case study adhd

Patient Case #1: 19-Year-Old Male With ADHD

Craig Chepke, MD, DFAPA, FAPA
Andrew J. Cutler, MD

Stephen Faraone, PhD, presents the case of a 19-year-old male with ADHD.

EP: 1 . Prevalence of Adult ADHD

Ep: 2 . diagnosis and management of adults adhd compared to children.

EP: 3 . Diagnosing Adults With ADHD Based on Patient Presentation

EP: 4 . Unmet Needs in the Treatment of Adult ADHD

EP: 5 . Efficacy and Safety of Treatment Options Utilized in Adult ADHD

Ep: 6 . future of adult adhd, ep: 7 . patient case #1: 19-year-old male with adhd.

EP: 8 . Patient Case #1: Prompting an ADHD Consultation

Ep: 9 . patient case #1: differentiating between adhd and other psychiatric comorbidities, ep: 10 . patient case #1: co-managing adhd, ep: 11 . patient case #1: dealing with treatment delay in adult adhd, ep: 12 . patient case #2: a 23-year-old patient with adhd, ep: 13 . patient case #2: impressions and challenges in adult adhd, ep: 14 . patient case #2: dealing with comorbidities in adult adhd, ep: 15 . patient case #2: addressing non-adherence and stigma of adult adhd, ep: 16 . patient case #2: importance of an integrative approach in adult adhd, ep: 17 . case 3: 24-year-old patient with adhd, ep: 18 . case 3: treatment goals in adult adhd, ep: 19 . case 3: factors driving treatment selection in adult adhd, ep: 20 . implications of pharmacogenetic testing in adhd, ep: 21 . novel drug delivery systems in adhd and take-home messages.

Stephen Faraone, PhD: That's a good one, yes, I'd like that, it's a very creative one, thank you, thank you. OK, let's move on to the case presentation. This first patient is a 19-year-old male, who presented to his psychiatrist after being referred by his primary care provider, PCP for ADHD consultation, during the interview, he noted he was a sophomore in college and is taking 17 credits. This semester chief complaint includes a lack of ability to focus in class as well as struggling with time management. He complained that every time he's in class, he finds himself thinking about many other responsibilities he must complete at home and feels that he cannot control it. He has had this complaint for the past 6 years, but refused to seek help, because he feared being put on medication. In high school, he was assigned a counselor who taught him behavior techniques such as making a schedule, and going on walks, which he found to be very effective. However, these techniques were less effective once he started college. His symptoms tend to get worse before exams, he often feels very anxious, leading to horrible performance on exams, he claimed that he has been this anxious since he took his LSAT tests. Currently, he is on academic probation, and is not allowed to be part of the Student Work Program, which was his only source of income. The patient has no history of substance abuse, no history of taking any medications for his symptoms, and no history of suicidal thoughts.

Transcript edited for clarity

New Study Shows High Doses of Amphetamine Increase Risk for Developing Psychosis

Treating ADHD in Children: Concerns, Controversies, Safety Measures

The CDC suggests that disrupted access to ADHD medications may increase risk of overdose and injury.

CDC Issues HAN Health Advisory Following DOJ Indictment of Digital Health Provider of Adderall

ADHD in Older Adults

Onyda XR: The First and Only Liquid Nonstimulant ADHD Medication

A study assessed the associations between the use of ADHD medications and CVD over the course of 14 years. Here's what the investigators found.

Longitudinal Study Looks at Risk of Cardiovascular Disease With Long-Term ADHD Medication Use

2 Commerce Drive Cranbury, NJ 08512

609-716-7777

cropped Screenshot 2023 08 20 at 23.18.57

ADHD Case Study: Unveiling Real-Life Experiences and Treatment Approaches

Brace yourself for a journey through the kaleidoscopic world of ADHD, where case studies illuminate the vibrant, chaotic, and often misunderstood experiences of those living with this complex condition. Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that affects millions of individuals worldwide, impacting their daily lives in profound and diverse ways. As we delve into the realm of ADHD case studies, we’ll uncover the intricate tapestry of symptoms, challenges, and triumphs that define the ADHD experience.

ADHD is characterized by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with functioning and development. According to the Centers for Disease Control and Prevention (CDC), approximately 9.4% of children aged 2-17 years in the United States have been diagnosed with ADHD, with the prevalence in adults estimated to be around 4.4%. These statistics underscore the significant impact of ADHD on individuals, families, and society as a whole.

The value of case studies in understanding ADHD cannot be overstated. While statistical data and clinical definitions provide a framework for comprehending the disorder, it is through the lens of individual experiences that we truly grasp the nuanced reality of living with ADHD. Case studies offer a window into the personal struggles, adaptive strategies, and unique strengths of those navigating life with this condition. By examining these real-life narratives, we gain invaluable insights that inform treatment approaches, support systems, and ADHD research .

Understanding ADHD Through Case Studies

Case studies in ADHD research come in various forms, each offering a distinct perspective on the disorder. Some focus on longitudinal observations, tracking an individual’s journey from childhood through adulthood. Others provide snapshots of specific challenges or interventions at particular life stages. There are also comparative case studies that examine ADHD presentations across different demographics or in conjunction with comorbid conditions.

The benefits of analyzing real-life ADHD cases are manifold. Firstly, they humanize the disorder, moving beyond clinical descriptions to reveal the day-to-day realities of living with ADHD. This personal touch fosters empathy and understanding among healthcare providers, educators, and the general public. Secondly, case studies often uncover unique coping mechanisms and strategies developed by individuals with ADHD, which can inform and inspire others facing similar challenges.

Moreover, case studies contribute significantly to ADHD research and treatment by highlighting patterns, raising new questions, and sometimes challenging existing assumptions. They provide a rich source of qualitative data that complements quantitative research, offering a more holistic understanding of the disorder. This comprehensive approach is crucial in developing effective, personalized treatment plans and support systems for individuals with ADHD.

Case Study on ADHD: The Story of Sarah

To illustrate the power of case studies, let’s delve into the story of Sarah, a 28-year-old marketing professional whose journey with ADHD spans from childhood to her current career.

Background and Early Signs: Sarah’s parents first noticed her restlessness and difficulty focusing during preschool. She was constantly in motion, struggled to complete tasks, and often seemed to be “in her own world.” Despite being bright and creative, Sarah’s academic performance was inconsistent, and she frequently lost or forgot important items.

Challenges in School and Social Settings: As Sarah progressed through elementary and middle school, her ADHD symptoms became more pronounced. She struggled to organize her thoughts and materials, often turning in assignments late or incomplete. Socially, Sarah’s impulsivity and tendency to interrupt others made it difficult for her to maintain friendships. Her self-esteem suffered as she internalized the frustration of teachers and peers who misinterpreted her behavior as laziness or disrespect.

Diagnosis Process and Initial Treatment: At age 12, Sarah’s parents sought professional help. After a comprehensive evaluation involving interviews, behavioral assessments, and cognitive tests, Sarah was diagnosed with ADHD, predominantly inattentive type. The diagnosis was both a relief and a challenge for Sarah and her family. They embarked on a journey to understand the disorder and explore treatment options.

Initially, Sarah’s treatment plan included a combination of stimulant medication and behavioral therapy. The medication helped improve her focus and impulse control, while therapy sessions taught her strategies for organization, time management, and social skills. Sarah’s parents and teachers also received education on ADHD, enabling them to create a more supportive environment.

Long-term Management and Outcomes: As Sarah entered adulthood, she continued to refine her ADHD management strategies. She learned to leverage her creative strengths in her marketing career while implementing systems to compensate for her organizational challenges. Sarah’s journey exemplifies the ongoing nature of ADHD management and the potential for individuals with ADHD to lead fulfilling, successful lives.

ADHD Case Study Examples: Diverse Presentations

Sarah’s story is just one example of the myriad ways ADHD can manifest. Let’s explore three more case studies that highlight the diversity of ADHD presentations and the importance of tailored interventions.

Case 1: Adult ADHD in the Workplace John, a 35-year-old software engineer, was diagnosed with ADHD in his late twenties. Despite his technical brilliance, John struggled with project deadlines, time management, and interpersonal communication at work. His case study reveals the unique challenges of adult ADHD in professional settings and the effectiveness of workplace accommodations, such as flexible schedules and task management tools. John’s experience underscores the importance of mastering life with ADHD in professional contexts.

Case 2: ADHD in a Gifted Child Emma, a 9-year-old identified as intellectually gifted, exhibited classic ADHD symptoms that were initially masked by her high academic achievement. Her case study highlights the complexities of diagnosing and supporting twice-exceptional children. Emma’s journey emphasizes the need for nuanced approaches to ADHD and learning , balancing intellectual stimulation with strategies to address executive function deficits.

Case 3: ADHD with Comorbid Anxiety Disorder Michael, a 19-year-old college student, grapples with both ADHD and generalized anxiety disorder. His case study illustrates the challenges of managing co-occurring conditions and the importance of integrated treatment approaches. Michael’s experience sheds light on the interplay between ADHD symptoms and anxiety, informing strategies for addressing complex presentations of the disorder.

Comparing and contrasting these diverse ADHD presentations reveals the heterogeneity of the disorder and the necessity for individualized assessment and treatment plans. Each case offers unique insights into the varied manifestations of ADHD across different life stages, cognitive profiles, and comorbid conditions.

Analyzing Treatment Approaches in ADHD Case Studies

The case studies we’ve explored demonstrate the range of treatment approaches used in managing ADHD. Let’s examine these interventions in more detail:

Medication-based Interventions: Pharmacological treatments, particularly stimulant medications like methylphenidate and amphetamines, play a significant role in many ADHD management plans. Sarah’s case illustrates how medication can improve core symptoms of inattention and hyperactivity. However, as seen in Michael’s situation with comorbid anxiety, medication selection and dosing require careful consideration of individual factors and potential side effects.

Behavioral Therapy and Cognitive Strategies: Cognitive-behavioral therapy (CBT) and other psychosocial interventions are crucial components of comprehensive ADHD treatment. These approaches help individuals develop coping strategies, improve executive functioning, and address emotional regulation. In Emma’s case, cognitive strategies were particularly important in helping her harness her intellectual strengths while managing ADHD symptoms.

Educational Accommodations and Support: For children and adolescents with ADHD, school-based interventions are often essential. These may include individualized education plans (IEPs), classroom accommodations, and specialized tutoring. Emma’s case highlights the importance of tailoring educational approaches to meet the unique needs of gifted children with ADHD.

Holistic Approaches: Diet, Exercise, and Lifestyle Changes: Many case studies, including John’s, emphasize the role of lifestyle factors in ADHD management. Regular exercise, balanced nutrition, adequate sleep, and mindfulness practices can significantly impact ADHD symptoms and overall well-being. These holistic approaches often complement traditional treatments and empower individuals to take an active role in managing their condition.

The effectiveness of these treatment approaches varies among individuals, underscoring the importance of personalized care plans. ADHD clinical trials continue to explore new interventions and refine existing ones, contributing to the evolving landscape of ADHD treatment options.

Lessons Learned from ADHD Case Studies

The wealth of information gleaned from ADHD case studies offers valuable insights for healthcare professionals, educators, and individuals affected by the disorder:

Key Insights for Healthcare Professionals: Case studies underscore the importance of comprehensive assessment and individualized treatment planning. They highlight the need for ongoing monitoring and adjustment of interventions, as ADHD presentations can evolve over time. Healthcare providers are reminded of the significance of considering comorbid conditions and life circumstances when developing treatment strategies.

Implications for Educators and Parents: The diverse presentations of ADHD illustrated in case studies emphasize the need for flexible and supportive educational environments. Educators and parents can learn from these narratives to better understand the challenges faced by individuals with ADHD and implement effective support strategies. The success stories within these case studies also serve as powerful motivators, showcasing the potential for individuals with ADHD to thrive with appropriate support.

Importance of Personalized Treatment Plans: Perhaps the most crucial lesson from ADHD case studies is the necessity of tailored interventions. What works for one individual may not be effective for another, highlighting the need for a patient-centered approach to ADHD management. This personalization extends beyond medication to encompass behavioral strategies, environmental modifications, and lifestyle adjustments.

Future Directions in ADHD Research: Case studies often uncover areas requiring further investigation, driving new research questions and methodologies. They can reveal emerging trends, such as the increasing recognition of adult ADHD, and inform the development of novel treatment approaches. The rich, qualitative data provided by case studies complement quantitative research, offering a more nuanced understanding of ADHD’s impact on daily life.

As we conclude our exploration of ADHD case studies, we’re reminded of the profound value these narratives bring to our understanding of the disorder. They offer a vivid portrayal of the challenges, triumphs, and everyday realities of living with ADHD, moving beyond clinical definitions to capture the human experience of the condition.

The case studies we’ve examined underscore the critical importance of individualized approaches to ADHD management. From Sarah’s journey through childhood and into a successful career, to John’s workplace adaptations, Emma’s twice-exceptional experience, and Michael’s complex presentation with comorbid anxiety, each story highlights the unique constellation of symptoms, strengths, and needs that characterize ADHD.

These personal accounts serve as powerful tools for raising awareness and fostering empathy. They challenge stereotypes and misconceptions about ADHD, revealing the diverse ways in which the disorder manifests across different individuals and life stages. Moreover, they offer hope and inspiration, showcasing the potential for individuals with ADHD to lead fulfilling, successful lives with appropriate support and interventions.

As we move forward, it’s crucial to continue sharing and learning from ADHD stories . These narratives not only inform clinical practice and research but also empower individuals with ADHD and their support networks. They remind us that behind every diagnosis is a unique individual with their own story, challenges, and potential.

Let us carry forward the insights gained from these case studies to create more inclusive, understanding, and supportive environments for individuals with ADHD. By doing so, we can contribute to a world where ADHD is not seen as a limitation, but as a different way of experiencing and interacting with the world—one that comes with its own set of challenges and remarkable strengths.

As we continue to unravel the complexities of ADHD through research, clinical practice, and personal narratives, let us remain committed to supporting, empowering, and celebrating the diverse experiences of individuals living with this fascinating and challenging condition. After all, it is through understanding and embracing these differences that we can truly appreciate the rich tapestry of human neurodiversity.

References:

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

2. Barkley, R. A. (2015). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (4th ed.). New York: Guilford Press.

3. Faraone, S. V., Biederman, J., & Mick, E. (2006). The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychological Medicine, 36(2), 159-165.

4. Kessler, R. C., Adler, L., Barkley, R., Biederman, J., Conners, C. K., Demler, O., … & Zaslavsky, A. M. (2006). The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. American Journal of Psychiatry, 163(4), 716-723.

5. National Institute for Health and Care Excellence. (2018). Attention deficit hyperactivity disorder: diagnosis and management. NICE guideline [NG87]. https://www.nice.org.uk/guidance/ng87

6. Sibley, M. H., Swanson, J. M., Arnold, L. E., Hechtman, L. T., Owens, E. B., Stehli, A., … & Jensen, P. S. (2017). Defining ADHD symptom persistence in adulthood: optimizing sensitivity and specificity. Journal of Child Psychology and Psychiatry, 58(6), 655-662.

7. Thapar, A., Cooper, M., & Rutter, M. (2017). Neurodevelopmental disorders. The Lancet Psychiatry, 4(4), 339-346.

8. Wilens, T. E., & Spencer, T. J. (2010). Understanding attention-deficit/hyperactivity disorder from childhood to adulthood. Postgraduate Medicine, 122(5), 97-109.

Understanding the Default Mode Network in ADHD: Implications for Diagnosis and Treatment

Daydreaming, once dismissed as mere distraction, may hold the key to unraveling the mysteries of ADHD and revolutionizing its diagnosis and treatment. As researchers delve deeper into the intricate workings of the human brain, they have uncovered a fascinating network of brain regions that becomes active when our minds wander. This network, known as the…

Is ADHD Testing Covered by Insurance? A Comprehensive Guide to Coverage and Costs

Buckle up for a wild ride through the labyrinth of insurance jargon, where the quest for ADHD testing coverage feels like a high-stakes treasure hunt with your mental health as the prize. As we embark on this journey, it’s crucial to understand the importance of ADHD testing and the financial concerns that often accompany it….

UF ADHD Testing: A Comprehensive Guide to Diagnosis and Support at the University of Florida

Navigating college life can feel like juggling flaming torches while riding a unicycle, but for students grappling with undiagnosed ADHD, it’s more akin to doing so blindfolded—which is why the University of Florida’s comprehensive testing and support services are a game-changer. For many students, the transition to university life brings a host of new challenges,…

ADHD Computer Tests: A Comprehensive Guide to Digital Assessments for Adults

Clicking, tapping, and staring at a screen might just reveal more about your brain than years of traditional psychiatric evaluations ever could. This revolutionary approach to diagnosing Attention Deficit Hyperactivity Disorder (ADHD) in adults has been gaining traction in recent years, offering a more objective and standardized method of assessment. As our understanding of ADHD…

Understanding ADHD Testing: Duration, Process, and What to Expect

Time isn’t just money when it comes to ADHD testing—it’s the key to unlocking a life-changing diagnosis and tailored treatment plan. Attention Deficit Hyperactivity Disorder (ADHD) is a complex neurodevelopmental condition that affects millions of individuals worldwide, impacting their daily lives, relationships, and overall well-being. The journey to understanding and managing ADHD begins with proper…

QB Test for ADHD: A Comprehensive Guide with Examples

Dodging virtual butterflies while tapping to phantom sounds might seem like an odd video game, but for those seeking answers about ADHD, it’s a revolutionary diagnostic tool called the QB Test. Attention Deficit Hyperactivity Disorder (ADHD) is a complex neurodevelopmental condition that affects millions of people worldwide, impacting their ability to focus, control impulses, and…

Attention Deficit Hyperactivity Disorder (ADHD): A Case Study and Exploration of Causes and Interventions

First Online: 02 March 2019

Cite this chapter

Bijal Chheda-Varma 5

3411 Accesses

The male to female ratio of ADHD is 4:1. This chapter on ADHD provides a wide perspective on understanding, diagnosis and treatment for ADHD. It relies on a neurodevelopmental perspective of ADHD. Signs and symptoms of ADHD are described through the DSM-V criteria. A case example (K, a patient of mine) is illustrated throughout the chapter to provide context and illustrations, and demonstrates the relative merits of “doing” (i.e. behavioural interventions) compared to cognitive insight, or medication alone. Finally, a discussion of the Cognitive Behavioral Modification Model (CBM) for the treatment of ADHD provides a snapshot of interventions used by clinicians providing psychological help.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save.

Get 10 units per month
Download Article/Chapter or eBook
1 Unit = 1 Article or 1 Chapter
Cancel anytime
Available as PDF
Read on any device
Instant download
Own it forever
Available as EPUB and PDF
Durable hardcover edition
Dispatched in 3 to 5 business days
Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Psychological Treatments in Adult ADHD: A Systematic Review

Attention-Deficit Hyperactivity Disorder

ADHD and Its Therapeutics

Alderson, R. M., Hudec, K. L., Patros, C. H. G., & Kasper, L. J. (2013). Working memory deficits in adults with attention-deficit/hyperactivity disorder (ADHD): An examination of central executive and storage/rehearsal processes. Journal of Abnormal Psychology, 122 (2), 532–541. http://dx.doi.org/10.1037/a0031742 .

Arcia, E., & Conners, C. K. (1998). Gender differences in ADHD? Journal of Developmental and Behavioral Pediatrics, 19 (2), 77–83. http://dx.doi.org/10.1097/00004703-199804000-00002 .

Barkley, R. A. (1990). Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment . New York: Guildford.

Google Scholar

Barkley, R. A. (1997). ADHD and the nature of self-control . New York: Guilford Press.

Barkley, R. A. (2000). Commentary on the multimodal treatment study of children with ADHD. Journal of Abnormal Child Psychology, 28 (6), 595–599. https://doi.org/10.1023/A:1005139300209 .

Article Google Scholar

Barkley, R., Knouse, L., & Murphy, K. Correction to Barkley et al. (2011). Psychological Assessment [serial online]. June 2011; 23 (2), 446. Available from: PsycINFO, Ipswich, MA. Accessed December 11, 2014.

