of women and girls suggests that women diagnosed with ADHD have a higher risk of experiencing symptoms of depression, anxiety, and eating disorders. Swanson JM. Dysfunctional beliefs of this nature may be reinforced if they have a difficult-to-manage child with ADHD and are offered parent training interventions. Autism symptoms can also be "masked" in high-functioning children whose symptoms may go unrecognized until later years . However the decision of whether a group or individualised approach is preferable should be based on careful formulation and individual need. Considerations around pregnancy, the post-partum period and parenting may also be required, since rates of early pregnancy are higher in girls with ADHD. Treatment monitoring may require deviation from conventional outcomes from rating scales and behaviour management. Usami M. Functional consequences of attention-deficit hyperactivity disorder on children and their families. The key message is not to discount ADHD in females because they do not display the behavioural problems commonly associated with ADHDin males. One study reported that only 18.8% of male adult offenders diagnosed with ADHD in prison had a prior diagnosis of ADHD [211]. The lead author worked closely with the medical writer to synthesise the consensus report, which was then circulated to all authors for review and feedback. Thus psychoeducation should include indicators that problems of this nature may be developing. Interventions should be tailored to needs and address difficulties and challenges faced at home, school/work and in social activities. Sonuga-Barke E, Brandeis D, Cortese S, Daley D, Ferrin M, Holtmann M, et al. Although further research is required to determine the efficacy of e-learning methods for improving outcomes in ADHD, specific examples of successful application of these technologies have been reported (reviewed in [205]). If available, reports from childhood (for example, school, social service and/or previous clinical reports) are likely to be informative. Cortese S, Castellanos FX. Brook JS, Brook DW, Zhang C, Seltzer N, Finch SJ. A more consistent low mood may be due to demoralization driven by ADHD and its functional impairments, and may improve with ADHD medication. Data and Statistics About ADHD | CDC This may be from a parent or carer or another close member of the family. Biederman J, Faraone SV, Monuteaux MC, Bober M, Cadogen E. Gender effects on attention-deficit/hyperactivity disorder in adults, revisited. 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. The current health and social care system appears to be better geared toward identifying and treating ADHD presenting alongside behavioural and externalising problems, in particular those that present as overt, disruptive and aggressive in nature, and are more commonly seen in boys and men. The consensus group noted that exclusion, truancy and school phobia are associated with increased vulnerability of teenage girls with ADHD in relation to later substance misuse, antisocial behaviour, criminality, sexual exploitation and early pregnancy. The remaining authors have no disclosures. [. Is There a Female Protective Effect Against Attention-Deficit/Hyperactivity Disorder? Proactive planning regarding educational transitions should be made with the student with ADHD, the school and others involved in the students care, as appropriate. not necessarily ADHD specific) may help to mitigate many of the potential issues in the classroom by promoting engagement, increasing on-task behaviour and reducing social friction. Gillberg C, Gillberg IC, Rasmussen P, Kadesj B, Sderstrm H, Rstam M, et al. However, specific attention may be required to address the more complex situations adult females may face, e.g. Cortese S, Faraone SV, Bernardi S, Wang S, Blanco C. Gender differences in adult attention-deficit/hyperactivity disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Females with ADHD may be overlooked and/or their symptoms misinterpreted, particularly for those in highly structured environments, receiving a high level of support, and for those who have developed strategies to mask or compensate for their difficulties. However, given the complex clinical picture of many adults with ADHD, particularly with regards to the presence of comorbid conditions, prescribers need to be mindful of potential interactions with other drugs. For example, students with ADHD in further or higher education can apply for Disabled Students Allowance (https://www.gov.uk/disabled-students-allowances-dsas), which can fund assistive technology (e.g. This page includes ADHD data from different sources. Risk of substance use disorders is elevated for both males and females with ADHD. Conners Adult ADHD Diagnostic Interview for DSM-IV (CAADID). Among the reasons for this are changes in autism definitions, gender