progress in the effort to increase utilization of evidence-based practices. Multi-faceted, multi-level, and multi-disciplinary approaches to both research and intervention are recommended.
The scientific literature about attention-deficit hyperactivity disorder (ADHD) is based almost exclusively on male subjects, and girls with ADHD may be underidentified and undertreated. The aim of this study was to examine clinical correlates of ADHD in females using comprehensive assessments in multiple domains of functioning.
Subjects were 140 girls with ADHD and 122 comparison girls without ADHD ascertained from pediatric and psychiatric referral sources of the same age and social class. Subjects were assessed with structured diagnostic interviews, psychometric tests assessing intellectual functioning and academic achievement, as well as standardized assessments of interpersonal, school, and family functioning by raters who were blind to clinical diagnosis.
Compared with female controls, girls with ADHD were more likely to have conduct, mood, and anxiety disorders; lower IQ and achievement scores; and more impairment on measures of social, school, and family functioning.
These results extend to girls previous findings in boys indicating that ADHD is characterized by prototypical core symptoms of the disorder, high levels of comorbid psychopathology, and dysfunction in multiple domains. These results not only support findings documenting phenotypic similarities between the genders but also stress the severity of the disorder in females.
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.
The worldwide prevalence of ADHD: a systematic review and metaregression analysis
- G Polanczyk
- M S De Lima
- B L Horta
- J Biederman
- L A Rohde