Beck, A. T. (1976). Cognitive therapy and the emotional disorders . New York, NY: International Universities Press.

Brown, T. E. (2005). Attention deficit disorder: The unfocused mind in children and adults . New Haven, CT: Yale University Press.

Brown, T. (2013). A new understanding of ADHD in children and adults . New York: Routledge.

Chacko, A., Kofler, M., & Jarrett, M. (2014). Improving outcomes for youth with ADHD: A conceptual framework for combined neurocognitive and skill-based treatment approaches. Clinical Child and Family Psychology Review . https://doi.org/10.1007/s10567-014-0171-5 .

Chronis, A., Jones, H. A., Raggi, V. L. (2006, August). Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder. Clinical Psychology Review, 26 (4), 486–502. ISSN 0272-7358. http://dx.doi.org/10.1016/j.cpr.2006.01.002 .

Curatolo, P., D’Agati, E., & Moavero, R. (2010). The neurobiological basis of ADHD. Italian Journal of Pediatrics, 36 , 79. http://doi.org/10.1186/1824-7288-36-79 . http://www.sciencedirect.com/science/article/pii/S0272735806000031 .

Curtis, D. (2010). ADHD symptom severity following participation in a pilot, 10-week, manualized, family-based behavioral intervention. Child & Family Behavior Therapy, 32 , 231–241. https://doi.org/10.1080/07317107.2010.500526 .

De Young, R. (2014). Using the Stroop effect to test our capacity to direct attention: A tool for navigating urgent transitions. http://www.snre.umich.edu/eplab/demos/st0/stroopdesc.html .

Depue, B. E., Orr, J. M., Smolker, H. R., Naaz, F., & Banich, M. T. (2015). The organization of right prefrontal networks reveals common mechanisms of inhibitory regulation across cognitive, emotional, and motor processes. Cerebral Cortex (New York, NY: 1991), 26 (4), 1634–1646.

D’Onofrio, B. M., Van Hulle, C. A., Waldman, I. D., Rodgers, J. L., Rathouz, P. J., & Lahey, B. B. (2007). Causal inferences regarding prenatal alcohol exposure and childhood externalizing problems. Archives of General Psychiatry, 64, 1296–1304 [PubMed].

DSM-V. (2013). Diagnostic and statistical manual of mental disorders . American Psychological Association.

Eisenberg, D., & Campbell, B. (2009). Social context matters. The evolution of ADHD . http://evolution.binghamton.edu/evos/wp-content/uploads/2012/02/eisenberg-and-campbell-2011-the-evolution-of-ADHD-artice-in-SF-Medicine.pdf .

Gizer, I. R., Ficks, C., & Waldman, I. D. (2009). Hum Genet, 126 , 51. https://doi.org/10.1007/s00439-009-0694-x .

Hinshaw, S. P., & Scheffler, R. M. (2014). The ADHD explosion: Myths, medication, money, and today’s push for performance . New York: Oxford University Press.

Kapalka, G. M. (2008). Efficacy of behavioral contracting with students with ADHD . Boston: American Psychological Association.

Kapalka, G. (2010). Counselling boys and men with ADHD . New York: Routledge, Taylor & Francis Group.

Book Google Scholar

Knouse, L. E., et al. (2008, October). Recent developments in psychosocial treatments for adult ADHD. National Institute of Health, 8 (10), 1537–1548. https://doi.org/10.1586/14737175.8.10.1537 .

Laufer, M., Denhoff, E., & Solomons, G. (1957). Hyperkinetic impulse disorder in children’s behaviour problem. Psychosomatic Medicine, 19, 38–49.

Raggi, V. L., & Chronis, A. M. (2006). Interventions to address the academic impairment of children and adolescents with ADHD. Clinical Child and Family Psychology Review, 9 (2), 85–111. https://doi.org/10.1007/s10567-006-0006-0 .

Ramsay, J. R. (2011). Cognitive behavioural therapy for adult ADHD. Journal of Clinical Outcomes Management, 18 (11), 526–536.

Retz, W., & Retz-Junginger, P. (2014). Prediction of methylphenidate treatment outcome in adults with attention deficit/hyperactivity disorder (ADHD). European Archives of Psychiatry and Clinical Neuroscience . https://doi.org/10.1007/s00406-014-0542-4 .

Safren, S. A., Otto, M. W., Sprich, S., Winett, C. L., Wilens, T. E., & Biederman, J. (2005, July). Cognitive-behavioral therapy for ADHD in medication-treated adults with continued symptoms. Behaviour Research and Therapy, 43 (7), 831–842. ISSN 0005-7967. http://dx.doi.org/10.1016/j.brat.2004.07.001 . http://www.sciencedirect.com/science/article/pii/S0005796704001366 .

Sibley, M. H., Kuriyan, A. B., Evans, S. W., Waxmonsky, J. G., & Smith, B. H. (2014). Pharmacological and psychosocial treatments for adolescents with ADHD: An updated systematic review of the literature. Clinical Psychology Review, 34 (3), 218–232. https://doi.org/10.1016/j.cpr.2014.02.001 .

Simchon, Y., Weizman, A., & Rehavi, M. (2010). The effect of chronic methylphenidate administration on presynaptic dopaminergic parameters in a rat model for ADHD. European Neuropsychopharmacology, 20 (10), 714–720. ISSN 0924-977X. https://doi.org/10.1016/j.euroneuro.2010.04.007 . http://www.sciencedirect.com/science/article/pii/S0924977X10000891 .

Swanson, J. M., & Castellanos, F. X. (2002). Biological bases of ADHD: Neuroanatomy, genetics, and pathophysiology. In P. S. Jensen & J. R. Cooper (Eds.), Attention deficit hyperactivity disorder: State if the science, best practices (pp. 7-1–7-20). Kingston, NJ: Civic Research Institute.

Toplak, M. E., Connors, L., Shuster, J., Knezevic, B., & Parks, S. (2008, June). Review of cognitive, cognitive-behavioral, and neural-based interventions for attention-deficit/hyperactivity disorder (ADHD). Clinical Psychology Review, 28 (5), 801–823. ISSN 0272-7358. http://dx.doi.org/10.1016/j.cpr.2007.10.008 . http://www.sciencedirect.com/science/article/pii/S0272735807001870 .

Wu, J., Xiao, H., Sun, H., Zou, L., & Zhu, L.-Q. (2012). Role of dopamine receptors in ADHD: A systematic meta-analysis. Molecular Neurobiology, 45 , 605–620. https://doi.org/10.1007/s12035-012-8278-5 .

Download references

Author information

Authors and affiliations.

Foundation for Clinical Interventions, London, UK

Bijal Chheda-Varma

You can also search for this author in PubMed Google Scholar

Editor information

Editors and affiliations.

UCL, London, UK

John A. Barry

Norfolk and Suffolk NHS Foundation Trust, Wymondham, UK

Roger Kingerlee

Change, Grow, Live, Dagenham/Southend, Essex, UK

Martin Seager

Community Interest Company, Men’s Minds Matter, London, UK

Luke Sullivan

Rights and permissions

Reprints and permissions

Copyright information

About this chapter

Chheda-Varma, B. (2019). Attention Deficit Hyperactivity Disorder (ADHD): A Case Study and Exploration of Causes and Interventions. In: Barry, J.A., Kingerlee, R., Seager, M., Sullivan, L. (eds) The Palgrave Handbook of Male Psychology and Mental Health. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-04384-1_15

Download citation

DOI : https://doi.org/10.1007/978-3-030-04384-1_15

Published : 02 March 2019

Publisher Name : Palgrave Macmillan, Cham

Print ISBN : 978-3-030-04383-4

Online ISBN : 978-3-030-04384-1

eBook Packages : Behavioral Science and Psychology Behavioral Science and Psychology (R0)

Share this chapter

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

Publish with us

Policies and ethics

Find a journal
Track your research

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Publications
Account settings
My Bibliography
Collections
Citation manager

Save citation to file

Email citation, add to collections.

Create a new collection
Add to an existing collection

Add to My Bibliography

Your saved search, create a file for external citation management software, your rss feed.

Search in PubMed
Search in NLM Catalog
Add to Search

Attention deficit/hyperactivity disorder in adults: A case study

Affiliations.

1 University of North Dakota, United States of America. Electronic address: [email protected].
2 University of North Dakota, United States of America.
3 Dana Wiley, MD PA.
PMID: 35461644
DOI: 10.1016/j.apnu.2021.12.003

Attention-Deficit/Hyperactivity Disorder (ADHD) is often misdiagnosed or mistreated in adults because it is often thought of as a childhood problem. If a child is diagnosed and treated for the disorder, it often persists into adulthood. In adult ADHD, the symptoms may be comorbid or mimic other conditions making diagnosis and treatment difficult. Adults with ADHD require an in-depth assessment for proper diagnosis and treatment. The presentation and treatment of adults with ADHD can be complex and often requires interdisciplinary care. Mental health and non-mental health providers often overlook the disorder or feel uncomfortable treating adults with ADHD. The purpose of this manuscript is to discuss the diagnosis and management of adults with ADHD.

Keywords: Adult; Attention Deficit/Hyperactivity Disorder; Misuse; Psychoeducation; Stimulant.

PubMed Disclaimer

Related information

Linkout - more resources, full text sources.

Elsevier Science
Ovid Technologies, Inc.
MedlinePlus Health Information
Citation Manager

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

Research article
Open access
Published: 12 August 2020

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

Susan Young ORCID: orcid.org/0000-0002-8494-6949 1 , 2 ,
Nicoletta Adamo 3 , 4 ,
Bryndís Björk Ásgeirsdóttir 2 ,
Polly Branney 5 ,
Michelle Beckett 6 ,
William Colley 7 ,
Sally Cubbin 8 ,
Quinton Deeley 9 , 10 ,
Emad Farrag 11 ,
Gisli Gudjonsson 2 , 12 ,
Peter Hill 13 ,
Jack Hollingdale 14 ,
Ozge Kilic 15 ,
Tony Lloyd 16 ,
Peter Mason 17 ,
Eleni Paliokosta 18 ,
Sri Perecherla 19 ,
Jane Sedgwick 3 , 20 ,
Caroline Skirrow 21 , 22 ,
Kevin Tierney 23 ,
Kobus van Rensburg 24 &
Emma Woodhouse 10 , 25

BMC Psychiatry volume 20 , Article number: 404 ( 2020 ) Cite this article

234k Accesses

159 Citations

709 Altmetric

Metrics details

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.

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.

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.

Peer Review reports

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental condition described in diagnostic classification systems (ICD-10, DSM-5 [ 1 , 2 ]). It is characterised by difficulties in two subdomains: inattention, and hyperactivity-impulsivity. Three primary subtypes can be identified: predominantly inattentive, hyperactive-impulsive, and combined presentations. Symptoms persist over time, pervade across situations and cause significant impairment [ 3 ].

ADHD is present in childhood and symptoms tend to decline with increasing age [ 4 ], with consistent reductions documented in hyperactive-impulsive symptoms but more mixed results regarding the decline in inattentive symptoms [ 5 , 6 , 7 ]. This trajectory does not appear to be different in affected males or females [ 6 , 8 ]. A meta-analysis of longitudinal studies published in 2005 showed that up to one-third of childhood cases continued to meet full diagnostic criteria into their 20s, with around 65% continuing to experience impairing symptoms [ 9 ]. More recent studies in large clinical cohorts indicate that persistence of ADHD into adulthood may be much more common. Two studies from child mental health clinics in the UK and the Netherlands have reported persistence in around 80% of children with the combined type presentation into early adulthood [ 10 , 11 ], potentially relating to the high severity of ADHD in this group and the use of more objective ratings [ 12 ]. The proportion meeting full diagnostic criteria for ADHD then continues to decline in adult samples [ 13 ]. Simultaneously, experiences of ADHD symptoms often change over the course of development: hyperactivity may be replaced by feelings of ‘inner restlessness’ and discomfort; inattention may manifest as difficulty completing chores or work-based activities (e.g. filling out forms, remembering appointments, meeting deadlines) [ 1 ].

Psychiatric comorbidity is very common, which may complicate identification and treatment [ 14 ]. In children with ADHD this includes conduct disorder (CD), oppositional defiant disorder (ODD), disruptive mood dysregulation disorder, autism spectrum disorder (ASD), developmental coordination disorder, tic disorders, anxiety and depressive disorders, reading disorders, and learning and language disorders [ 15 , 16 , 17 ]. Comorbid conditions are also extremely common in adults and include ASD, anxiety and depressive disorders, bipolar disorder, eating disorders, obsessive compulsive disorder, substance use disorders, personality disorders, and impulse control disorders [ 18 , 19 ].

Prevalence of ADHD is estimated at 7.1% in children and adolescents [ 20 ], and 2.5-5% in adults [ 4 , 21 ], and around 2.8% in older adults [ 22 ]. Sex differences in the prevalence of ADHD are well documented. Clinical referrals in boys typically exceed those for girls, with ratios ranging from 3-1 to 16-1 [ 23 ]. The discrepancy of ADHD rates in community samples remains significant, although it is less extreme, at around a 3-1 ratio of boys to girls [ 4 ]. Nevertheless the discrepancy in the sex-ratio between clinic and community samples highlights that a large number of girls with ADHD are likely to remain unidentified and untreated, with implications for long-term social, educational and mental health outcomes [ 24 ].

This disparity in prevalence between boys and girls may stem from a variety of potential factors. The contribution of greater genetic vulnerability, endocrine factors, psychosocial contributors, or a propensity to respond negatively to certain early life stressors in boys have been proposed or investigated as potential contributors to sexual dimorphism in prevalence and presentation [ 25 , 26 ]. Whilst in childhood there is a clear male preponderance of ADHD, in adult samples sex differences in prevalence are more modest or absent [ 21 , 27 , 28 , 29 ]. This may be due to a variety of factors, with potential contributions from the greater reliance on self-report in older samples, greater persistence in females alongside increased levels of remission in males, and potentially more common late onset cases in females [ 25 , 26 , 28 ].

Comprehensive views of the aetiology of ADHD incorporate biological, environmental and cultural perspectives and influences [ 25 ]. Substantial genetic influences have been identified in ADHD [ 30 ]. Individuals who have ADHD are more likely to have children, parents and/or siblings with ADHD [ 31 , 32 ]. The ‘female protective effect’ theory suggests that girls and women may need to reach a higher threshold of genetic and environmental exposures for ADHD to be expressed, thereby accounting for the lower prevalence in females and the higher familial transmission rates seen in families where females are affected [ 33 , 34 ]. Research suggests that siblings of affected girls have more ADHD symptoms compared with siblings of affected boys [ 33 , 34 ].

There is increasing recognition that females with ADHD show a somewhat modified set of behaviours, symptoms and comorbidities when compared with males with ADHD; they are less likely to be identified and referred for assessment and thus their needs are less likely to be met. It is unknown how often a diagnosis of ADHD is being missed or misdiagnosed in females, but it has become clear that a better understanding of ADHD in girls and women is needed if we are to improve their longer-term wellbeing and functional and clinical outcomes [ 35 , 36 ].

This report provides a selective review the research literature on ADHD in girls and women, and aims to provide guidance to improve identification, treatment and support for girls and women with ADHD across the lifespan, developed through a multidisciplinary consensus meeting according to the clinical expertise and knowledge among attendees. To support medical and mental health practitioners in their understanding of ADHD in females, we provide consensus guidance on the presentation of ADHD in females and triggers for referral. We establish specific advice regarding the assessment, interventions, and multi-agency liaison needs in girls and women with ADHD.

In line with previous definitions, we use the terms sex to identify a biological category (male/female), and gender to define a social role and cultural-social properties [ 37 ]. However, we acknowledge the complex differences between the sexes that occur independently of ADHD status [ 38 ], and discuss both biological differences and social roles in the current consensus.

The consensus aimed to provide practical guidance to professionals working with girls and women with ADHD, drawing on the scientific literature and the professional experience of the authors. To achieve this aim, professionals specialising in ADHD convened in London on 30th November 2018 for a meeting hosted by the United Kingdom ADHD Partnership (UKAP; www.UKADHD.com ). Meeting attendees included experts in ADHD across a range of mental health professions, including healthcare specialists (nursing; general practice; child, adolescent and adult psychiatry; clinical and forensic psychology; counselling), academic, educational and occupational specialists. Service-users and ADHD charity workers were also represented. Attendees engaged in discussions throughout the day, with the aim of reaching consensus.

The meeting commenced with presentations of preliminary data obtained from (1) an ongoing systematic review on the clinical and psychosocial presentation of females in comparison with males with ADHD (currently being led by SY and OK); and (2) epidemiological research on sex differences in self-reported ADHD symptoms in population based adolescent cohorts. Following a question and answer session, attendees then separated into three breakout groups. Each group was tasked with providing practical solutions relevant to their assigned topic. Discussions were facilitated by group leaders and summarized by note-takers. Following the small-group work, all attendees re-assembled. Group leaders then presented findings to all meeting attendees for another round of discussion and debate, until consensus was reached. Group discussions included the following themes:

1: Identification and assessment of ADHD in females

Presentation in females and what might trigger referral?

Considering sex differences when conducting ADHD assessments

2: Interventions and treatments for ADHD in females

Pharmacological

Non-pharmacological

3: Multi-agency liaison

Educational considerations

Other multi-agency considerations

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 in clinical needs and presentation. Recommendations that differed between age groups are presented separately.

The consensus group incorporated evidence from a broad range of sources. However, the assessment, pharmacological treatment, and multiagency support features reflect clinical practice and legislature in the United Kingdom (UK), and may differ in other countries.

All consensus proceedings, including group and feedback sessions were video-recorded and transcribed. One note-taker was allocated to each breakout group, and notes were subsequently circulated to each breakout group contributor for review and agreement. All materials were sent to the medical writer, who consolidated the meeting transcription, electronic slide presentations and small-group notes. 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. A final draft was circulated to all authors for agreement and approval.

Results and consensus outcome

Presentation of adhd in females.

Although much of the scientific literature indicates an overlap in the clinical presentation of males and females with ADHD, the available evidence often draws on predominantly male samples [ 39 ] due to the higher prevalence of ADHD in males [ 4 ]. Some sex differences have been reported, which are described below, and briefly summarised in Table 1 .

ADHD symptoms

Research in population-based samples indicates that for both sexes the hyperactive-impulsive type predominates in pre-schoolers, whereas the inattentive-type is the most common presentation from mid-to-late childhood and into adulthood [ 4 , 21 ]. By contrast, clinical studies typically report a greater prevalence of combined-type ADHD [ 5 , 12 , 22 ]. Early meta-analyses of gender effects have found lower severity of hyperactivity-impulsivity [ 40 ], or all ADHD symptoms (inattention, hyperactivity, impulsivity) [ 24 ] in girls than boys, although individual studies show more mixed results [ 8 , 35 , 41 , 42 ].

Inconsistent findings may reflect that clinic referral and diagnosis tends to favour combined subtypes equally across genders, whilst community sampling points to greater prevalence of inattentive type ADHD in girls than in boys [ 43 ]. Hyperactive-impulsive symptoms have been linked to higher clinic ascertainment rates [ 4 ], and may be more commonly seen in boys [ 40 ], with inattention symptoms being less obvious and therefore less likely to be detected. These differences may lead to the perception that females with ADHD are less impaired [ 44 ].

People may experience and respond to the same behaviour of males and females in different ways due to gender-related behavioural expectations [ 42 ]. For example in two studies where teachers were presented with ADHD-like vignettes, when simply varying the child’s name and pronouns used from male to female, boys names were more likely to be referred for additional support [ 45 ] and considered more suitable for treatment [ 46 ]. Parents may also underestimate impairment and severity of hyperactive/impulsive symptoms in girls whilst over-rating these same symptoms in boys [ 47 ]. Compensatory behaviours in girls, such as socially adaptive behaviour, compliance, increased resilience [ 47 ] or coping strategies to mask behaviour [ 48 ] may also contribute to differing perceptions that may in turn prevent referral.

Less is known about the presentation of ADHD in older adults but evidence suggests whilst symptoms tend to decline, ADHD may persist into middle and old age, with a more even male-to-female community prevalence and referral rate with increasing age [ 22 , 49 ].