bias, and racial and economic disparities that affect healthcare access. There are multiple potential triggers that may prompt the referral of females for assessment, shown in Table Table2.2. Ginsberg Y, Lindefors N. Methylphenidate treatment of adult male prison inmates with attention-deficit hyperactivity disorder: Randomised double-blind placebo-controlled trial with open-label extension. The SNAP-IV Teacher and Parent Rating Scale: 90 item. The Adult Psychiatric Morbidity household survey conducted in England found that 27% of females who experienced extensive physical and sexual violence had ADHD traits [189]. However, ADHD may also be associated with general impairments in intellectual functioning, which tends to be more prominent in females [24, 40]. Other than reimbursement of travel expenses to attend the meeting, none of the authors received any financial compensation for attending the meeting or writing the manuscript, aside from CS who received funds for medical writing assistance. Federal government websites often end in .gov or .mil. One study with data from the US National Epidemiologic Survey on Alcohol and Related Conditions, showed that reckless driving was significantly more frequent in men compared with women with ADHD, reflecting the same pattern as seen the general population [29]. ADHD can present differently in both children and adults. Jiang HY, Zhang X, Jiang CM, Fu HB. Updated European Consensus Statement on diagnosis and treatment of adult ADHD. Studies suggest that females with ADHD present with differences in their profile of symptoms, comorbidity and associated functioning compared with males. Small modifications to symptoms may help to capture more female-centric behaviour (see topic for examples). De Zwaan M, Gru B, Mller A, Graap H, Martin A, Glaesmer H, et al. 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. Barner JC, Khoza S, Oladapo A. ADHD medication use, adherence, persistence and cost among Texas Medicaid children. Young S, Gudjonsson G, Chitsabesan P, Colley B, Farrag E, Forrester A, et al. Most research about ADHD centers on externalizing symptoms seen more commonly in. Cheung CHM, Rijsdijk F, McLoughlin G, Brandeis D, Banaschewsk T, Asherson P, et al. A systematic review and network meta-analysis recommended methylphenidate for children and adolescents and amphetamines for adults, taking into account both efficacy and safety [140]. Indeed, careful examination of developmental history will elucidate whether symptoms are longstanding and have been exacerbated by situational or biological changes, or whether they represent new-onset symptoms that are less indicative of ADHD. They are not the sole domain of healthcare practitioners and can be applied (with patient consent) by allied professionals, such as social care providers and those working in educational and occupational establishments, to guide whether referral might be merited. De Ridder A, De Graeve D. Healthcare use, social burden and costs of children with and without ADHD in Flanders. Sedgwick JA. School staff should be trained on the importance of early detection, educational needs and interventions and support strategies that can improve educational outcomes. Externalising conditions have a stronger impact on behaviour in class, whilst internalising problems may impact on motivation and ability to engage in education. Wang B, Yao N, Zhou X, Liu J, Lv Z. This is associated with a further reduction in educational and occupational opportunities. It was substantially revised by SY with further input from EF and BC. QbTest scales have normative data specific to each sex (age 6-60) and may therefore be more sensitive to ADHD in females. What Does ADHD Look Like in Women? Many Doctors Don't Know - ADDitude Impulsive behaviour is also associated with substance misuse. Ottosen C, Petersen L, Larsen JT, Dalsgaard S. Gender Differences in Associations between Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder. [. As relevant,risk (sexual risk, substance misuse), and self-management should be addressed in adolescence, withadult interventions including employment problems, child-rearing and parenting. Uchida M, Spencer TJ, Faraone SV, Biederman J. The identification of specific educational or learning problems may also be an important trigger for referral. For teenage girls with ADHD, the desire to develop robust and supportive social networks can be strong, and the rejection and social isolation experienced by many may mean that family support is especially valued [87]. Age-appropriate, common co-occurring conditions in females with ADHD should be explored, including ASD, tics, mood disorders, anxiety, eating disorders, fibromyalgia and chronic fatigue syndrome. Children taking ADHD medication scored significantly higher on an educational achievement test than children with ADHD who did not. Those