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
Summary & key facts
A group of UK experts met to make clear, practical guidance about how ADHD shows up in girls and women. They reviewed research and agreed that many females with ADHD are missed because their symptoms can be quieter, look different from boys', or get hidden by coping strategies and by gender bias. The experts say doctors and schools should use fuller assessments, work across services, and follow people over their lives. They also say medicines and talking therapies can help and are expected to improve work, reduce use of services, and make long-term outcomes better. This guidance is an expert consensus, not a new experiment.
- Experts from the United Kingdom ADHD Partnership met to create practical guidance on identifying and treating girls and women with ADHD.
- Research reviewed by the group suggests that fewer females get diagnosed partly because their symptoms are less likely to be recognised and they face referral bias.
- Girls and women with ADHD often show a more ‘internal’ or quieter pattern of symptoms that can be missed, and they sometimes use coping strategies that hide their difficulties.
- The experts recommended doing thorough assessments, involving multiple services (for example schools, health and social care), and using a lifespan approach because symptoms and life challenges change with age.
- The statement says that using both medication and psychological treatments is expected to increase productivity, lower use of services, and improve long-term wellbeing for females with ADHD.
- This paper reports an expert consensus—agreement among specialists—so it summarises professional opinion and existing studies rather than presenting new experimental results.
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.