Comorbidity

Externalising problems are more prevalent in males with ADHD [ 24 ], manifesting as higher rates of comorbid oppositional defiant disorder (ODD) and conduct disorder (CD) [ 40 ], characterised by rule-breaking behaviour [ 50 , 51 ] and fights in school [ 36 ]. In adulthood, men with ADHD more commonly show antisocial behaviours characteristic of antisocial personality disorder [ 52 , 53 , 54 ]. Whilst these problems are more prevalent in males, they typically remain elevated in individuals with ADHD across both sexes in comparison with the general population. The lower rates of disruptive behavioural problems in females may contribute to lower rates of referral for ADHD assessment and support [ 48 , 55 ].

Compared with males with ADHD, internalising disorders (e.g. emotional problems, anxiety, depression) are more often reported in females [ 24 , 29 , 47 , 51 , 53 , 56 ]. Borderline personality traits in ADHD tend to be associated with women [ 57 ] with hyperactive/impulsive symptoms being associated with self-harming behaviours [ 58 ]. Additionally, women with ADHD have been found to be at higher risk for some adverse outcomes, including greater mental health impairment [ 29 ], severe mental illness (schizophrenia) [ 59 ] and admissions to in-patient psychiatric hospitals in adulthood [ 60 ].

The less overt presentation of ADHD in girls and women may mask the underlying condition due to females not meeting stereotypical expectations of ADHD behaviour. Instead females may be more likely to attract a primary diagnosis of internalising disorders or personality disorders, in turn delaying diagnosis and appropriate treatment [ 45 , 47 , 48 ].

Disordered eating behaviour has been associated with ADHD across both sexes. Whilst individual studies have shown increased disordered eating in girls and women with ADHD [ 53 , 61 ], a meta-analysis of twelve studies identified increased risk of all eating disorder syndromes (bulimia nervosa, anorexia nervosa and binge eating disorder), amongst individuals with ADHD, with similar risk estimates for males and females [ 62 ]. Meta-analysis has also confirmed increased co-occurrence of obesity in children and adults with ADHD [ 63 , 64 ], albeit with no difference between males and females.

Consensus meeting attendees highlighted the co-occurrence of somatic symptoms such as pain and fatigue with ADHD in females, based on clinical observation. There is little available research on sex differences in the prevalence of somatic symptoms such as pain and fatigue in people with ADHD. However, elevated ADHD symptoms have been reported in clinical cohorts with fibromyalgia [ 65 ], and chronic fatigue syndrome [ 66 ].

Young people with ADHD are at greater risk for tobacco and alcohol use in mid adolescence [ 67 ]. In adulthood they are more likely to become smokers [ 68 ], engage in higher rates of substance use [ 69 ] and develop alcohol and drug use disorders [ 70 ]. A prospective follow-up study of a nationwide birth cohort using Danish registry data reported that ADHD increased the risk of all substance use disorder (SUD) outcomes [ 71 ], with comparable risks seen for males and females. Females with ADHD (but without any comorbid conditions) had a higher risk of alcohol and cannabis abuse when compared with males.

Associated features, functional problems and impairments

In both children and adults ADHD is commonly accompanied by emotional lability and emotion dysregulation problems (irritability, low frustration tolerance, mood changes) [ 72 , 73 , 74 ]. Difficulties of this nature may be more common or severe in girls and women [ 30 , 56 , 57 , 58 ] and emotion dysregulation problems are associated with a broad range of impairments in adulthood, including educational, occupational, social, familial, criminal, driving and financial problems [ 75 , 76 ]. In an Icelandic study of ADHD symptoms in university students, poor social functioning best predicted dissatisfaction with life in males, whereas among females the best predictor of life dissatisfaction was poor emotional control [ 77 ].

Cognitive problems are well established in ADHD [ 78 , 79 , 80 ], spanning difficulties with executive dysfunction (such as inhibition, planning, working memory and set shifting) and non-executive cognitive domains (e.g. word reading, reaction times, colour or letter naming, response consistency). However, ADHD may also be associated with general impairments in intellectual functioning, which tends to be more prominent in females [ 24 , 40 ]. Subtle social cognition deficits, including facial and vocal emotion recognition, have also been reported in both males and females with ADHD, with no clear sex-related differences [ 81 ].

A similar level of social impairment has been identified for ADHD males and females [ 24 , 40 , 82 ]. Autistic-like symptoms, including social and communication impairments, are common in both girls and boys with ADHD, and although these present at a higher rate in boys, likely influenced by the higher base incidence of ASD in boys, alongside greater difficulties in detecting ASD in girls [ 16 ]

Children with ADHD are more likely to experience rejection and unpopularity and have fewer friendships than their peers [ 83 ] and social problems can persist into adulthood [ 75 ]. Disruption to relationships with parents, siblings and peers has been reported for females with ADHD [ 84 , 85 ]. Girls with ADHD may apply a range of ineffective strategies to resolve their peer relationship problems [ 86 , 87 ], and experience more bullying than their peers [ 88 ], including physical, social-relational, and cyberbullying victimisation [ 23 , 89 , 90 ], whilst in boys physical victimisation appears to be more common [ 91 ]. Peer victimisation has been associated with reduced self-esteem and self-efficacy, and increased anxiety and depression symptoms in young people with ADHD [ 90 , 91 ]. Adverse outcomes have been associated with interpersonal difficulties in females with ADHD including lower satisfaction with romantic relationships [ 92 ] and lower self esteem [ 48 ].

There is some evidence to suggest that elevated symptoms of ADHD are associated with excessive internet use in children and adolescents [ 93 ], as well as adults [ 94 ], but the causal direction of this association is unclear (i.e. elevated ADHD symptoms could trigger excessive internet use, or excessive internet use could lead to elevated symptoms of ADHD) [ 95 ]. Excessive gaming [ 96 ] has also been reported. It is not clear whether this association is stronger in males or females or if it is equivalent across the sexes [ 93 , 94 , 97 ]. A large web-based survey of adult internet behaviours and psychopathology in Norway found that elevated ADHD symptoms were associated with increased addictive technological behaviours, including social media use and gaming [ 98 ]. Overall however, addictive social media use was more common in women [ 98 ].

Throughout adolescence and the transition into adulthood, there is an increase in risk taking behaviour which may be associated with symptoms of hyperactivity and/or impulsivity [ 48 ]. For example, young people with ADHD become sexually active earlier, have more sexual partners and are more frequently treated for sexually transmitted infections [ 99 ]. Rates of teenage, early or unplanned pregnancies are elevated in girls and women with ADHD [ 100 , 101 , 102 ]. Pregnant women with ADHD are more likely to smoke up to the third trimester, or be obese or underweight [ 102 ].

A review of ADHD and driving reported that adults with a history of ADHD may be more likely to be unsafe or reckless drivers and have more frequent or severe crashes [ 103 ], albeit with no specific examination of sex differences. 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 ]. This suggests that reckless driving is likely to be similarly proportionally enhanced in women as in men with ADHD.

Studies specifically reporting driving problems in women with ADHD have shown no significant association between ADHD and driving outcomes [ 68 , 100 , 104 ]. However, results from a prospective follow-up study of a nationwide birth cohort in Danish registers, reported increased mortality rate among individuals with ADHD; when compared with males with ADHD, females with ADHD had an increased mortality rate after controlling for comorbid CD, ODD and SUD [ 104 ]. The excess mortality in ADHD was mainly driven by deaths from unnatural causes, especially accidents. The authors speculate that the gender difference may be driven by females being less likely to be diagnosed and receive treatment than males with the disorder, leading to greater risk of accidental death.

Delinquency and criminality in females with ADHD is more common compared with their non-ADHD peers but less severe or prevalent than reported in males with ADHD [ 85 , 105 , 106 ]. A study examining adult criminal outcomes in children with ADHD, showed males were twice more likely to be convicted than females, but convictions in females occurred at eighteen times the rate seen in the general population [ 106 ]. Prevalence of ADHD in prison populations is estimated at 25%, with no significant differences seen in relation to gender or age [ 107 ].

Triggers for referral

There are multiple potential triggers that may prompt the referral of females for assessment, shown in Table 2 . Some of these triggers are indicative of other associated conditions and it is the clustering of multiple trait-like symptoms that are pervasive and impairing that is informative, rather than state-like symptoms showing situational change. The decision to refer would also be strongly supported if there is a first-degree relative with ADHD.

The stereotype of the ADHD ‘disruptive boy’ [ 47 ] is likely to influence the likelihood of referral and access to diagnosis and treatment. The key message is not to disregard females because they do not present with the externalising behavioural problems, or the disruptive, hard-to-manage presentation (e.g. engaging in boisterous, loud behaviours) commonly associated with males with ADHD. 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.

It is important to be mindful that environmental demands (including educational, occupational, financial, familial and social functions and responsibilities) increase in number, scope and complexity with age and level of independence, whilst support resources decline [ 108 ]. Many young peoples’ struggles and impairments become apparent as they lose the family and educational scaffolding that was previously in place. Therefore, young people (both males and females) may be particularly vulnerable at times of transition, when symptoms become exposed. Increased functional demands on transition to secondary school (planning ahead, organising work and juggling assignments) may lead them to feel overwhelmed. This may impact on self-esteem and result in learner anxiety and perfectionism in an attempt to compensate. Periods of transition may therefore unmask unidentified ADHD by exposing or exacerbating symptoms, together with the development of internalising problems leading to increased vulnerability.

These environmental changes often occur at a time when girls undergo changes in their physiological and sexual maturation. There is growing recognition that puberty is a phase of high risk for mental health problems [ 109 ]. 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.

Difficulty coping with more complex social interactions and resolving interpersonal conflict may also trigger cause for concern. As girls with ADHD move into their teenage years, difficulty maintaining friendships often becomes more marked and they may feel rejected and socially isolated. Some respond with bravado to buffer them from social isolation but a ‘brave face’ is unlikely to prevent them from feeling distressed and developing low mood and anxiety. Dysfunctional coping strategies and the lack of a support network may lead them to express these feelings by self-harming behaviours (e.g. cutting) or changes in eating patterns.

The identification of specific educational or learning problems may also be an important trigger for referral. Children may be diagnosed with specific learning difficulties, such as dyslexia, when a diagnosis of ADHD may be more appropriate. Parents/carers and teachers may note the disparity between educational performance (day-to-day classroom contribution) and achievement (end grades).

Many young people with ADHD do not exceed the mandatory minimum level of schooling, and the problems described above may become even more marked when they enter further education and/or leave home. Research suggests that adolescent school girls with elevated ADHD symptoms make significantly fewer plans for their future than their peers, suggesting that they leave this to chance and opportunistic encounters [ 86 ]. Those who enter the world of work may find that their difficulties evolve into employment impairments and limitations. However, as they mature young people may begin to develop greater awareness of their difficulties, leading to an increase in self-referrals.

For both males and females, a comprehensive assessment should be completed to accurately capture the symptoms of ADHD across multiple settings, their persistence over time and associated functional impairments. High rates of comorbidity are typically present. The assessment process is typically tripartite involving the use of rating scales, a clinical interview and ideally objective information from informants or school reports. Key recommendations for enhancing diagnostic assessment in girls and women are provided in Table 3 .

Rating Scales

Rating scales can obtain perspectives from different informants (e.g. family, teacher, youth worker, occupational health practitioner) in a consistent, quick and easy way. 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.

While rating scales are useful aids for clinical assessment and treatment monitoring, findings should be interpreted cautiously if they are used for screening purposes as they are non-specific markers of potential problems [ 110 ]. Rigid adherence to cut-offs may lead to a high proportion of false positives and negatives. There are many rating scales available with varying merits and limitations and some are yet to be updated to reflect revisions to diagnostic criteria. Where possible both informant- and patient-rated scales should be obtained. Rating scales in common use are presented in Table 4 .

Rating scale norms are predominantly from male or mixed samples, which may disadvantage their use in females, although some provide female-specific norms (see Table 4 ). Where female norms are not available, greater emphasis should be placed on collateral information (e.g. parental and school reports). The Nadeau and Quinn checklists may also be used as indication of possible ADHD in girls and women [ 126 , 127 ], providing structured self-enquiry of ADHD symptoms and associated problems, including a range of difficulties such as learning problems, social/interpersonal and behavioural problems.

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.

The clinical interview

A clinical diagnostic interview, supplemented by a mental state examination, should consider the extent to which the individual’s functioning is age appropriate and obtain examples of how difficulties interfere with functioning and development in home and education/work environments. For children this is usually carried out in the presence of a person close to the child, has known the child for a long time, and is familiar with their developmental history and functioning in different settings (commonly a parent or carer).

Age-appropriate, common co-occurring conditions in females with ADHD should be explored, including ASD, tics, mood disorders, anxiety, and eating disorders. Fibromyalgia, chronic fatigue syndrome, body dysmorphic disorder and gender dysphoria may also be explored as possible co-occurring conditions. The assessor needs to consider what is primary (i.e. occurring alongside and independently to ADHD) and what is secondary (i.e. caused or exacerbated by ADHD). It will help to determine whether the presenting problem is trait-like or episodic in nature. Clinicians should be alert to signs of self-harming behaviours (especially cutting), which typically peak in adolescence and early adulthood [ 128 , 129 ]. Substance and alcohol use disorders should also be assessed in teenagers and adults. Sleep problems are commonly seen in both males and females with ADHD [ 130 , 131 ], and it is important to determine whether this primarily relates to symptoms of ADHD or co-occurring anxiety.

Since heritability of ADHD is high, ranging between 70-80% in both children and adults [ 132 ], it is important to be mindful that informants who are family members may also have ADHD (possibly undiagnosed) which may affect their judgment of ‘typical’ behaviour. The assessor should therefore obtain specific examples of behaviour from the informant and use these to make clinically informed judgments, rather than relying upon the informants’ perception of what is typical or atypical.

Semi-structured clinical diagnostic interviews are helpful as they guide the healthcare practitioner to complete a comprehensive developmental and clinical interview, whilst allowing for individual differences to be considered. For example, symptoms relating to excessive talking, blurting out answers, fidgeting, interrupting and/or intruding on others have been reported as more frequently endorsed by women than men with ADHD [ 53 , 55 ] and may be more sensitive to the presentation in females. Small modifications may help to capture more female-centric behaviour (e.g. ‘excessive talking and giggling’ instead of ‘excessive talking’) [ 133 ]. Commonly used diagnostic interviews are presented in Table 4 . 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 ].

When assessing adults, the clinical interview is usually completed with the affected individual but whenever possible collateral information should also be obtained. This may be from a parent or carer or another close member of the family. If a reliable informant cannot be identified who knew (and can recall) the individual well during their childhood, it may be helpful to obtain information from an informant who currently knows the individual well (e.g. a partner or a close friend who has known them for a significant period time, 5 years or more) in order to supplement self-reported information with a secondary perspective. If available, reports from childhood (for example, school, social service and/or previous clinical reports) are likely to be informative. Importantly, however, it may not be possible to rely on school reports when assessing females, as subtle hyperactive-impulsive symptoms may have been missed by teachers and/or they omit to comment on interpersonal or relationship problems. School reports may comment more on attentional problems (such as daydreaming or lacking in motivation and effort).

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. 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. However, not all strategies are helpful. Coping strategies may be less overt, such as avoiding specific events, settings or people, not facing up to problems, spending too much time online or not seeking out help when needed. Teenage and adult females with ADHD may turn to alcohol, cannabis and other substances to manage emotional turmoil, social isolation and rejection. Some may seek to obtain a social network by forming damaging relationships (for example, joining a gang, engaging in promiscuous and unsafe sexual practices, or criminal activities). If there is cause for concern, a risk assessment should be included that enquires into suicidal ideation, the use of illicit drugs, substances and alcohol, antisocial attitudes and behaviours, harm to self and others, bullying and assault, excessive internet use, unsafe sexual practices and exploitation of a sexual, financial or social nature. In some cases, a physical health assessment may be warranted.

With older age and persistent inattentive symptoms, there may be an increasing risk that individuals with ADHD are incorrectly diagnosed with mild cognitive impairment. Self- perceived ADHD symptoms, and in particular inattention, are found to increase with age in diagnosed adults and perceived symptom severity appears to be exacerbated by concurrent depressive symptoms [ 49 ]. It is not uncommon that adults with ADHD are treated for anxiety and/or depression in the first instance. Clinicians should be mindful that those with treatment resistant anxiety and/or depression should be screened for possible undiagnosed ADHD. 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.

Objective assessments

Whenever possible, the assessor should obtain collateral information from independent sources. This may include direct observations in a specific setting (e.g. in clinic, at home or at school). A wealth of useful information may be obtained from observing a child in school and speaking directly with teachers. When assessing adults, perusal of school, college and/or employment reports (if available) can be helpful.

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. Some have been specifically developed for ADHD populations and focus on assessing attention, impulsivity and vigilance in children and adults. Neuropsychological tests such as the Test of Everyday Attention (TEA) / Test of Everyday Attention for Children (TEACh), may be helpful supplements to the diagnostic process. Those most commonly used in clinical practice include the Conners’ Continuous Performance Test, third edition (CPT 3 [age 8+]) [ 135 ] and the QbTest [ 136 ], the latter including a measure of hyperactivity. QbTest scales have normative data specific to each sex (age 6-60) and may therefore be more sensitive to ADHD in females. The assessor should be mindful that an individual with ADHD may perform relatively well on novel tasks, especially those presented as computerised games providing immediate gratification via rapid feedback. Moreover, findings may lack ecological validity and not reflect performance in the ‘real world’. Neuropsychological assessments are not specific markers of ADHD and should only be used to augment clinical decision making and not be used as stand-alone diagnostic tools.

Interventions and Treatments

Prompt identification and treatment of ADHD is recommended, as there is evidence of long-term functional benefits associated with treatment [ 137 , 138 ]. ADHD is typically treated with psychoactive medication, psychoeducation and therapeutic interventions at all ages, and a stronger treatment effect has been reported with multi-modal treatment [ 138 ]. A brief summary of treatment recommendations is presented in Table 5 .

In the context of changes in the presentation of ADHD with development and ageing, regular treatment reviews are advised. These can revisit and optimise current pharmacological and non-pharmacological approaches, or revisit those patients who previously may not have been suitable for specific treatments or who did not show good response.

Pharmacological management

ADHD is commonly treated with psychostimulants, such as methylphenidate and amphetamine. In certain cases, a nonstimulant such as atomoxetine, an extended-release form of guanfacine or clonidine, or bupropion may be prescribed, especially when stimulants are inappropriate or have been unsuccessful. These medications, with the exception of bupropion are recommended by the National Institute of Health and Care Excellence (NICE) guidance [ 139 ]. 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 ]. Larger confidence intervals in relation to the tolerability and efficacy of bupropion, clonidine and guanfacine were reported, indicating less conclusive results with regards to the efficacy and tolerability of these oral medications [ 140 ].

Treatment recommendations do not differ by sex and differ only modestly by age (NICE, 2018 [ 139 ]). The overarching opinion in the consensus group was that there are no differences in the medicines used to treat ADHD in girls and boys. Stimulant medications show good efficacy for improving ADHD symptoms in both children [ 141 ] and adults [ 142 ], and response appears comparable in females and males [ 143 , 144 ]. However girls with ADHD tend to be less likely to be prescribed stimulant treatment than boys with ADHD, and are likely to start treatment at an older age [ 145 ].

The potential benefits of treatment must be viewed in the context of lifetime adverse outcomes associated with poorly managed ADHD described previously. Prompt identification and treatment may help to improve longer-term functional, health and mental health outcomes. Reduced rates of comorbidity (including depression, anxiety disorders, and disruptive behaviour disorders) have been noted in stimulant treated ADHD populations [ 146 , 147 ], although the converse effect has also been reported [ 148 ]. Comorbid ADHD is associated with treatment resistant depression [ 149 ] and regular treatment for ADHD may reduce rates of treatment resistance [ 150 ]. Pharmacological treatment of ADHD is also associated with improved educational [ 146 ] and occupational [ 151 ] outcomes, as well reduced rates of criminality [ 152 ]. Pharmacotherapy for ADHD appears to be a protective factor for obesity [ 64 ], and some limited evidence suggests that it may increase efficacy of weight management strategies (reviewed in [ 153 ]). Additionally, there appears to be a benefit of ADHD treatment with regards to substance use disorders. A study of commercial healthcare claims showed reduced emergency department visits related to substance use disorders when patients were prescribed treatment for ADHD [ 154 ].