who enter the world of work may find that their difficulties evolve into employment impairments and limitations. Prevalence of ADHD in prison populations is estimated at 25%, with no significant differences seen in relation to gender or age [107]. Many of the functional problems experienced by women with ADHD in relation to educational, social, and risk-related behaviours are a continuation of those present in their teenage years. Assessors should bear in mind that family members may also have ADHD which may affect their judgment of typical behaviour. Presenting problems may be attributed solely to these specific learning difficulties and/or ASD because school staff are more familiar with them and have a more limited knowledge about ADHD. Biederman J, Kwon A, Aleardi M, Chouinard VA, Marino T, Cole H, et al. Gudjonsson GH, Sigurdsson JF, Sigfusdottir ID, Young S. An epidemiological study of ADHD symptoms among young persons and the relationship with cigarette smoking, alcohol consumption and illicit drug use. Until psychiatrists learn to recognize ADD symptoms in girls, we have to take our mental health evaluations into our own hands. level of coursework, method of examination). Xue J, Zhang Y, Huang Y, Tusconi M. A meta-analytic investigation of the impact of mindfulness-based interventions on ADHD symptoms. Dysfunctional coping strategies and the lack of a support network may lead them to express these feelings by self-harming behaviours (e.g. Dawson AE, Wymbs BT, Evans SW, DuPaul GJ. Regular review is required throughout development and may be especially important at times of key transitions. Since hyperactive and impulsive behaviours tend to decline as patients move into adulthood and impairments associated with inattention are often sustained, it is helpful to re-administer age appropriate scales as young people with ADHD become adults. HHS Vulnerability Disclosure, Help Sex differences in the prevalence of ADHD are well documented. The impact of limited diagnoses, difficult to manage symptoms, and a shortage of experts who specialize in the treatment of females of any age, cannot be . . More research is also required to elucidate the interaction of hormones, ADHD symptoms and stimulant medication on functioning during key times of hormonal change (e.g. New tests available in S'pore to help assess adults for ADHD In adulthood, men with ADHD more commonly show antisocial behaviours characteristic of antisocial personality disorder [5254]. Rigid adherence to cut-offs may lead to a high proportion of false positives and negatives. Brewerton TD, Duncan AE. Follow-up sessions are essential for support at key points of transition. As a result, neither consent for participation, nor ethical approval for this work were required. National Library of Medicine Adolescents and adults are more likely to receive direct interventions without parental/carer input. Often these strategies have an adaptive or functional purpose, for example, enabling them to remain focused or sustain attention, or to disguise stress and distress. The developmental changes that occur during puberty and later in adolescence may lead females with ADHD to be particularly psychologically vulnerable if they are not able to access support. It is important that both child and adult educational professionals have an understanding of ADHD in girls and young women, recognise its presentation and associated vulnerabilities, and have access to screening tools. This includes more frequent treatment monitoring and psychoeducation at times of personal transition, with a greater focus on functional and emotional aspects of the disorder. For these types of problems, often a group intervention is helpful and cost-effective. Aside from addressing core ADHD symptoms and executive deficits, specific interventions should focus on developing skills and coping strategies for co-occurring conditions, such as managing poor emotional regulation, low mood and anxiety, controlling the impulse to deliberately self-harm (including skin picking and cutting), eating for pleasure or restricting food. In: Buitelaar JK, Kan CC, Asherson P, editors. Teaching staff may not be as aware of the benefits of referral and ADHD treatment in girls [45], and children with the inattentive subtype [204]. In a case study, a woman with ADHD showed positive response to treatment adjustment around the menstrual cycle, which included augmentation with an antidepressant (fluoxetine) during the immediate pre-menstrual period to reduce problems with moodiness, irritability and inattention normally well controlled through stimulant medication alone [162]. By Elizabeth Broadbent Verified Updated on November 17, 2022 Sternat T, Fotinos K, Fine A, Epstein I, Katzman MA. It is important to emphasise that problems may be less overt in females with ADHD compared with boys due to them being