Whilst pharmacological treatments themselves should not differ by sex, the way in which they are managed and monitored should occur in a sex-sensitive manner. The consensus group observed that prescribers need to consider ADHD presentations and associated problems in females to appropriately target what medication aims to improve. It may be less helpful to strictly adhere to conventional rating scales or focus on behaviour management to identify treatment-related changes. Instead, treatment response may be better captured through individualised targets, such as measures of emotional regulation, participation in education, and academic attainment. In the UK, all government funded schools have attainment ratings for each child, which could be examined by the prescriber prior to commencement of medications and monitored over time in conjunction with prescribing. Girls with emotional regulation difficulties (for whom internalising difficulties are often a key component of their ADHD) could benefit from measuring changes in emotional lability with medication use.

Parents and carers may not be as aware of the benefits of medication in girls, especially those with inattentive presentations in the absence of challenging or disruptive behaviour. Psychoeducation regarding available treatments and what they are targeting, provided for parents and girls with ADHD themselves, may help to ensure engagement in treatment and improve adherence to treatment regimens. Where required, adherence may be improved by using long-acting stimulant medication in place of short-acting medications [ 155 , 156 , 157 ].

In early to late adolescence, recommended treatment regimens in ADHD remain the same as in early childhood, and do not differ between girls and boys. The use of medication should be followed up over time to verify if medications are effective and well tolerated, and to manage the effects of related conditions (e.g. anxiety, depression) if they emerge. Side effects of stimulants need to be considered, particularly the side effect of appetite suppression if eating disorders are a concern [ 158 ].

There is some early evidence to suggest that ADHD medications may differentially affect women depending on progression of their menstrual cycle. Two small studies have shown that hormonal changes during the menstrual cycle (oestrogen and progesterone levels) may impact on the subjective euphoric and stimulating effects of d-amphetamine in healthy women who are not affected by ADHD [ 159 , 160 ]. Changes in subjective ratings of stimulation have also been noted in young women unaffected by ADHD in response to d-amphetamine after application of estradiol patches (commonly used to treat problems associated with menopause) [ 161 ]. Cellular and small neuroimaging studies which show early evidence of a link between dopamine systems (implicated in the aetiology of ADHD) and gonadal hormones (reviewed in 49). 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 ].

Whilst the evidence above does not support treatment adjustment according to the menstrual cycle, anecdotal clinical accounts were given during the consensus meeting supporting that this approach benefits certain patients. The consensus group noted that this type of regular medication adjustment may be easier to manage for adult women who can take more control of their dosing, rather than adolescent girls who tend to respond better to routine. There were also anecdotal accounts of symptom exacerbation in women during the post-menopausal period. During this time physicians may consider the use of hormone replacement therapy, if deemed beneficial.

As hormonal changes take place during puberty, the postpartum period and the menopause, patients may report changes in their symptoms and re-evaluation of treatment regimens may be helpful. It may be advised that women track their symptoms during these periods to establish patterns which may help support changes to the medication regimen when reviewed by their physician.

There is no evidence to indicate that females in either early, middle or later adulthood should be treated any differently with respect to specific medicines for ADHD symptoms. 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. If ADHD treatment improves co-morbid conditions, medication regimens could potentially be simplified.

Women with ADHD are highly likely to suffer from mental illness and SUDs. Clinicians need to be mindful of, and discuss with their patients, the risks around alcohol and drug use whilst on ADHD medications. Affective symptoms (most commonly emotional lability or volatility) associated with ADHD, may be misattributed to depressive disorders. For women with ADHD in whom depressive mood symptoms are apparent but not pervasive, it is advisable to treat the ADHD symptoms first and monitor for improvement. A more consistent low mood may be due to demoralization driven by ADHD and its functional impairments, and may improve with ADHD medication.

Symptoms or problems experienced by women with ADHD may also overlap with those indicating a personality disorder, such as BPD. Careful consideration is required to establish the underlying condition(s). This will have follow-on implications for treatments, which differ significantly between personality disorders and ADHD. Biosocial theory suggests that BPD may arise as a function of the interaction of early vulnerabilities (impulsivity and heightened emotional sensitivity) with the environment [ 163 ]. If ADHD symptomatology may predispose individuals to later personality disorders [ 164 ], it is possible that early detection and appropriate treatment could prevent the later development of these conditions [ 165 ]. However, there is no clear empirical evidence supporting this hypothesis at present [ 109 ].

Historically, prescribing ADHD medication during pregnancy or breastfeeding was not advised due to a lack of evidence for safety and risks of unknown adverse effects to the baby. However, a recently published systematic review and meta-analysis reported that exposure to ADHD medication during pregnancy does not appear to be associated with serious adverse maternal or neonatal outcomes [ 166 ]. Nevertheless, the group were cautious regarding this outcome and considered that until these findings have been robustly replicated, prescribing ADHD medication during pregnancy or breastfeeding should be avoided. There may be situations however where risks of not treating ADHD may outweigh potential risks to the foetus and continued prescribing may be necessary subject to more careful obstetric monitoring. In this case, women with ADHD need to be informed of these risks.

Women may find their ADHD symptoms worsen or become particularly difficult to manage while breastfeeding given additional life pressures that occur in the presence of a new baby. Whilst it may be possible to use short acting stimulant medication, timed around breastfeeding to minimise transfer between mother and child [ 167 ], there is minimal scientific evidence to support this approach, and it would be generally safer to advise the cessation of medications during this period altogether. Where ADHD medication is necessary, then an alternative to breastfeeding is needed to minimise any risk to the baby.

Prescribers should be aware that mothers with ADHD may experience difficulties in managing their own symptoms alongside the increased demands from family life, and these difficulties may be augmented by the presence of ADHD in their own children. They may benefit from more frequent evaluations of ancillary support requirements and/or a careful review of medication dosage.

Non-pharmacological management

A number of meta-analyses of data from child and adolescent samples have shown that non-pharmacological interventions targeting cognitive processes show small to moderate effects on ADHD symptom outcomes when rated by individuals who are close to the treatment setting (often parents), but that effects become attenuated or non-significant when outcomes are obtained from individuals who are blinded to the interventions (often teachers) or adequately controlled active or sham conditions [ 168 , 169 , 170 ]. Research has documented this effect for specific interventions such as cognitive training (for example, training of attention, memory, inhibitory functions) [ 169 ], and neurofeedback [ 170 ] - although more recent research suggests that effects of neurofeedback are more modest rather than absent when assessed by probably blinded evaluators [ 171 ].

Meta-analyses also show potentially more promising outcomes from non-pharmacological interventions that target behaviours and outcomes beyond ADHD symptoms alone in children and adolescents, with ADHD intervention in children producing a moderate effect on parent stress [ 172 ], and organisational skills interventions which resulted improved ratings from both parents and teachers and with modest improvement in academic function [ 173 ]. Behavioural interventions were found to have a moderate positive effects on a range of outcomes including changes in parenting and conduct problems, even when rated by blinded assessors [ 174 ].

Meta analyses also indicate more promising results from cognitive behavioural therapy, and mindfulness interventions on ADHD symptoms in studies with primarily adult samples, albeit without comparisons from blinded raters [ 175 , 176 ]. Benefits of non-pharmacological treatments in adults are also shown to range beyond improvements in ADHD symptoms, as shown in a recent report from a psychological intervention programme in adults with high levels of ADHD symptoms across three municipalities in Denmark. Participant outcomes were compared with matched controls receiving ‘treatment as usual’ drawn from the Danish Registers at 6 and 12 months post-treatment follow-up. The study showed that participation in the programme was associated with increased employment, education rates and reduced use of cash benefits and social services [ 177 ]

The efficacy of a psychological approach varies across the lifespan and the content of treatment should be tailored to meet the individual presentations and needs of individuals with ADHD [ 178 ]. Regular review of how a person is coping may be especially important at times of key transitions. Since the needs of females with ADHD differ considerably as they mature, the goals of treatment are presented across three age ranges: primary age (5-11 years), secondary age (12-18 years) and adulthood (age 18+).

Primary age

ADHD often places a significant psychological, emotional, and economic burden on families as well as the individual; increased stress and discord in the family unit has been reported [ 179 , 180 ]. Where ADHD affects females, it is also more common in their family members [ 33 , 34 ], resulting in bidirectional effects of ADHD in the mother-child relationship. The aim of non-pharmacological interventions therefore is to support individuals with ADHD and their families to develop and/or improve skills and coping strategies. Psychoeducation and psychological interventions directed at both patient and family are needed to achieve this, as they provide the tools to make helpful changes and achieve positive immediate and long-term functional outcomes.

There are two types of parenting intervention that may be offered to parents/carers in this age-group: (1) parent/carer support interventions, where people can meet and share experiences with others, and (2) parent/carer mediated interventions, sometimes referred to as ‘parent training’. The latter is an indirect intervention as the parent/carer is taught to deliver interventions to their child. Ideally both approaches should integrate a psychoeducational component as this is likely to lead to better outcomes.

Psychoeducation and interventions for girls in this age group should include discussion about the difficulties and challenges they will face at home, in school and in social activities - and how they may respond. At school this may relate to difficulty with sustaining attention, organisation, time management, planning activities, prioritising and organising tasks. They may also require generic skills for coping with interpersonal difficulties and/or social events, conflict management, emotional lability, anxiety and feelings of distress. Some girls may need interventions to address discrete problems, including sleep problems [ 131 ], enuresis [ 181 ], bullying [ 89 , 90 ] and repetitive behaviours such as nail biting [ 182 ]. 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.

Both group and individual sessions working directly with the child may be helpful additions to parent/carer mediated treatments, although individual treatments may be more appropriate for those with severe symptoms, intellectual limitations and/or those who are unable to tolerate group sessions (e.g. due to lack of confidence, poor social communication). Two specific programmes have been developed for young children with cognitive, emotional, social and/or behavioural problems; one for individual delivery [ 183 ] and the other for group delivery [ 184 , 185 ].

Secondary age

As children mature, they are more likely to receive direct interventions without input from their parents or carers. The best mode of psychological treatment is cognitive behavioural therapy (CBT) together with psychoeducation (which can be provided to both patients and parent/carers together or independently). Parents and carers need to be aware of the elevated risk of deliberate self-harming behaviour (e.g. cutting), eating disorders, substance abuse, risk-taking behaviours, and vulnerability to exploitation in teenage girls with ADHD. Thus psychoeducation should include indicators that problems of this nature may be developing.

The focus of treatment in this age group should include information and guidance on the need for adherence to medication. There is evidence that adherence to pharmacotherapy declines in the teenage years, although adherence appears to be modestly better in girls than in boys [ 155 , 157 , 186 ]. These changes have been attributed to adverse effects, sub-optimal response, reduction in parent supervision, increased need for autonomy, and social stigma associated with ADHD diagnosis and taking medication [ 155 , 156 ]. It is important to provide psychoeducation to encourage young people with ADHD to understand and take ownership of their diagnosis and treatment, rather than feeling it has been imposed on them. Those diagnosed with ADHD for the first time in their teenage years are likely to require different intervention strategies to those who have been treated pharmacologically earlier in childhood. For example, psychoeducation should include information on the purposes and benefits of particular medications, as well as strategies around self-management.

Problems presenting in younger childhood often become more marked with age due to increasing academic and social expectations. These are important years in terms of a young person’s education and interventions can help to support executive function (e.g. improving skills to address problems with time management, focus, sustaining attention, organisation and planning) which may in turn support their coping in secondary schooling. Teenage girls may particularly benefit from treatment aimed at improving self-concept and identity. This may be achieved by unpacking the association between ADHD, lack of achievement, poor self-efficacy, lack of self-confidence, poor self-image and low self-esteem.

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. Additional support for new skills required in teenage years, such as managing money, may also be helpful.

In adolescence, young people develop a strong focus on peer relationships and a tendency towards social conformity [ 187 ]. 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 ]. Simultaneously interpersonal conflict with family members is not uncommon, and girls may engage with dysfunctional social groups and activities in an attempt to gain a sense of ‘belonging’ and to be accepted. Girls with ADHD are at increased risk of being victims of bullying [ 23 , 90 ], and social media may provide additional challenges since it offers a public platform for victimisation.

Behavioural and oppositional problems remain elevated in teenage girls with ADHD in comparison with their peers, albeit not as elevated as in boys with ADHD. Girls with ADHD may attract detentions, suspensions or exclusions from school for their conduct or oppositional behaviour. Their behaviours may be more socially motivated (e.g. spiteful, manipulative, threatening behaviours and/or lashing out at peers) rather than overt aggression. Social skills and interpersonal relationship interventions become salient at this age. These may aim to develop coping strategies to regulate emotions, build confidence, raise self-esteem and manage peer pressure, deal with rejection and manage conflict.

Interventions to address impulsivity and associated risk-taking behaviour may be helpful. These problems may manifest in early onset of sexual behaviour. The desire to be accepted into a peer network may be a motivating factor. Girls with ADHD are more likely to be pressurised into sex or engage in risky sexual behaviour. They are also more vulnerable to sexual exploitation or perceived exhibitionism (including internet grooming, ‘sexting’ and posting inappropriate content [ 188 ]). This may result in disproportionate social stigma for adolescents and young women with ADHD, in the face of violations of social expectations of female sexuality (where promiscuity may enhance male but damage female reputations). As girls become sexually active, the need for contraception should be discussed.

Impulsive behaviour is also associated with substance misuse. The risks around substance use and interactions with ADHD medication, including risks for addiction, need to be discussed.

Considerations around pregnancy, the post-partum period and parenting may also be required, since rates of early pregnancy are higher in girls with ADHD. Early pregnancy, may load additional stress and impairment on young girls with ADHD. The consensus group noted difficulties in young ADHD mothers not only in relation to child discipline and behaviour management, but also in relation to the organisational demands of parenting (for example, ensuring bottles are washed, medical and other appointments are kept, child’s clothes are cleaned).

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.

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. In adulthood, psychoeducation and CBT interventions should continue to address core ADHD symptoms, executive dysfunction, comorbid conditions and dysfunctional strategies (e.g. substance abuse, deliberate self-harm). However, specific attention may be required to address the more complex situations adult females may face, e.g. multitasking occupational demands, home management and family/parenting responsibilities. 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.

Interventions need to address the potential for women with ADHD to be vulnerable in terms of their sexual behaviour and relationships, to support their sexual health and safety. Social stigma associated with risky sexual behaviour in women may augment social problems and limit occupational opportunities. In combination with low self-esteem, this may render women with ADHD vulnerable to sexual harassment, exploitation, and/or abusive or inappropriate relationships. 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 ].

The bulk of household, and parental and caring duties are often borne by women [ 190 , 191 , 192 ], reflecting social and cultural constraints and expectations. These may result in increased impairment and anxiety in relation to these roles and duties in women compared with men. The consensus group identified that the demands placed on mothers often differ from those of fathers and that low self-esteem may be related to perceived failure to reach societal expectations. Mothers may lack confidence or experience feelings of guilt over their perceived inadequacy as a parent. Dysfunctional beliefs of this nature may be reinforced if they have a difficult-to-manage child with ADHD and are offered ‘parent training’ interventions. The group acknowledged that the term ‘parent training’ is unhelpful and may be perceived as pejorative.

However, at the same time harsh, lax or negative parenting styles have been identified to be elevated in mothers with ADHD [ 193 ]. Mothers with ADHD may benefit from life skills coaching, guidance and support in parenting, including ancillary support around parenting strategies. This may be particularly helpful for more vulnerable mothers: those that are young, are sole caregivers for their children, and/or are parenting a child with ADHD. Tailored assessments, support plans and social interventions may help to improve outcomes for this vulnerable group.

Women with ADHD may experience problems in the workplace, such as disorganisation, forgetfulness, inattention, accepting constructive criticism and appraisal, and difficulties managing interpersonal relationships with colleagues. This is likely to be exacerbated in the presence of concurrent intellectual dysfunction and/or other comorbidity. For these types of problems, often a group intervention is helpful and cost-effective. However the decision of whether a group or individualised approach is preferable should be based on careful formulation and individual need. Women may also benefit from targeted support in managing feelings of stress and distress, managing and regulating emotions, coping with rejection and/or feelings of isolation, managing interpersonal conflict, assertiveness training, compromise and negotiation steps, which may help to improve their occupational outcomes and their ability to cope with everyday social interactions.

Multi-agency liaison

This section addresses issues that arise at a broader institutional level. Primarily, support for females with ADHD may be improved through the psychoeducation and training of individuals who work within these institutions. Some may act as referral gatekeepers and, as such, they have the potential to support or hinder the referral process and to positively or negatively influence the progress of young people and adults within these institutions. A brief summary of multi-agency liaison recommendations is presented in Table 6 .

Educational considerations and adjustments

ADHD is associated with low educational attainment and academic underachievement [ 99 , 146 , 195 ]. Interventions should focus on supporting attendance and engagement with education to avoid early school leaving, diminished educational attainment, and associated vulnerabilities. Since ADHD is classified as a disability under the UK Equality Act [ 196 ], reasonable adjustments to education provision are mandated (examples may include: additional examination time, academic coaching, rest-breaks during examination, or possibility for part-time study [ 197 ]). Research suggests that simple interventions, including physical adjustments (table set-up, creating a time-out corner), and behaviour management techniques, as well as joint goal setting with primary age children, can help to improve ADHD symptoms, social and emotional functioning, and reduce conduct problems in the classroom [ 198 ]. However, adjustments cannot be put in place unless ADHD is first recognised and diagnosed.

Young people affected by ADHD are at increased risk for repeating grades, dropping out of high school, being suspended or expelled, and failing to obtain school or higher education qualifications [ 85 , 99 , 199 ]. Maintaining strong links with school is key to promoting adolescent health and social development [ 110 ]. Whilst early or unplanned pregnancy is associated with a reduction in educational and occupational opportunities, school achievement problems in adolescent girls with ADHD have also been shown to predate and predict risky sexual behaviour and unplanned pregnancy [ 200 ]. 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. There is a danger that punitive measures may be harsher for girls who display hyperactive or disruptive symptoms, due to this behaviour constituting a greater violation of social norms and expectations. Excessive punitive measures can lead to loss of engagement with education. Disciplinary problems (e.g. suspensions, verbal or written warnings or expulsions) predict earlier discontinuation of education in boys with ADHD [ 201 ], although disciplinary problems are less commonly reported in girls [ 85 ].

Externalising conditions have a stronger impact on behaviour in class, whilst internalising problems may impact on motivation and ability to engage in education. Girls with ADHD may present as easily distracted, disorganised, overwhelmed and lacking in effort or motivation. Inattention is more highly predictive of educational under-achievement compared with hyperactivity [ 202 , 203 ]. Females who are more likely to have the diagnosis missed or misdiagnosed, may be particularly disadvantaged since treatment with ADHD medication has been found to mediate educational outcome. For example, a large-scale study of cross-sectional and longitudinal data in ~10,000 12-year old twins from the Netherlands Twin Register showed the potential efficacy of treatment on academic outcomes [ 203 ]. Children taking ADHD medication scored significantly higher on an educational achievement test than children with ADHD who did not.

Individuals with ADHD and intellectual impairments, both male and female, present with complex needs that make it harder for them to engage in education. Many young people with ADHD will have associated specific learning difficulties such as dyslexia, dyscalculia and dysgraphia. 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. It may be helpful for students (at all levels of education) who have or who are suspected of having specific learning difficulties to be screened for ADHD, since young people with ADHD may also present with difficulties in reading and writing.

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. Training should be disseminated broadly across school staff, including teachers and special educational needs coordinators, as well as teaching assistants, school lunch aides, and after-school club staff who are more likely to supervise children during less structured periods of the day or during one-to-one work in classrooms. It is important that key personnel avoid over-simplistic causation when assessing individual needs (e.g. focusing on their family situation) and understanding of the bi-directional nature of ADHD difficulties in terms of family relationships.

All educational staff should be trained in how to screen females for ADHD and how to make onward referrals for treatment, if indicated. School staff should be trained on the importance of early detection, educational needs and interventions and support strategies that can improve educational outcomes. Training sessions should raise awareness of the current bias towards males in the clinical referral process. 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 ]. Addressing gender-specific ADHD issues, and gender expectations and stereotypes may help staff to better identify affected females. If ADHD is suspected, schools may consider adopting sensitive screening tools for ADHD (Table 4 ) or broader mental health problems (e.g. the SDQ [ 116 ]). These tend to be cost-effective, quick and reliable, and can help to identify vulnerable girls and young women. Difficulties can arise in maintaining medication treatment programmes in school and staff should be mindful that children may find this stigmatising, especially those who require short-acting medications to be dispensed at school.

Many of the training needs for educational staff remain the same in secondary as in primary school. However, transition to secondary school is accompanied by increased academic demands, and increased requirement for self-organisation and personal responsibility against a backdrop of navigating a new social environment. Young people with ADHD are likely to find this shift in self-management and responsibility especially challenging. ADHD symptoms may become exacerbated and more noticeable, triggering referral for the first time. Good learning and teaching practices (i.e. 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.

Efforts toward Technology Enhanced Learning or e-Learning, are likely to be especially helpful for young people with ADHD. With the appropriate content and support, these learning resources have the potential to go beyond improving academic outcomes in secondary school by improving psychosocial functioning (e.g. helping young people to acquire skills to manage risks of exploitation, bullying and/or victimisation in the school environment or online via social media and communication platforms). 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 ]).

Careers advice should consider the strengths and weaknesses of female students rather than focus solely on current performance, bearing in mind the relative developmental delay, underachievement, immaturity (and sometimes naivety) of young people with ADHD. Research indicates that occupational ‘fit’ can serve to exacerbate or reduce impairments associated with ADHD. For example, some individuals with ADHD show a preference for more stimulating environments, active, hands-on, or busy and fast-paced jobs [ 206 ]. Career planning that incorporates work experience, non-linear progression towards tertiary education and opportunities to re-sit exams or demonstrate potential may be beneficial for those who have struggled to sustain their engagement in a formal school setting.

Guidance for those wishing to embark in further education should take account of the course demands involved (e.g. level of coursework, method of examination). For those who move away from home, transition is further complicated by the many challenges involved in independent living such as financial management, taking responsibility for domestic and occupational arrangements and healthcare. Moving away from home often escalates social demands, with pressure to integrate with people of different ages, cultural backgrounds and interests. It is essential that young people with ADHD make supportive links within the educational organisation (e.g. disability services or student support services) who can support them to access the help to meet their needs, and coordinate with primary health services. This needs to be planned and thought through in advance because a lack of structure and support at this key stage of transition may unveil or amplify ADHD symptoms, together with associated clinical and functional impairments. Adequate support can help young people with ADHD access additional resources. 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. speech to text software), specialist mentoring (to help with organisational and planning skills) and “academic coaching”.

In general young people with ADHD reach or complete higher education at a later age than their peers [ 201 ]. This can be due to having to repeat years, re-take modules, and obtain extensions for coursework. Many drop out early due to educational or social problems, or early pregnancy. This emphasises the importance for young people having the opportunity to re-access education in later years. However whilst special educational needs support may be available up to age 25 in the UK, women with unrecognised ADHD may experience difficulties in accessing these provisions or meeting eligibility criteria for learning difficulties. Flexible learning systems and support with childcare are helpful initiatives, e.g. in the UK women with children who wish to return to education can obtain childcare support through government initiatives, such as Care to Learn ( https://www.gov.uk/care-to-learn ), and Childcare Grants ( https://www.gov.uk/childcare-grant ).

Occupational considerations and adjustments

In adulthood, ADHD is associated with unemployment or working in unskilled occupations [ 201 ], difficulty maintaining jobs [ 99 , 201 ], and impaired work performance and financial stress [ 207 ]. A longitudinal study following up girls age from eight until age 30, found that women with childhood ADHD were more likely than their peers to have no or few qualifications, be in poorly paid employment, claim benefits, live in temporary or social housing and have a low income [ 68 ].

ADHD qualifies as a disability under the UK Equality Act 2010 [ 196 ], because it can have a substantial and long-term impact on a person’s ability to perform day-to-day activities. This status can afford women with ADHD certain rights, and access to certain services. For women with ADHD commencing employment, additional support may be required regarding the decision to disclose they have a disability. They may need support in understanding the demands of an organisation, the work-role and personnel structure, how to manage interpersonal conflict, and guidance on how to manage their time, plan and prioritise tasks. Diaries, itineraries, lists, reminder notes and similar scaffolding techniques can be adapted to individual needs through a wide range of digital apps currently available at low or no cost.

Women with ADHD may experience particular difficulty returning to work after having children. This is associated with employment penalties linked to educational problems and potentially having left school early with few or no qualifications. Initiatives such as Specialist Employability Support ( https://www.gov.uk/specialist-employability-support ) are available to provide intensive support and training for unemployed people with a disability.

Occupational difficulties may be further compounded by a difficulty managing the effects of persisting ADHD symptoms on job-related and social performance in the workplace, together with the need to balance occupational demands with childcare. Reasonable adjustments in the workplace may be helpfully put in place [ 208 ] but these may only be achieved if women with ADHD elect to disclose they have a disability. This may not be an easy decision as the individual must balance the need to optimise the environment against their fear of social and occupational stigma, the latter including the possibility they may be held back in promotion and/or other career advancement.

On the other hand, disclosing a disability allows for women with ADHD to be treated more favourably under the UK Equality Act 2010 [ 196 ], and benefit from reasonable adjustments that remove barriers in the workplace that would otherwise disadvantage them. Reasonable adjustments are assessed on a case by case basis and extra support for the costs of making reasonable adjustments in the workplace can come from the Access to Work government initiative (see: https://www.gov.uk/access-to-work ). These rights apply to women with ADHD returning to work, taking up employment or becoming diagnosed at any time during their working lives. Employers who fail to comply with this duty would be liable for disability discrimination.

Health and social care

Research suggests an increased involvement of ADHD children with the social care and foster care systems [ 209 , 210 ]. Equipping social care professionals with tools similar to those used in school settings (e.g. the SDQ) may promote a higher level of insight and understanding. Males may be overrepresented in these systems due to high rates of comorbidity with disruptive behavioural problems. Females with ADHD may be more likely to come into contact with social services if they are young single parents struggling with child-care responsibilities; however their underlying ADHD may be unrecognised.

The overrepresentation of developmental disorders in the care population may be the result of a failure in existing services to recognise the specific contribution of these conditions to family breakdown, and an absence of targeted support in such cases. The group recommends that all children at risk of entering the care system should be systematically screened for developmental disorders. Social care professionals may struggle to identify the parenting potential in undiagnosed women with ADHD, and attribute difficulties more to a chaotic lifestyle choice rather than to any underlying disorder. Given the high heritability rates [ 132 ] it is also helpful to consider that other family members may also share symptoms and suffer with associated impairments, when examining family dynamics.

Social and family services will benefit from training so they can provide specific psychoeducational input to support young mothers of ADHD children and young mothers with ADHD. If deemed appropriate, they might refer mothers with ADHD to mental health services for targeted support that aims to develop skills and coping strategies, and to help them manage their own mental health and personal needs and those of their child.

The early sexual activity, promiscuity and higher risk for sexually transmitted diseases in some females with ADHD is likely to increase contact with sexual health clinics. ADHD training should therefore be extended to include service-providers at these clinics in order to raise awareness of the presentation and needs of females with ADHD. For example this may lead to better understanding of the need for additional sexual health education, including digital health education, which in turn may better support these young women and prevent sexual exploitation.

Criminal justice system

Increased rates of delinquent or criminal behaviour may lead to contact with the criminal justice system [ 107 ]. Prevalence of ADHD in incarcerated populations is high, estimated at around one quarter (25.5%) but with no significant differences overall in relation to gender or age. There is however a lower prevalence in adult women than men (22.1% in female adults v. 31.2%, male adults), whereas female youths have a similar prevalence to male youths (30.8% and 29.5%, respectively) [ 107 ]. One study reported that only 18.8% of male adult offenders diagnosed with ADHD in prison had a prior diagnosis of ADHD [ 211 ]. It is likely that this proportion is even lower for females.

Evidence indicates that ADHD treatment is associated with reduced rates of criminality [ 212 ], is tolerated and effective in prison inmates [ 213 ], and improves their quality of life and cognitive function [ 214 ]. This has led to speculation that effective identification and treatment of ADHD may help to reduce reoffending, albeit with reservations surrounding potential for diversion or misuse of medications, treatment adherence, and discontinuity of ADHD treatment after release [ 215 ]. Current best practice recommendations for screening, identifying, treating and supporting ADHD in prisoners and youth offenders are provided in a previous review and consensus report [ 194 ], with particular recommendations for support provided for female offenders.

Females with ADHD are likely to be perceived to deviate substantially from stereotypical expectations of behaviour. The differential diagnosis between BPD and ADHD may be particularly important for females in forensic settings, where a high rate of comorbidity has been reported [ 216 ]. In the criminal justice system, including prison, there may possibly be a more sympathetic approach toward female offenders but, as for males, their ADHD is unlikely to be recognised. The group noted that ADHD is commonly perceived as ‘bad behaviour’ rather than a vulnerability in this setting, perhaps reflecting high rates of critical incidents (verbal and physical aggression, damage to property, self-injury) being reported in prison [ 217 ]. This may be intensified in female offenders with ADHD due to poor understanding of the condition. Further research regarding the interface between the criminal justice system and females with ADHD is needed.

Over 30 years ago, Berry, Shaywitz and Shaywitz warned that girls constitute a ‘silent minority’ in ADHD, with more internalised behaviour making them less likely to be referred for assessment [ 36 ]. This does not appear to have changed. Females with ADHD remain more likely to be unrecognised or mis-identified leading to lower than expected rates of referral, assessment and treatment for ADHD. Whilst this has been attributed to the higher rate of internalised and inattentive only presentation in girls, this omission is remarkable, given that the predominantly inattentive subtype of ADHD has been endorsed by the Diagnostic and Statistical Manual, a key diagnostic tool, for many years.

There are specific barriers that seem to hinder the recognition of ADHD in girls and women. These include symptomatic differences, gender biases due to stereotypical expectations, comorbidities and compensatory functions, which mask or overshadow the effects of ADHD symptoms. There is strong public perception that ADHD is a behavioural disorder that primarily affects males. Hence the challenge is to raise awareness and provide training on the presence and presentation of ADHD in females to agencies that regularly interface with children, young people and adults.

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. It is erroneous to consider that females do not present with hyperactive and impulsive symptoms – they do. 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. Understanding the expression of ADHD in females is the first step towards improving detection, assessment, and treatment, and ultimately enhancing long-term outcomes for girls and women with ADHD.

One of the most consistent topics discussed at the consensus (and across all breakout groups) related to how social-relational and psychosexual problems seem to be more marked in females with ADHD compared with males. Difficulties in managing and maintaining functional interpersonal relationships hinder some girls and women from developing or maintaining a positive social network or accessing peer support. ADHD symptoms and emotional lability seem to be related to dysfunctional coping strategies and dissatisfaction with life [ 77 ]. Lack of planning for the future [ 86 ] may mean that girls and women with ADHD lack constructive activities and occupations in adulthood. These effects may lead to affected girls and women becoming overwhelmed, anxious and low in mood. In turn they may respond by applying dysfunctional coping strategies, such as self-harm and substance use.

Females with ADHD overall have an earlier onset of sexual activity, more sexual partners, and an increased risk of contracting sexually transmitted infections or having an unplanned pregnancy. They are at risk of sexual exploitation, perceived exhibitionism or being considered promiscuous. Social stigma associated with risky sexual behaviour in women may augment social problems, and render affected women vulnerable to being victimised, bullied, harassed, abused, or entering into unhealthy relationships. Young girls with ADHD may become young mothers with ADHD (and possibly also mothers of children with ADHD). This is associated with a further reduction in educational and occupational opportunities. 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.

Treatment has been reported to moderate the lifetime risks of ADHD for both males and females. The consensus group identified where adjustments to approaches in treatment are needed to better support girls and women with ADHD. 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. The consensus group considered that multi-agency liaison will also be needed to support some girls and women with ADHD. Furthermore, raising awareness of, and providing training about, ADHD in institutions (e.g. educational, social, family, sexual health and criminal justice services) as well as the key healthcare system (primary health, child and adolescent mental health services and adult general psychiatry) will be helpful to improve detection of girls and women with ADHD, increase understanding and reduce stigma.

The consensus highlighted the relative dearth of research on the life-span experience of females with ADHD. Given the higher prevalence of ADHD in males, it would be helpful if studies reporting sex-mixed cohorts segregated data and results by gender. This would be particularly helpful in large clinical or population-based studies, where information on girls with ADHD would otherwise be buried as variance under the predominant male group. Providing sex-segregated results and data for all studies of ADHD (perhaps under supplementary data) would provide information to inform future meta-analyses.

Future research should investigate the presentation and needs of females with ADHD: how they might better be identified and assessed, and how their treatment response should best be evaluated and monitored to effectively improve outcomes. The most recent meta-analyses of gender differences in ADHD symptom presentation and associated features was reported over 15 years ago. An updated meta-analysis including all recent data is now needed. 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. during the menstrual cycle, pregnancy and the postpartum period, and menopause), to help inform treatment plans. Factors that are associated with hyperactive/impulsive symptoms in females with ADHD and how these differ to males should be investigated further, including sexual behaviours and their motivations in girls and women with ADHD, as well as vulnerabilities to victimisation, physical and sexual assault and cyberbullying.

This consensus will inform effective identification, treatment and support of girls and women with ADHD. To facilitate identification, it is important to move away from the previously predominating ‘disruptive boy’ stereotype of ADHD and understand the more subtle and internalised presentation that predominates in girls and women. In treatment, it is important to consider a lifespan model of care for females with ADHD, which supports the complex and developmentally changing presentation of ADHD in females. Appropriate intervention is expected to have a positive impact on affected girls and women with ADHD, their families, and more broadly on society leading to increased productivity, decreased resource utilization and, most importantly, better outcomes for girls and women.

Availability of data and materials

Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.

Abbreviations

ADHD Child Evaluation

Attention-Deficit/Hyperactivity Disorder

Autism Spectrum Disorder

Adult ADHD Self-report Rating Scale

Borderline Personality Disorder

Conners’ Adult Rating Scales

Cognitive Behavioural Therapy

Conners’ Comprehensive Behavior Rating Scales

Conduct Disorder

Conners’ Continuous Performance Test, third edition

Development and Wellbeing Assessment

Diagnostic Interview of Adult ADHD

Diagnostic Interview for ADHD in Adults with Intellectual Disability

Diagnostic and Statistical Manual of Mental Disorders

Education, Health and Care Plan

International Classification of Diseases

Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version

Learning Disability

Oppositional Defiant Disorder

Personalised Education Plan

The Vanderbilt ADHD Rating Scales

Quantified Behavior Test

Strengths and Difficulties Questionnaire

Swanson, Nolan, and Pelham-IV Questionnaire

Substance Use Disorder

United Kingdom of Great Britain and Northern Ireland

United Kingdom ADHD Partnership

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington DC: American Psychiatric Association; 2013.

Book Google Scholar

World Health Organization. International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10): Version 2019. 2019. https://icd.who.int/browse10/2019/en . Accessed 24 Apr 2020.

Google Scholar

Asherson P. ADHD across the lifespan. Medicine (Baltimore). 2016;40:623–7 https://doi.org/10.1016/j.mpmed.2016.08.012 .

Willcutt EG. The Prevalence of DSM-IV Attention-Deficit/Hyperactivity Disorder: A Meta-Analytic Review. Neurotherapeutics. 2012;9:490–9.

PubMed PubMed Central Google Scholar

Larsson H, Dilshad R, Lichtenstein P, Barker ED. Developmental trajectories of DSM-IV symptoms of attention-deficit/ hyperactivity disorder: Genetic effects, family risk and associated psychopathology. J Child Psychol Psychiatry. 2011;52:954–63.

PubMed Google Scholar

Lapalme M, Déry M, Dubé M, Lemieux A. Developmental Course of ADHD Symptoms Based on Multirater Report in Girls and Boys With or Without a Disruptive Behavior Disorder. J Emot Behav Disord. 2018;26:106–18.

Hinshaw SP, Owens EB, Sami N, Fargeon S. Prospective follow-up of girls with attention-deficit/hyperactivity disorder into adolescence: Evidence for continuing cross-domain impairment. J Consult Clin Psychol. 2006;74:489–99.

Monuteaux MC, Mick E, Faraone SV, Biederman J. The influence of sex on the course and psychiatric correlates of ADHD from childhood to adolescence: A longitudinal study. J Child Psychol Psychiatry Allied Discip. 2010;51:233–41.

Faraone SV, Biederman J, Mick E. The age-dependent decline of attention deficit hyperactivity disorder: A meta-analysis of follow-up studies. Psychol Med. 2006;36:159–65.

Cheung CHM, Rijsdijk F, McLoughlin G, Brandeis D, Banaschewsk T, Asherson P, et al. Cognitive and neurophysiological markers of ADHD persistence and remission. Br J Psychiatry. 2016;208:548–55.

van Lieshout M, Luman M, Twisk JWR, van Ewijk H, Groenman AP, Thissen AJAM, et al. A 6-year follow-up of a large European cohort of children with attention-deficit/hyperactivity disorder-combined subtype: outcomes in late adolescence and young adulthood. Eur Child Adolesc Psychiatry. 2016;25:1007–17.

Du Rietz E, Cheung CHM, McLoughlin G, Brandeis D, Banaschewski T, Asherson P, et al. Self-report of ADHD shows limited agreement with objective markers of persistence and remittance. J Psychiatr Res. 2016;82:91–9.

Karam RG, Breda V, Picon FA, Rovaris DL, Victor MM, Salgado CAI, et al. Persistence and remission of ADHD during adulthood: A 7-year clinical follow-up study. Psychol Med. 2015;45:2045–56.

CAS PubMed Google Scholar

Thapar A, Cooper M. Attention Deficit Hyperactivity Disorder. Lancet. 2016;387:1240–50.

Gillberg C, Gillberg IC, Rasmussen P, Kadesjö B, Söderström H, Råstam M, et al. Co-existing disorders in ADHD - Implications for diagnosis and intervention. Eur Child Adolesc Psychiatry, Suppl. 2004;13:80–92.

Young S, Fridman A, Mandy W. Autistic spectrum disorder symptoms in children and adolescents with attention-deficit/ hyperactivity disorder: ameta-analytical review. Psychological Medicine. 2019:1–14 https://doi.org/10.1017/S0033291719002368 .

Mayes SD, Calhoun SL, Waxmonsky JG, Kokotovich C, Baweja R, Lockridge R, et al. Demographic Differences in Disruptive Mood Dysregulation Disorder Symptoms in ADHD, Autism, and General Population Samples. J Atten Disord. 2019;23:849–58.

Sobanski E. Psychiatric comorbidity in adults with attention-deficit/hyperactivity disorder (ADHD). Eur Arch Psychiatry Clin Neurosci. 2006;256(Suppl. 1):26–31.

Kessler R, Adler L, Barkley R, Biederman J, Conner CK, Demler O, et al. The Prevalence and Correlates of Adult ADHD in the United States: Results From the National Comorbidity Survey Replication. Am J Psychiatry. 2006;163:716–23 https://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.2006.163.4.716 .

Thomas R, Sanders S, Doust J, Beller E, Glasziou P. Prevalence of Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-analysis. Pediatrics. 2015;135:e994–1001.

Simon V, Czobor P, Bálint S, Mészáros Á, Bitter I, Meszáros Á, et al. Prevalence and correlates of adult attention-deficit hyperactivity disorder: meta-analysis. Br J Psychiatry. 2009;194:204–11.