less boisterous and hyperactive, yet their struggles with impulse control may manifest in a different way such as blurting out hurtful things to friends and family in anger, or deliberately self-harming behaviours. Some girls and women with ADHD become competent at camouflaging their struggles with compensatory strategies, which may lead to an underestimation of their underlying problems. In both children and adults ADHD is commonly accompanied by emotional lability and emotion dysregulation problems (irritability, low frustration tolerance, mood changes) [7274]. Yen J-Y, Yen C-F, Chen C-S, Tang T-C, Ko C-H. Appetite suppression as a side effect of stimulant medication should be considered if eating disorders are a concern. Both individual and group CBT interventions will be helpful in this age-group, the latter providing the opportunity to meet and talk to others who have similar experiences as well as acquire and rehearse social skills in a contained environment. Service-users and ADHD charity workers were also represented. The rate of ADHD among prisoners is similar for male and female offenders. Psychological Medicine. Young girls with ADHD may become young mothers with ADHD (and possibly also mothers of children with ADHD). As children mature, they are more likely to receive direct interventions without input from their parents or carers. Regular review of how a person is coping may be especially important at times of key transitions. Early pregnancy, may load additional stress and impairment on young girls with ADHD. Social impairment in girls with ADHD: Patterns, gender comparisons, and correlates. ADHD: Overdiagnosed and Overtreated, or Misdiagnosed and Mistreated? cutting), eating disorders, substance abuse, risk-taking behaviours, and vulnerability to exploitation in teenage girls with ADHD. The impact of individual and methodological factors in the variability of response to methylphenidate in ADHD pharmacogenetic studies from four different continents. J Atten Disord. Group discussions included the following themes: Taking a lifespan perspective, each theme was explored in relation to specific age groups considered to be associated with pertinent periods for environmental and biological change, and change inclinical needs and presentation. Treating adolescent girls and women with ADHD: Gender-specific issues. 16, 23 Hence, patients are more likely to be treated for comorbid disorders than for ADHD in psychiatric clinics. Rating scales in common use are presented in Table Table44. ADHD Diagnosis in Women: Symptoms Doctors Don't Understand - ADDitude Women with ADHD are highly likely to suffer from mental illness and SUDs. Bullying and attention-deficit-hyperactivity disorder in 10-year-olds in a Swedish community. The Association between Adult ADHD Symptoms and Internet Addiction among College Students: The Gender Difference. Autism Spectrum Disorder (ASD) is often unrecognized, especially in mild forms and in women. By contrast, clinical studies typically report a greater prevalence of combined-type ADHD [5, 12, 22]. Social skills and interpersonal relationship interventions become salient at this age. Interventions to address impulsivity and associated risk-taking behaviour may be helpful. There are three clinical interviews that prompt the assessor to consider the presence of co-existing conditions (which may differ between males and females); ACE, ACE+ [134] and the DAWBA [118]. Key recommendations for enhancing diagnostic assessment in girls and women are provided in Table Table33. FOIA Treating ADHD in girls and women: key consensus recommendations. It is important to encourage the patient to identify and focus on their strengths and positive attributes rather than solely on perceived weaknesses and failures. Childhood predictors of becoming a teenage mother among Finnish girls. Tests that assess executive dysfunction may help to determine deficits in higher order processing skills such as task switching, perseveration, planning, sequencing and organising information. KvR has received honoraria for educational talks from Shire, Lilly, Janssen, Medici and Flynn. Research is needed to tease out the motivations and causal mechanisms of these behaviours and outcomes in females with ADHD, and if, how and why they may differ from those of males. Equipping social care professionals with tools similar to those used in school settings (e.g. Rating scales can obtain perspectives from different informants (e.g. The https:// ensures that you are connecting to the Cortese S, Ferrin M, Brandeis D, Buitelaar J, Daley D, Dittmann RW, et al. However, these are generally less overt and aggressive in nature than the conduct problems displayed by males and instead seem to relate to more social-relational and psychosexual problems and behaviours.
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