Michielsen M, Semeijn E, Comijs HC, Van De Ven P, Beekman ATF, Deeg DJH, et al. Prevalence of attention-deficit hyperactivity disorder in older adults in the Netherlands. Br J Psychiatry. 2012;201:298–305.

Nøvik TS, Hervas A, Ralston SJ, Dalsgaard S, Rodrigues Pereira R, Lorenzo MJ, et al. Influence of gender on attention-deficit/hyperactivity disorder in Europe - ADORE. Eur Child Adolesc Psychiatry. 2006;15(Suppl. 1):1–24.

Gershon J. A Meta-Analytic Review of Gender Differences in ADHD. J Atten Disord. 2002;5:143–54.

Hinshaw SP. Attention Deficit Hyperactivity Disorder (ADHD): Controversy, Developmental Mechanisms, and Multiple Levels of Analysis. Annu Rev Clin Psychol. 2018;14:291–316.

Greven CU, Richards JS, Buitelaar JK. Sex differences in ADHD. In: Banaschewski T, Coghill D, Zuddas A, editors. Oxford Textbook of Attention Deficit Hyperactivity Disorder. Oxford: Oxford University Press; 2018.

De Zwaan M, Gruß B, Müller A, Graap H, Martin A, Glaesmer H, et al. The estimated prevalence and correlates of adult ADHD in a German community sample. Eur Arch Psychiatry Clin Neurosci. 2012;262:79–86.

Moffitt TE, Houts R, Asherson P, Belsky DW, Corcoran DL, Hammerle M, et al. Is adult ADHD a childhood-onset neurodevelopmental disorder? Evidence from a four-decade longitudinal cohort study. Am J Psychiatry. 2015;172:967–77.

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). J Clin Psychiatry. 2016;77:e421–8.

Cortese S. The neurobiology and genetics of Attention-Deficit/Hyperactivity Disorder (ADHD): What every clinician should know. Eur J Paediatr Neurol. 2012;16:422–33 https://doi.org/10.1016/j.ejpn.2012.01.009 .

Biederman J, Faraone SV, Monuteaux MC. Impact of exposure to parental attention-deficit hyperactivity disorder on clinical features and dysfunction in the offspring. Psychol Med. 2002;32:817–27.

Banerjee TD, Middleton F, Faraone SV. Environmental risk factors for attention-deficit hyperactivity disorder. Acta Paediatr. 2007;96:1269–74.

Taylor MJ, Lichtenstein P, Larsson H, Anckarsäter H, Greven CU, Ronald A. Is There a Female Protective Effect Against Attention-Deficit/Hyperactivity Disorder? Evidence From Two Representative Twin Samples. J Am Acad Child Adolesc Psychiatry. 2016;55:504–12 e2.

Rhee SH, Waldman ID. Etiology of sex differences in the prevalence of ADHD: An examination of inattention and hyperactivity-impulsivity. Am J Med Genet. 2004;127B:60–4.

Biederman J, Kwon A, Aleardi M, Chouinard VA, Marino T, Cole H, et al. Absence of gender effects on attention deficit hyperactivity disorder: Findings in nonreferred subjects. Am J Psychiatry. 2005;162:1083–9.

Berry CA, Shaywitz JE, Shaywitz B. Girls with attention deficit disorder: a silent minority? A report on behavioral and cognitive characterisitics. Pediatrics. 1985;76:801–9.

Gentile DA. Special Section : Sex or Gender? Technical Commentary A Call for a New Terminological Standard. Psychol Sci. 2012;4:120–2.

Williamson D, Johnston C. Gender differences in adults with attention-deficit/hyperactivity disorder: A narrative review. Clin Psychol Rev. 2015;40:15–27 https://doi.org/10.1016/j.cpr.2015.05.005 .

Gershon J. Gender Differences in ADHD. ADHD Rep. 2016;10:8–16.

Gaub M, Carlson CL. Gender differences in ADHD: A meta-analysis and critical review. J Am Acad Child Adolesc Psychiatry. 1997;36:1036–45 https://doi.org/10.1097/00004583-199708000-00011 .

Newcorn JH, Halperin JM, Jensen PS, Abikoff HB, Arnold LE, Cantwell DP, et al. Symptom profiles in children with ADHD: Effects of comorbidity and gender. J Am Acad Child Adolesc Psychiatry. 2001;40:137–46 https://doi.org/10.1097/00004583-200102000-00008 .

Millenet S, Laucht M, Hohm E, Jennen-Steinmetz C, Hohmann S, Schmidt MH, et al. Sex-specific trajectories of ADHD symptoms from adolescence to young adulthood. Eur Child Adolesc Psychiatry. 2018;27:1067–75 https://doi.org/10.1007/s00787-018-1129-9 .

Mowlem FD, Rosenqvist MA, Martin J, Lichtenstein P, Asherson P, Larsson H. Sex differences in predicting ADHD clinical diagnosis and pharmacological treatment. Eur Child Adolesc Psychiatry. 2019;28:481–9 https://doi.org/10.1007/s00787-018-1211-3 .

Quinn P, Wigal S. Perceptions of girls and ADHD: Results from a national survey. Medscape Gen Med. 2004;6.

Sciutto MJ, Nolfi CJ, Bluhm C. Effects of child gender and symptom type on referrals for ADHD by elementary school teachers. J Emot Behav Disord. 2004;12:247–53.

Pisecco S, Huzinec C, Curtis D. The Effect of Child Characteristics on Teachers’ Acceptability of Classroom-Based Behavioral Strategies and Psychostimulant Medication for the Treatment of ADHD. J Clin Child Psychol. 2001;30:413–21.

Mowlem F, Agnew-Blais J, Taylor E, Asherson P. Do different factors influence whether girls versus boys meet ADHD diagnostic criteria? Sex differences among children with high ADHD symptoms. Psychiatry Res. 2018;2019(272):765–73 https://doi.org/10.1016/j.psychres.2018.12.128 .

Quinn PO, Madhoo M. A review of attention-deficit/hyperactivity disorder in women and girls: uncovering this hidden diagnosis. Prim Care Companion CNS Disord. 2014;16 https://doi.org/10.4088/PCC.13r01596 .

Bramham J, Murphy DGM, Xenitidis K, Asherson P, Hopkin G, Young S. Adults with attention deficit hyperactivity disorder: An investigation of age-related differences in behavioural symptoms, neuropsychological function and co-morbidity. Psychol Med. 2012;42:2225–34.

Abikoff HB, Jensen PS, Arnold LLE, Hoza B, Hechtman L, Pollack S, et al. Observed classroom behavior of children with ADHD: Relationship to gender and comorbidity. J Abnorm Child Psychol. 2002;30:349–59.

Skogli EW, Teicher MH, Andersen PN, Hovik KT, Øie M. ADHD in girls and boys - gender differences in co-existing symptoms and executive function measures. BMC Psychiatry. 2013;13.

Rasmussen K. Untreated ADHD in Adults Are There Sex Differences in Symptoms, Comorbidity, and Impairment? J Atten Disord. 2008;2010:353–60.

Edvinsson D, Lindström E, Bingefors K, Lewander T, Ekselius L. Gender differences of axis I and II comorbidity in subjects diagnosed with attention-deficit hyperactivity disorder as adults. Acta Neuropsychiatr. 2013;25:165–74.

Klein RG, Mannuzza S, Ramos Olazagasti MA, Roizen E, Hutchison JA, Lashua EC, et al. Clinical and functional outcome of childhood attention-deficit/ hyperactivity disorder 33 years later. Arch Gen Psychiatry. 2012;69:1295–303.

Biederman J, Faraone SV, Monuteaux MC, Bober M, Cadogen E. Gender effects on attention-deficit/hyperactivity disorder in adults, revisited. Biol Psychiatry. 2004;55:692–700.

Quinn P. Gender differences in ADHD. In: Buitelaar JK, Kan CC, Asherson P, editors. ADHD in Adults: Characterization, Diagnosis, and Treatment. Cambridge: Cambridge Univeristy Press; 2011.

Stepp SD, Burke JD, Hipwell AE, Loeber R. Trajectories of attention deficit hyperactivity disorder and oppositional defiant disorder symptoms as precursors of borderline personality disorder symptoms in adolescent girls. J Abnorm Child Psychol. 2012;40:7–20.

Hollingdale J, Woodhouse E, Asherson P, Gudjonsson GH, Young S. A Pilot Study Examining ADHD and Behavioural Disturbance in Female Mentally Disordered Offenders. AIMS Public Heal. 2014;1:100–8.

Dalsgaard S, Mortensen PB, Frydenberg M, Maibing CM, Nordentoft M, Thomsen PH. Association between attention-deficit hyperactivity disorder in childhood and schizophrenia later in adulthood. Eur Psychiatry. 2014;29:259–63 https://doi.org/10.1016/j.eurpsy.2013.06.004 .

Dalsgaard S, Mortensen PB, Frydenberg M, Thomsen PH. Conduct problems, gender and adult psychiatric outcome of children with attention-deficit hyperactivity disorder. Br J Psychiatry. 2002;181:416–21.

Brewerton TD, Duncan AE. Associations between Attention Deficit Hyperactivity Disorder and Eating Disorders by Gender: Results from the National Comorbidity Survey Replication. Eur Eat Disord Rev. 2016;24:536–40.

Nazar BP, Bernardes C, Peachey G, Sergeant J, Mattos P, Treasure J. The risk of eating disorders comorbid with attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. Int J Eat Disord. 2016;49:1045–57.

Cortese S, Moreira-Maia CR, St Fleur D, Morcillo-Peñalver C, Rohde LA, Faraone SV. Association between ADHD and obesity: A systematic review and meta-analysis. Am J Psychiatry. 2016;173:34–43.

Kim J, Mutyala B, Agiovlasitis S, Fernhall B. Health behaviors and obesity among US children with attention deficit hyperactivity disorder by gender and medication use. Prev Med (Baltim). 2011;52:218–22 https://doi.org/10.1016/j.ypmed.2011.01.003 .

Reyero F, Ponce G, Rodriguez-Jimenez R, Fernandez-Dapica P, Taboada D, Martin V, et al. High frequency of childhood ADHD history in women with fibromyalgia. Eur Psychiatry. 2011;26:482–3 https://doi.org/10.1016/j.eurpsy.2010.03.012 .

Sáez-Francàs N, Alegre J, Calvo N, Antonio Ramos-Quiroga J, Ruiz E, Hernández-Vara J, et al. Attention-deficit hyperactivity disorder in chronic fatigue syndrome patients. Psychiatry Res. 2012;200:748–53.

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. J Child Psychol Psychiatry Allied Discip. 2012;53:304–12.

Brassett-Grundy A, Butler NR. Prevalence and adult outcomes of Attention-Deficit/Hyperactivity Disorder: evidence from a 30-year prospective longitudinal study. BG Occas Pap no 2. 2004. /core/documents/download.asp?id=1210&log_stat=1.

Huntley Z, Young S. Alcohol and Substance Use History Among ADHD Adults: The Relationship With Persistent and Remitting Symptoms, Personality, Employment, and History of Service Use. J Atten Disord. 2014;18:82–90.

Charach A, Yeung E, Climans T, Lillie E. Childhood attention-deficit/hyperactivity disorder and future substance use disorders: comparative meta-analyses. J Am Acad Child Adolesc Psychiatry. 2011;50:9–21 https://doi.org/10.1016/j.jaac.2010.09.019 .

Ottosen C, Petersen L, Larsen JT, Dalsgaard S. Gender Differences in Associations between Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder. J Am Acad Child Adolesc Psychiatry. 2016;55:227–34.e4 https://doi.org/10.1016/j.jaac.2015.12.010 .

Shaw P, Stringaris A, Nigg J, Leibenluft E. Emotion Dysregulation in Attention Deficit Hyperactivity Disorder. Am J Psychiatry. 2014;171:276–93.

Corbisiero S, Mörstedt B, Bitto H, Stieglitz R-D. Emotional Dysregulation in Adults With Attention-Deficit/Hyperactivity Disorder-Validity, Predictability, Severity, and Comorbidity. J Clin Psychol. 2017;73:99–112 https://doi.org/10.1002/jclp.22317 .

Faraone SV, Rostain AL, Blader J, Busch B, Childress AC, Connor DF, et al. Practitioner Review: Emotional dysregulation in attention-deficit/hyperactivity disorder – implications for clinical recognition and intervention. J Child Psychol Psychiatry Allied Discip. 2019;60:133–50.

Barkley RA, Fischer M. The unique contribution of emotional impulsiveness to impairment in major life activities in hyperactive children as adults. J Am Acad Child Adolesc Psychiatry. 2010;49:503–13 https://doi.org/10.1016/j.jaac.2010.01.019 .

Skirrow C, Asherson P. Emotional lability, comorbidity and impairment in adults with attention-deficit hyperactivity disorder. J Affect Disord. 2013;147:80–6.

Gudjonsson GH, Sigurdsson JF, Eyjolfsdottir GA, Smari J, Young S. The relationship between satisfaction with life, ADHD symptoms, and associated problems among university students. J Atten Disord. 2009;12:507–15.

Willcutt EG, Doyle AE, Nigg JT, Faraone S, Pennington BF. Validity of the executive function theory of attention-deficit/hyperactivity disorder: a meta-analytic review. Biol Psychiatry. 2005;57:1336–46 https://doi.org/10.1016/j.biopsych.2005.02.006 .

Boonstra AM, Oosterlaan J, Sergeant JA, Buitelaar JK. Executive functioning in adult ADHD: A meta-analytic review. Psychol Med. 2005;35:1097–108.

Rucklidge JJ, Tannock R. Neuropsychological profiles of adolescent with ADHD: Effects of reading difficulties and gender. J Child Psychol Psychiatry Allied Discip. 2002;43:988–1003.

Bora E, Pantelis C. Meta-analysis of social cognition in attention-deficit/hyperactivity disorder (ADHD): Comparison with healthy controls and autistic spectrum disorder. Psychol Med. 2016;46:699–716.

Ros R, Graziano PA. Social Functioning in Children With or At Risk for Attention Deficit/Hyperactivity Disorder: A Meta-Analytic Review. J Clin Child Adolesc Psychol. 2018;47:213–35 https://doi.org/10.1080/15374416.2016.1266644 .

Nijmeijer JS, Minderaa RB, Buitelaar JK, Mulligan A, Hartman CA, Hoekstra PJ. Attention-deficit/hyperactivity disorder and social dysfunctioning. Clin Psychol Rev. 2008;28:692–708.

Greene RW, Biederman J, Faraone SV, Monuteaux MC, Mick E, Dupre EP, et al. Social impairment in girls with ADHD: Patterns, gender comparisons, and correlates. J Am Acad Child Adolesc Psychiatry. 2001;40:704–10.

Babinski DE, Pelham WE, Molina BSG, Gnagy EM, Waschbusch DA, Yu J, et al. Late adolescent and young adult outcomes of girls diagnosed with ADHD in childhood: An exploratory investigation. J Atten Disord. 2011;15:204–14.

Young S, Heptinstall E, Sonuga-Barke EJS, Chadwick O, Taylor E. The adolescent outcome of hyperactive girls: Self-report of psychosocial status. J Child Psychol Psychiatry Allied Discip. 2005;46:255–62.

Young S, Chadwick O, Heptinstall E, Taylor E, Sonuga-Barke EJS. The adolescent outcome of hyperactive girls: Self-reported interpersonal relationships and coping mechanisms. Eur Child Adolesc Psychiatry. 2005;14:245–53.

Holmberg K, Hjern A. Bullying and attention-deficit-hyperactivity disorder in 10-year-olds in a Swedish community. Dev Med Child Neurol. 2008;50:134–8.

Sciberras E, Ohan J, Anderson V. Bullying and peer victimisation in adolescent girls with attention-deficit/hyperactivity disorder. Child Psychiatry Hum Dev. 2012;43:254–70.

Heiman T, Olenik-Shemesh D, Eden S. Cyberbullying involvement among students with ADHD: relation to loneliness, self-efficacy and social support. Eur J Spec Needs Educ. 2015;30:15–29 https://doi.org/10.1080/08856257.2014.943562 .

Becker SP, Mehari KR, Langberg JM, Evans SW. Rates of peer victimization in young adolescents with ADHD and associations with internalizing symptoms and self-esteem. Eur Child Adolesc Psychiatry. 2017;26:201–14.

Bruner MR, Kuryluk AD, Whitton SW. Attention-deficit/hyperactivity disorder symptom levels and romantic relationship quality in college students. J Am Coll Heal. 2015;63:98–108.

Yen JY, Ko CH, Yen CF, Wu HY, Yang MJ. The Comorbid Psychiatric Symptoms of Internet Addiction: Attention Deficit and Hyperactivity Disorder (ADHD), Depression, Social Phobia, and Hostility. J Adolesc Heal. 2007;41:93–8.

Ko C-H, Yen J-Y, Chen C-S, Chen C-C, Yen C-F. Psychiatric Comorbidity of Internet Addiction in College Students: An Interview Study. CNS Spectr. 2008;13:147–53 https://doi.org/10.1017/S1092852900016308 .

Wang B, Yao N, Zhou X, Liu J, Lv Z. The association between attention deficit/hyperactivity disorder and internet addiction: A systematic review and meta-analysis. BMC Psychiatry. 2017;17:1–12.

Yen JY, Liu TL, Wang PW, Chen CS, Yen CF, Ko CH. Association between Internet gaming disorder and adult attention deficit and hyperactivity disorder and their correlates: Impulsivity and hostility. Addict Behav. 2017;64:308–13 https://doi.org/10.1016/j.addbeh.2016.04.024 .

Yen J-Y, Yen C-F, Chen C-S, Tang T-C, Ko C-H. The Association between Adult ADHD Symptoms and Internet Addiction among College Students: The Gender Difference. CyberPsychology Behav. 2009;12:187–91 https://doi.org/10.1089/cpb.2008.0113 .

Andreassen CS, Billieux J, Griffiths MD, Kuss DJ, Demetrovics Z, Mazzoni E, et al. The relationship between addictive use of social media and video games and symptoms of psychiatric disorders: A large-scale cross-sectional study. Psychol Addict Behav. 2016;30:252–62.

Barkley RA, Fischer M, Smallish L, Fletcher K. Young adult outcome of hyperactive children: Adaptive functioning in major life activities. J Am Acad Child Adolesc Psychiatry. 2006;45:192–202 https://doi.org/10.1097/01.chi.0000189134.97436.e2 .

Owens EB, Zalecki C, Gillette P, Hinshaw SP. Girls with Childhood ADHD as Adults: Cross-Domain Outcomes by Diagnostic Persistence. J Consult Clin Psychol. 2017;85:723–36 https://doi.org/10.1037/ccp0000217.Girls .

Lehti V, Niemelö S, Heinze M, Sillanmöki L, Helenius H, Piha J, et al. Childhood predictors of becoming a teenage mother among Finnish girls. Acta Obstet Gynecol Scand. 2012;91:1319–25.

Skoglund C, Kopp Kallner H, Skalkidou A, Wikström A-K, Lundin C, Hesselman S, et al. Association of Attention-Deficit/Hyperactivity Disorder With Teenage Birth Among Women and Girls in Sweden. JAMA Netw Open. 2019;2:e1912463 https://doi.org/10.1001/jamanetworkopen.2019.12463 .

Barkley RA, Cox D. A review of driving risks and impairments associated with attention-deficit/hyperactivity disorder and the effects of stimulant medication on driving performance. J Safety Res. 2007;38:113–28.

Dalsgaard S, Ostergaard SD, Leckman JF, Mortensen PB, Pedersen MG. Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: A nationwide cohort study. Lancet. 2015;385:2190–6.

Molina BSG, Flory K, Hinshaw SP, Greiner AR, Arnold LE, Swanson JM, et al. Delinquent behavior and emerging substance use in the MTA at 36 months: Prevalence, course, and treatment effects. J Am Acad Child Adolesc Psychiatry. 2007;46:1028–40 https://doi.org/10.1097/chi.0b013e3180686d96 .

Dalsgaard S, Mortensen PB, Frydenberg M, Thomse PH. Long-term criminal outcome of children with attention deficit hyperactivity disorder. Crim Behav Ment Heal. 2013;23:86–98.

Young S, Moss D, Sedgwick O, Fridman M, Hodgkins P. A meta-Analysis of the prevalence of attention deficit hyperactivity disorder in incarcerated populations. Psychol Med. 2015;45:247–58.

Turgay A, Goodman DW, Asherson P, Lasser RA, Babcock TF, Pucci ML, et al. Lifespan Persistence of ADHD: The life transition model and its application. J Clin Psychiatry. 2012;73:192–201.

Patton GC, Viner R. Pubertal transitions in health. Lancet. 2007;369:1130–9.

Taylor A, Deb S, Unwin G. Scales for the identification of adults with attention deficit hyperactivity disorder (ADHD): A systematic review. Res Dev Disabil. 2011;32:924–38 https://doi.org/10.1016/j.ridd.2010.12.036 .

Conners. Comprehensive Behavior Rating Scales (Conners CBRS). North Tonawanda: Multi-Health Systems Inc; 2008.

Swanson JM. The SNAP-IV Teacher and Parent Rating Scale: 90 item. http://www.shared-care.ca/files/Scoring_for_SNAP_IV_Guide_26-item.pdf . Accessed 1 Oct 2019.

Young S. Rate and Rate C Scales, ACE. https://www.psychology-services.uk.com/adhd.htm . Accessed 1 Oct 2019.

Kaufman J, Birmaher B, Axelson D, Perepletchikova F, Brent D, Ryan N. K-SADS-PL Screener (2016). 2016. https://www.kennedykrieger.org/sites/default/files/library/documents/faculty/ksads-dsm-5-screener.pdf . Accessed 1 Oct 2019.

Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, Williamson D, Ryan N. Schedule for affective disorders and Schizophrenia for schoolage children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry. 1997;36(7):980–8.

Goodman R. The Strengths and Difficulties Questionnaire: : A Research Note. J Child Psychol Psychiatry. 1997;38:581–6 http://www.sdqinfo.com/py/sdqinfo/b3.py?language=Englishqz (UK). Accessed 1 Oct 2019.

Wolraich M, Lambert W, Doffing M, Bickman L, Simmons T, Worley K. Psychometric Properties of the Vanderbilt ADHD Diagnostic Parent Rating Scale in a Referred Population. J Pediatr Psychol. 2003;28:559–86 https://www.nichq.org/sites/default/files/resource-file/NICHQ_Vanderbilt_Assessment_Scales.pdf . Accessed 1 Oct 2019.

Goodman R, Ford T, Richards H, Gatward R, Meltzer H. The Development and Well-Being Assessment: Description and initial validation of an integrated assessement of child and adolescent psychopathology. J Child Psychol Psychiatry Allied Discip. 2000;41:645–55 https://www.dawba.info/py/dawbainfo/b1list.py?language=English .

CAS Google Scholar

Conners C, Erhardt D, Sparrow E. The Conners adult ADHD rating scale. Toronto, Ontario, Canada: Multi-Health Systems Inc.; 1998.

Ustun B, Adler LA, Rudin C, Faraone SV, Spencer TJ, Berglund P, et al. The world health organization adult attention-deficit/hyperactivity disorder self-report screening scale for DSM-5. JAMA Psychiatry. 2017;74:520–6.

Psychology Services Limited. ADHD Child Evaluation: A diagnostic interview of ADHD in children. 2015. http://www.divacenter.eu/Content/Downloads/ACE.pdf . Accessed 16 May 2019.

DIVA Foundation. Young DIVA-5. 2017. http://www.divacenter.eu/DIVA.aspx?id=535&cc=GB . Accessed 16 May 2019.

Young S. Psychology Services Limited. ACE+: A diagnostic interview of ADHD in adults; 2016. p. 1–43. https://www.psychology-services.uk.com/resource-registration.htm?type=resources&id=ACEPLUS_English.pdf . Accessed 10 Jan 2020.

Epstein JN, Johnson DE, Conners CK. Conners’ Adult ADHD Diagnostic Interview for DSM-IV (CAADID). NorthTonawanda: Multi Health Systems; 2001. https://www.mhs.com/MHS-Assessment?prodname=caadhf .

DIVA Foundation. DIVA-5. 2017. http://www.divacenter.eu/DIVA.aspx?id=529&cc=GB . Accessed 16 May 2019.

Nadeau K, Littman E, Quinn P. AD/HD self-rating scale for girls. Advantage Books, LLC; 2015. https://www.researchgate.net/publication/242642028_ADHD_SELF-RATING_SCALE_FOR_GIRLS . Accessed 2 Oct 2019..

Nadeau K, Quinn P. Women’s AD/HD Self-assessment symptom inventory (SASI). In: Nadeau KG, Quinn PO, editors. Understanding Women With AD/HD. MD, USA: Advantage books; 2002. p. 24–43. http://www.merkercounseling.com/ADHDSelfAssessmentWomen.pdf . Accessed 1 Oct 2019.

Hinshaw SP, Owens EB, Zalecki C, Huggins SP, Montenegro-Nevado AJ, Schrodek E, et al. Prospective Follow-up of Girls with Attention-deficit/ Hyperactivity Disorder into Early Adulthood: Continuing Impairment Includes Elevated Risk for Suicide Attempts and Self-Injury. J Consult Clin Psychol. 2012;80:1041–51.

Swanson EN, Owens EB, Hinshaw SP. Pathways to self-harmful behaviors in young women with and without ADHD: A longitudinal examination of mediating factors. J Child Psychol Psychiatry Allied Discip. 2014;55:505–15.

Philipsen A, Hornyak M, Riemann D. Sleep and sleep disorders in adults with attention deficit / hyperactivity disorder. Sleep Med Rev. 2006;10:399–405.

Cortese S, Faraone SV, Konofal E, Lecendreux M. Sleep in Children With Attention-Deficit/Hyperactivity Disorder: Meta-Analysis of Subjective and Objective Studies. J Am Acad Child Adolesc Psychiatry. 2009;48:894–908 https://doi.org/10.1097/CHI.0b013e3181ae09c9 .

Kooij JJS, Bijlenga D, Salerno L, Jaeschke R, Bitter I, Balázs J, et al. Updated European Consensus Statement on diagnosis and treatment of adult ADHD. Eur Psychiatry. 2019;56:14–34 https://doi.org/10.1016/j.eurpsy.2018.11.001 .

Ohan JL, Johnston C. Gender appropriateness of symptom criteria for attention-deficit/ hyperactivity disorder, oppositional-defiant disorder, and conduct disorder. Child Psychiatry Hum Dev. 2005;35:359–81.

Young S. BGaze ACE. https://bgaze.com/en/ace . Accessed 2 Oct 2019.

Conners CK. Conners’ Continuous Performance Test - third edition. Bloomington: Pearson; 2014.

Ulberstad F. QbTest Technical Manual. rev. ed. Stockholm: QbTech AB; 2012.

Shaw M, Hodgkins P, Caci H, Young S, Kahle J, Woods AG, et al. A systematic review and analysis of long-term outcomes in attention deficit hyperactive disorder. BMC Med. 2012;10:1–15 https://doi.org/10.1186/1741-7015-10-99 .

Arnold LE, Hodgkins P, Caci H, Kahle J, Young S. Effect of treatment modality on long-term outcomes in attention-deficit/hyperactivity disorder: A systematic review. PLoS One. 2015;10:1–19.

National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: diagnosis and management. 2019. https://www.nice.org.uk/guidance/ng87 . Accessed 8 Nov 2019.

Cortese S, Adamo N, Del Giovane C, Mohr-Jensen C, Hayes AJ, Carucci S, et al. Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. Lancet Psychiatry. 2018;5:727–38 https://doi.org/10.1016/S2215-0366(18)30269-4 .

Dulcan M, Dunne JE, Ayres W, Arnold V, Benson RS, Bernet W, et al. Practice parameters for the assessment and treatment of children, adolescents, and adults with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 1997;36(10 Suppl):85S–121S.

Mészáros Á, Czobor P, Bálint S, Komlósi S, Simon V, Bitter I. Pharmacotherapy of adult attention deficit hyperactivity disorder (ADHD): A meta-analysis. Int J Neuropsychopharmacol. 2009;12:1137–47.

Sharp WS, Walter JM, Marsh WL, Ritchie GF, Hamburger SD, Castellanos FX. ADHD in girls: Clinical comparability of a research sample. J Am Acad Child Adolesc Psychiatry. 1999;38:40–7.

Polanczyk G, Faraone SV, Bau CHD, Victor MM, Becker K, Pelz R, et al. The impact of individual and methodological factors in the variability of response to methylphenidate in ADHD pharmacogenetic studies from four different continents. Am J Med Genet Part B Neuropsychiatr Genet. 2008;147:1419–24.

Dalsgaard S, Leckman JF, Nielsen HS, Simonsen M. Gender and injuries predict stimulant medication use. J Child Adolesc Psychopharmacol. 2014;24:253–9.

CAS PubMed PubMed Central Google Scholar

Biederman J, Monuteaux MC, Spencer T, Wilens TE, Faraone SV. Do stimulants have a protective effect on the development of psychiatric disorders in youth with ADHD? A ten-year follow-up study. Pediatrics. 2009;124:71–8.

Daviss WB, Birmaher B, Diler RS, Mintz J. Does Pharmacotherapy for Attention-Deficit/Hyperactivity Disorder Predict Risk of Later Major Depression? J Child Adolesc Psychopharmacol. 2008;18:257–64 https://doi.org/10.1089/cap.2007.0100 .

Madjar N, Shlosberg D, Leventer-Roberts M, Akriv A, Ghilai A, Hoshen M, et al. Childhood methylphenidate adherence as a predictor of antidepressants use during adolescence. Eur Child Adolesc Psychiatry. 2019; https://doi.org/10.1007/s00787-019-01301-z .

Sternat T, Fotinos K, Fine A, Epstein I, Katzman MA. Low hedonic tone and attention-deficit hyperactivity disorder: Risk factors for treatment resistance in depressed adults. Neuropsychiatr Dis Treat. 2018;14:2379–87.

Chen MH, Pan TL, Hsu JW, Huang KL, Su TP, Li CT, et al. Attention-deficit hyperactivity disorder comorbidity and antidepressant resistance among patients with major depression: A nationwide longitudinal study. Eur Neuropsychopharmacol. 2016;26:1760–7 https://doi.org/10.1016/j.euroneuro.2016.09.369 .

Halmøy A, Fasmer OB, Gillberg C, Haavik J. Occupational Outcome in Adult ADHD: Impact of Symptom Profile, Comorbid Psychiatric Problems, and Treatment. J Atten Disord. 2009;13:175–87.

Dalsgaard S, Nielsen HS, Simonsen M. Consequences of ADHD medication use for children’s outcomes. J Health Econ. 2014;37:137–51 https://doi.org/10.1016/j.jhealeco.2014.05.005 .

Cortese S, Castellanos FX. The relationship between ADHD and obesity: Implications for therapy. Expert Rev Neurother. 2014;14:473–9.

Quinn PD, Chang Z, Hur K, Gibbons RD, Lahey BB, Rickert ME, et al. ADHD medication and substance-related problems. Am J Psychiatry. 2017;174:877–85.

Lachaine J, Beauchemin C, Sasane R, Hodgkins PS. Treatment patterns, adherence, and persistence in ADHD: A Canadian perspective. Postgrad Med. 2012;124:139–48.

Gajria K, Lu M, Sikirica V, Greven P, Zhong Y, Qin P, et al. Adherence, persistence, and medication discontinuation in patients with attention-deficit/hyperactivity disorder - A systematic literature review. Neuropsychiatr Dis Treat. 2014;10:1543–69.

Barner JC, Khoza S, Oladapo A. ADHD medication use, adherence, persistence and cost among Texas Medicaid children. Curr Med Res Opin. 2011;27:13–22.

Graham J, Coghill D. Adverse Effects of Pharmacotherapies for Attention-Deficit Hyperactivity Disorder : Epidemiology. Prevention and Management I. CNS Drugs. 2008;22:213–37.

Justice AJH, de Wit H. Acute effects of d -amphetamine during the follicular and luteal phases of the menstrual cycle in women. Psychopharmacology (Berl). 2002;145:67–75.

White TL, Justice AJH, De Wit H. Differential subjective effects of D-amphetamine by gender, hormone levels and menstrual cycle phase. Pharmacol Biochem Behav. 2002;73:729–41.

Justice AJH, de Wit H. Acute Effects of Estradiol Pretreatment on the Response to d-Amphetamine in Women. Neuroendocrinology. 2000;71:67–75.

Quinn PO. Treating adolescent girls and women with ADHD: Gender-specific issues. J Clin Psychol. 2005;61:579–87.

Crowell SE, Beauchaine TP, Linehan MM. A Biosocial Developmental Model of Borderline Personality: Elaborating and Extending Linehan’s Theory. Psychol Bull. 2009;135:495–510. https://doi.org/10.1037/a0015616 .

Matthies S, Philipsen A. Comorbidity of Personality Disorders and Adult Attention Deficit Hyperactivity Disorder (ADHD)—Review of Recent Findings. Curr Psychiatry Rep. 2016;18:1–7.

Young S, Gudjonsson GH. ADHD symptomatology and its relationship with emotional, social and delinquency problems. Psychol Crime Law. 2006;12:463–71.

Jiang HY, Zhang X, Jiang CM, Fu HB. Maternal and neonatal outcomes after exposure to ADHD medication during pregnancy: A systematic review and meta-analysis. Pharmacoepidemiol Drug Saf. 2019;28:288–95.

Spigset O, Brede WR, Zahlsen K. Excretion of Methylphenidate in Breast Milk Mirtazapine and Breastfeeding : Maternal and. Am J Psychiatry. 2007;2:348.

Sonuga-Barke E, Brandeis D, Cortese S, Daley D, Ferrin M, Holtmann M, et al. Nonpharmacological Interventions for ADHD: Systematic Review and Meta-analysis of Randomized Controlled Trials of Dietary and Psychological Treatments. Am J Psychiatry. 2013;170:275–89 https://doi.org/10.1176/appi.ajp.2012.12070991 .

Cortese S, Ferrin M, Brandeis D, Buitelaar J, Daley D, Dittmann RW, et al. Cognitive training for attention-deficit/hyperactivity disorder: Meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials. J Am Acad Child Adolesc Psychiatry. 2015;54:164–74 https://doi.org/10.1016/j.jaac.2014.12.010 .

Cortese S, Ferrin M, Brandeis D, Holtmann M, Aggensteiner P, Daley D, et al. Neurofeedback for Attention-Deficit/Hyperactivity Disorder: Meta-Analysis of Clinical and Neuropsychological Outcomes From Randomized Controlled Trials. J Am Acad Child Adolesc Psychiatry. 2016;55:444–55.

Riesco-Matías P, Yela-Bernabé JR, Crego A, Sánchez-Zaballos E. What Do Meta-Analyses Have to Say About the Efficacy of Neurofeedback Applied to Children With ADHD? Review of Previous Meta-Analyses and a New Meta-Analysis. J Atten Disord. 2019.

Theule J, Cheung K, Aberdeen K. Children’s ADHD Interventions and Parenting Stress: A Meta-Analysis. J Child Fam Stud. 2018;27:2744–56 https://doi.org/10.1007/s10826-018-1137-x .

Bikic A, Reichow B, McCauley SA, Ibrahim K, Sukhodolsky DG. Meta-analysis of organizational skills interventions for children and adolescents with Attention-Deficit/Hyperactivity Disorder. Clin Psychol Rev. 2017;52:108–23 https://doi.org/10.1016/j.cpr.2016.12.004 .

Daley D, Van Der Oord S, Ferrin M, Danckaerts M, Doepfner M, Cortese S, et al. Behavioral interventions in attention-deficit/hyperactivity disorder: A meta-analysis of randomized controlled trials across multiple outcome domains. J Am Acad Child Adolesc Psychiatry. 2014;53:835–47.e5 https://doi.org/10.1016/j.jaac.2014.05.013 .

Young Z, Moghaddam N, Tickle A. The Efficacy of Cognitive Behavioral Therapy for Adults With ADHD: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Atten Disord. 2020;24:875–88.

Xue J, Zhang Y, Huang Y, Tusconi M. A meta-analytic investigation of the impact of mindfulness-based interventions on ADHD symptoms. Med (United States). 2019;98:1–10.

Ramboll and the National Board of Social Services Denmark. Better help for young people and adults with ADHD and corresponding difficulties Final evaluation report. 2020. https://www.psychology-services.uk.com/danish-report-on-r-r2-adhd . Accessed 23 Apr 2020.

Young S, Myanthi AJ. Practitioner Review: Non-pharmacological treatments for ADHD: A lifespan approach. J Child Psychol Psychiatry Allied Discip. 2010;51:116–33.

De Ridder A, De Graeve D. Healthcare use, social burden and costs of children with and without ADHD in Flanders. Belgium. Clin Drug Investig. 2006;26:75–90.

Usami M. Functional consequences of attention-deficit hyperactivity disorder on children and their families. Psychiatry Clin Neurosci. 2016;70:303–17.

Shreeram S, He JP, Kalaydjian A, Brothers S, Merikangas KR. Prevalence of enuresis and its association with attention-deficit/ hyperactivity disorder among U.S. children: Results from a nationally representative study. J Am Acad Child Adolesc Psychiatry. 2009;48:35–41.

Ghanizadeh A, Mohammadi MR, Moini R. Comorbidity of Psychiatric Disorders and Parental Psychiatric Disorder of ADHD Children. J Atten Disord. 2008:149–55 https://doi.org/10.1177/1087054708314601 .

Young S, Smith J. Helping Children with ADHD. A CBT Guide for Practitioners, Parents and Teachers. Chichester: Wiley; 2017.

Young S. The STAR Detective Facilitator Manual: A Cognitive Behavioral Group Intervention to Develop Skilled Thinking and Reasoning for Children with Cognitive, Behavioral, Emotional and Social Problems. London: Jessica Kingsley; 2017.

Young S. Becoming a STAR Detective!: Your Detective’s Notebook for Finding Clues to How You Feel. London: Jessica Kingsley; 2017.

Atzori P, Usala T, Carucci S, Danjou F, Zuddas A. Predictive Factors for Persistent Use and Compliance of Immediate-Release Methylphenidate: A 36-Month Naturalistic Study. J Child Adolesc Psychopharmacol. 2009;19:673–81.

Blakemore S-J. Inventing ourselves: the secret life of the teenage brain: Doubleday; 2018.

Dawson AE, Wymbs BT, Evans SW, DuPaul GJ. Exploring how adolescents with ADHD use and interact with technology. J Adolesc. 2019;71:119–37 https://doi.org/10.1016/j.adolescence.2019.01.004 .

McManus S, Meltzer H, Brugha T, Bebbington P, Jenkins R. Adult Psychiatric Morbidity in England 2007: Results of a household survey. Leeds: The NHS Information Centre; 2009.

Treas J, Tai T. Gender Inequality in Housework Across 20 European Nations: Lessons from Gender Stratification Theories. Sex Roles. 2016;74:495–511 https://doi.org/10.1007/s11199-015-0575-9 .

Ferrant G, Pesando LM, Nowacka K. Unpaid Care Work: The missing link in the analysis of gender gaps in labour outcomes. OECD Development Centre. 2014. https://www.oecd.org/dev/development-gender/Unpaid_care_work.pdf . Accessed 15 May 2019.

Age UK. Breaking Point The Social Care Burden on Women. 2019. https://www.ageuk.org.uk/contentassets/c3dac0771e614672b363c5fe7e6f826e/breaking-point-age-uk.pdf . Accessed 15 May 2019.

Park JL, Hudec KL, Johnston C. Parental ADHD symptoms and parenting behaviors: A meta-analytic review. Clin Psychol Rev. 2017;56:25–39 https://doi.org/10.1016/j.cpr.2017.05.003 .

Young S, Gudjonsson G, Chitsabesan P, Colley B, Farrag E, Forrester A, et al. Identification and treatment of offenders with attention-deficit/hyperactivity disorder in the prison population: A practical approach based upon expert consensus. BMC Psychiatry. 2018;18:1–16.

Uchida M, Spencer TJ, Faraone SV, Biederman J. Adult Outcome of ADHD: An Overview of Results From the MGH Longitudinal Family Studies of Pediatrically and Psychiatrically Referred Youth With and Without ADHD of Both Sexes. J Atten Disord. 2018;22:523–34.

House of Lords Select Committee on the Equality Act. The Equality Act 2010: the impact on disabled people: London Station Off; 2016. p. 1–171.

Sedgwick JA. University students with attention deficit hyperactivity disorder (ADHD): A literature review. Ir J Psychol Med. 2018;35:221–35.

Veenman B, Luman M, Hoeksma J, Pieterse K, Oosterlaan J. A Randomized Effectiveness Trial of a Behavioral Teacher Program Targeting ADHD Symptoms. J Atten Disord. 2019;23:293–304.

LeFever GB, Villers MS, Morrow AL, Vaughn ES. Parental perceptions of adverse educational outcomes among children diagnosed and treated for ADHD: A call for improved school/provider collaboration. Psychol Sch. 2002;39:63–71.

Owens EB, Hinshaw SP. Adolescent Mediators of Unplanned Pregnancy among Women with and without Childhood ADHD. J Clin Child Adolesc Psychol. 2020;49:229–38 https://doi.org/10.1080/15374416.2018.1547970 .

Kuriyan AB, Pelham WE, Molina BSGG, Waschbusch DA, Gnagy EM, Sibley MH, et al. Young adult educational and vocational outcomes of children diagnosed with ADHD. J Abnorm Child Psychol. 2013;41:27–41 https://doi.org/10.1007/s10802-012-9658-z .

Polderman TJC, Boomsma DI, Bartels M, Verhulst FC, Huizink AC. A systematic review of prospective studies on attention problems and academic achievement: Review. Acta Psychiatr Scand. 2010;122:271–84.

de Zeeuw EL, van Beijsterveldt CEM, Ehli EA, de Geus EJC, Boomsma DI. Attention Deficit Hyperactivity Disorder Symptoms and Low Educational Achievement: Evidence Supporting A Causal Hypothesis. Behav Genet. 2017;47:278–89.

Moldavsky M, Groenewald C, Owen V, Sayal K. Teachers’ recognition of children with ADHD: Role of subtype and gender. Child Adolesc Ment Health. 2013;18:18–23.

Drigas AS, Ioannidou R-E, Kokkalia G, Lytras MD. ICTs, mobile learning and social media to enhance learning for attention difficulties. J Univers Comput Sci. 2014;20:1499–510.

Lasky AK, Weisner TS, Jensen PS, Hinshaw SP, Hechtman L, Arnold LE, et al. ADHD in context: Young adults’ reports of the impact of occupational environment on the manifestation of ADHD. Soc Sci Med. 2016;161:160–8.

Brook JS, Brook DW, Zhang C, Seltzer N, Finch SJ. Adolescent ADHD and Adult Physical and Mental Health, Work Performance, and Financial Stress. Pediatrics. 2013;131:5–13 https://doi.org/10.1542/peds.2012-1725 .

Adamou M, Arif M, Asherson P, Aw TC, Bolea B, Coghill D, et al. Occupational issues of adults with ADHD. BMC Psychiatry. 2013;13.

Garland AF, Hough RL, McCabe KM, Yeh M, Wood PA, Aarons GA. Prevalence of psychiatric disorders in youths across five sectors of care. J Am Acad Child Adolesc Psychiatry. 2001;40:409–18 https://doi.org/10.1097/00004583-200104000-00009 .

Harman JS, Childs GE, Kelleher KJ. Mental health care utilization and expenditures by children in foster care. Arch Pediatr Adolesc Med. 2000;154:1114–7 https://jamanetwork.com/journals/jamapediatrics/fullarticle/352217 .

Young S, González RA, Fridman M, Hodgkins P, Kim K, Gudjonsson GH. The economic consequences of attention-deficit hyperactivity disorder in the Scottish prison system. BMC Psychiatry. 2018;18:1–11.

Lichtenstein P, Halldner L, Zetterqvist J, Sjölander A, Serlachius E, Fazel S, et al. Medication for attention deficit-hyperactivity disorder and criminality. N Engl J Med. 2012;367:2006–14.

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. Br J Psychiatry. 2012;200:68–73.

Ginsberg Y, Hirvikoski T, Grann M, Lindefors N. Long-term functional outcome in adult prison inmates with ADHD receiving OROS-methylphenidate. Eur Arch Psychiatry Clin Neurosci. 2012;262:705–24.

Ginsberg Y, Långström N, Larsson H, Lichtenstein P. ADHD and criminality: Could treatment benefit prisoners with ADHD who are at higher risk of reoffending? Expert Rev Neurother. 2013;13:345–8.

Rösler M, Retz W, Yaqoobi K, Burg E, Retz-Junginger P. Attention deficit/hyperactivity disorder in female offenders: Prevalence, psychiatric comorbidity and psychosocial implications. Eur Arch Psychiatry Clin Neurosci. 2009;259:98–105.

Young S, Gudjonsson GH, Wells J, Asherson P, Theobald D, Oliver B, et al. Attention deficit hyperactivity disorder and critical incidents in a Scottish prison population. Pers Individ Dif. 2009;46:265–9 https://doi.org/10.1016/j.paid.2008.10.003 .

Download references

Acknowledgements

We are grateful to the assistance of Catherine Coles, Alex Nolan and Hannah Stynes who attended the consensus meeting and made notes during the breakout sessions.

The meeting was funded by the UK ADHD Partnership (UKAP), who has been in receipt of unrestricted educational donations from Takeda. Takeda had no influence or involvement in determining the topic and arrangements of the day, the consensus process and outcomes, or writing the final manuscript. 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.

Author information

Authors and affiliations.

Psychology Services Limited, PO 1735, Croydon, London, CR9 7AE, UK

Susan Young

Department of Psychology, Reykjavik University, Reykjavik, Iceland

Susan Young, Bryndís Björk Ásgeirsdóttir & Gisli Gudjonsson

Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK

Nicoletta Adamo & Jane Sedgwick

Service for Complex Autism and Associated Neurodevelopmental Disorders, South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, London, UK

Nicoletta Adamo

Oxford ADHD and Autism Centre, Oxford, UK

Polly Branney

ADHD Action, Harrogate, North Yorkshire, UK

Michelle Beckett

CLC Consultancy, Perth, UK

William Colley

Manor Hospital, Oxford, UK

Sally Cubbin

National Autism Unit, Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Beckenham, UK

Quinton Deeley

Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, London, UK

Quinton Deeley & Emma Woodhouse

South London & Maudsley NHS Foundation Trust, Maudsley Health, Abu Dhabi, UAE

Emad Farrag

Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK

Gisli Gudjonsson

Independent Consultant in Child and Adolescent Psychiatry, Private Practice, London, UK

Michael Rutter Centre, South London and Maudsley Hospital, London, UK

Jack Hollingdale

Koc University, Istanbul, Turkey

ADHD Foundation, Liverpool, UK

ADHD and Psychiatry Services Limited, Liverpool, UK

Peter Mason

Tavistock and Portman NHS Foundation Trust, London, UK

Eleni Paliokosta

St Thomas’ Hospital London, London, UK

Sri Perecherla

Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, UK

Jane Sedgwick

Cambridge Cognition, Cambridge, UK

Caroline Skirrow

School of Psychological Science, University of Bristol, Bristol, UK

Neuropsychiatry Team, National Specialist CAMHS, South London and Maudsley NHS Foundation Trust, London, UK

Kevin Tierney

Adult ADHD and AS Team & CYP ADHD and ASD Service in Northamptonshire, Northampton, UK

Kobus van Rensburg

Compass, London, UK

Emma Woodhouse

You can also search for this author in PubMed Google Scholar

Contributions

SY was responsible for the planning and scientific input of this consensus statement. All authors (except NA and EF) attended the consensus meeting. CS completed the first draft of the manuscript. It was substantially revised by SY with further input from EF and BC. The second draft was circulated to all authors for comment and endorsement of the consensus. Following further amendments, the final draft was circulated once more and all authors have read and approved the final manuscript.

Corresponding author

Correspondence to Susan Young .

Ethics declarations

Ethics approval and consent to participate.

The current report reflects a review of the research literature on ADHD in girls and women, and a consensus agreement amongst all authors based on this evidence and their clinical experience. As a result, neither consent for participation, nor ethical approval for this work were required.

Consent for publication

Not applicable

Competing interests

In the last 5 years: SY has received honoraria for consultancy and educational talks years from Janssen, HB Pharma and/or Shire. She is author of the ADHD Child Evaluation (ACE) and ACE+ for adults; and lead author of R&R2 for ADHD Youths and Adults. PH has received honoraria for consultancy and educational talks in the last 5 years from Shire, Janssen and Flynn. He has acted as an expert witness for Lilly. PM has received honoraria for consultancy and educational talks from Shire and Flynn. KvR has received honoraria for educational talks from Shire, Lilly, Janssen, Medici and Flynn. In addition SY, PB, WC, PH, PM and EW are affiliated on a full-time basis with consultancy firms/private practices. CS is employed by Cambridge Cognition. JS has received speakers’ honoraria from Shire, is in receipt of an educational grant from the Royal College of Nursing (RCN) Foundation Trust for a contribution towards PhD tuition & conference fees/ costs and is an Executive Committee Member of the UK Adult ADHD Network ( UKAAN.org ). The remaining authors have no disclosures.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Young, S., Adamo, N., Ásgeirsdóttir, B.B. et al. 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. BMC Psychiatry 20 , 404 (2020). https://doi.org/10.1186/s12888-020-02707-9

Download citation

Received : 27 January 2020

Accepted : 31 May 2020

Published : 12 August 2020

DOI : https://doi.org/10.1186/s12888-020-02707-9

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

Attention-deficit/hyperactivity disorder (ADHD)
Identification
Interventions

BMC Psychiatry

ISSN: 1471-244X

General enquiries: [email protected]

Information

Author Services

Initiatives

You are accessing a machine-readable page. In order to be human-readable, please install an RSS reader.

All articles published by MDPI are made immediately available worldwide under an open access license. No special permission is required to reuse all or part of the article published by MDPI, including figures and tables. For articles published under an open access Creative Common CC BY license, any part of the article may be reused without permission provided that the original article is clearly cited. For more information, please refer to https://www.mdpi.com/openaccess .

Feature papers represent the most advanced research with significant potential for high impact in the field. A Feature Paper should be a substantial original Article that involves several techniques or approaches, provides an outlook for future research directions and describes possible research applications.

Feature papers are submitted upon individual invitation or recommendation by the scientific editors and must receive positive feedback from the reviewers.

Editor’s Choice articles are based on recommendations by the scientific editors of MDPI journals from around the world. Editors select a small number of articles recently published in the journal that they believe will be particularly interesting to readers, or important in the respective research area. The aim is to provide a snapshot of some of the most exciting work published in the various research areas of the journal.

Original Submission Date Received: .

Active Journals
Find a Journal
Proceedings Series
For Authors
For Reviewers
For Editors
For Librarians
For Publishers
For Societies
For Conference Organizers
Open Access Policy
Institutional Open Access Program
Special Issues Guidelines
Editorial Process
Research and Publication Ethics
Article Processing Charges
Testimonials
Preprints.org
SciProfiles
Encyclopedia

Article Menu

Subscribe SciFeed
Recommended Articles
Google Scholar
on Google Scholar
Table of Contents

Find support for a specific problem in the support section of our website.

Please let us know what you think of our products and services.

Visit our dedicated information section to learn more about MDPI.

JSmol Viewer

College students with adhd: a selective review of qualitative studies.

1. Introduction

1.1. qualitative research methods, 1.2. the present study, 2. materials and methods, 2.1. search strategy, 2.2. study selection, 2.3. variable identification, 3.1. quantitative results, 3.2. qualitative results, 3.2.1. the college experience of students with adhd, 3.2.2. interventions, 3.2.3. cognitive and academic functioning, 3.2.4. self-functioning, 4. discussion, 5. conclusions, author contributions, conflicts of interest, appendix a. summaries of included studies, appendix a.1. the college experience of students with adhd, appendix a.1.1. college transitions, appendix a.1.2. adhd as an identity, appendix a.1.3. race, appendix a.1.4. community college, appendix a.2. interventions, appendix a.2.1. coaching, appendix a.2.2. strategies, appendix a.2.3. medication, appendix a.3. cognitive and academic functioning, appendix a.4. self-functioning.

Chung, W.; Jiang, S.F.; Paksarian, D.; Nikolaidis, A.; Castellanos, F.X.; Merikangas, K.R.; Milham, M.P. Trends in the prevalence and incidence of attention-deficit/hyperactivity disorder among adults and children of different racial and ethnic groups. JAMA Netw. Open 2009 , 2 , e1914344. [ Google Scholar ] [ CrossRef ]
Digest of Education Statistics. Available online: https://nces.ed.gov/programs/digest/d21/tables/dt21_311.10.asp (accessed on 4 April 2024).
Characteristics and Outcomes of Undergraduates with Disabilities. Available online: https://nces.ed.gov/pubs2018/2018432.pdf (accessed on 4 April 2024).
DuPaul, G.J.; Gormley, M.J.; Anastopoulos, A.D.; Weyandt, L.L.; Labban, J.; Sass, A.J.; Postler, K.B. Academic trajectories of college students with and without ADHD: Predictors of four-year outcomes. J. Clin. Child. Adolesc. Psychol. 2021 , 50 , 828–843. [ Google Scholar ] [ CrossRef ] [ PubMed ]
O’Rourke, S.R.; Bray, A.C.; Anastopoulos, A.D. Anxiety symptoms and disorders in college students with ADHD. J. Atten. Disord. 2020 , 24 , 1764–1774. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Anastopoulos, A.D.; Langberg, J.M.; Eddy, L.D.; Silvia, P.J.; Labban, J.D. A randomized controlled trial examining CBT for college students with ADHD. J. Consult. Clin. Psychol. 2021 , 89 , 21–33. [ Google Scholar ] [ CrossRef ]
Francis, A.R.; Weyandt, L.L.; Anastopoulos, A.D.; DuPaul, G.J.; Shepard, E. Outcomes and predictors of stimulant misuse in college students with and without ADHD. J. Atten. Disord. 2022 , 26 , 779–793. [ Google Scholar ] [ CrossRef ]
APA Dictionary of Psychology. Available online: https://dictionary.apa.org/qualitative-research (accessed on 15 January 2024).
Sabnis, S.V.; Newman, D.S.; Whitford, D.; Mossing, K. Publication and characteristics of qualitative research in School Psychology journals between 2006 and 2021. Sch. Psychol. 2023 , 38 , 330–336. [ Google Scholar ] [ CrossRef ]
Drew, C.J.; Hardman, M.L.; Hosp, J.L. Designing and Conducting Research in Education ; Sage: Thousand Oaks, CA, USA, 2008. [ Google Scholar ]
Schonfeld, I.S.; Mazzola, J.J. Strengths limitations of qualitative approaches to research in occupational health psychology. In Research Methods in Occupational Health Psychology: State of the Art in Measurement, Design, and Data Analysis ; Tetrick, L., Sinclair, R., Wang, M., Eds.; Routledge: London, UK, 2012; pp. 268–289. [ Google Scholar ]
Camic, P.M. Qualitative Inquiry in Psychological Research, Expanding Perspectives in Methodology and Design , 2nd ed.; American Psychological Association: Washington, DC, USA, 2021; pp. 3–26. [ Google Scholar ]
Leko, M.M.; Cook, B.G.; Cook, L. Qualitative methods in special education research. Learn. Disabil. Res. Pract. 2021 , 36 , 278–286. [ Google Scholar ] [ CrossRef ]
Page, M.J.; McKenzie, J.E.; Bossuyt, P.M.; Boutron, I.; Hoffmann, T.C.; Mulrow, C.D.; Moher, D. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021 , 372 , 71. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Madaus, J.W.; Gelbar, N.; Dukes, L.L., III; Lalor, A.R.; Lombardi, A.; Kowitt, J.; Faggella-Luby, M.N. Literature on postsecondary disability services: A call for research guidelines. J. Divers. High. Educ. 2018 , 11 , 133ff. [ Google Scholar ] [ CrossRef ]
Madaus, J.W.; Dukes, L.L., III; Lalor, A.R.; Aquino, K.; Faggella-Luby, M.; Newman, L.A.; Wessel, R.D. Research Guidelines for Higher Education and Disability. J. Postsecond. Educ. Disabil. 2020 , 33 , 319–338. [ Google Scholar ]
Lewandowski, L.J.; Lovett, B.J.; Codding, R.S.; Gordon, M. Symptoms of ADHD and academic concerns in college students with and without ADHD diagnoses. J. Atten. Disord. 2008 , 12 , 156–161. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Suhr, J.A.; Johnson, E.E. First do no harm: Ethical issues in pathologizing normal variations in behavior and functioning. Psychol. Inj. Law 2022 , 15 , 253–267. [ Google Scholar ] [ CrossRef ]
Nelson, J.M.; Lovett, B.J. Assessing ADHD in college students: Integrating multiple evidence sources with symptom and performance validity data. Psychol. Assess. 2019 , 31 , 793–804. [ Google Scholar ] [ CrossRef ]
Gascon, A.; Gamache, D.; St-Laurent, D.; Stipanicic, A. Do we over-diagnose ADHD in North America? A critical review and clinical recommendations. J. Clin. Psychol. 2022 , 78 , 2363–2380. [ Google Scholar ] [ CrossRef ]
Meaux, J.B.; Green, A.; Broussard, L. ADHD in the college student: A block in the road. J. Psychiatr. Ment. Health Nurs. 2009 , 16 , 248–256. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Morgan, K. The College Transition Experience of Students with ADHD. Ph.D. Thesis, Kansas State University, Manhattan, KS, USA, 2012. [ Google Scholar ]
McCall, Z.A. The transition experiences, activities, and supports of four college students with disabilities. Career Dev. 2015 , 38 , 162–172. [ Google Scholar ] [ CrossRef ]
Denson, T.C. The Transitioning Experiences of First-Year Students with ADHD into College: A Case Study. Ph.D. Thesis, Northcentral University, Phoenix, AZ, USA, 2021. [ Google Scholar ]
Stevens, A.E. Perspectives from College Students with ADHD: A Qualitative Examination of Parental Support and the Parent-Child Relationship in the Transition to College. Ph.D. Thesis, University of Wyoming, Laramie, WY, USA, 2020. [ Google Scholar ]
Mullins, L.; Preyde, M. The lived experience of students with an invisible disability at a Canadian university. Disabil. Soc. 2013 , 28 , 147–160. [ Google Scholar ] [ CrossRef ]
Johnston, V. University Students Diagnosed with Attention Deficit Hyperactivity Disorder: A Hermeneutical Phenomenological Study of Challenges and Successes. Ph.D. Thesis, Liberty University, Richmond, VA, USA, 2013. [ Google Scholar ]
Lux, S.J. The Lived Experiences of College Students with a Learning Disability and/or Attention Deficit Hyperactivity Disorder. Ph.D. Thesis, Iowa State University, Des Moines, IA, USA, 2016. [ Google Scholar ]
Alabdulwahab, R. Postsecondary Education for International Undergraduate Students with Learning Disabilities in the United States. Ph.D. Thesis, University of Northern Colorado, Greely, CO, USA, 20 December 2016. [ Google Scholar ]
Bolourian, Y.; Zeedyk, S.M.; Blacher, J. Autism and the university experience: Narratives from students with neurodevelopmental disorders. J. Autism Dev. Disord. 2018 , 48 , 3330–3343. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Bonomi, A.; Nichols, E.; Kammes, R.; Green, T. Sexual violence and intimate partner violence in college women with a mental health and/or behavior disability. J. Women’s Health 2018 , 27 , 359–368. [ Google Scholar ]
Pirozzi, M. The Perception of the College Experience for Students with ADHD. In Proceedings of the IHSES 2022—International Conference on Humanities, Social and Education Sciences, Los Angeles, CA, USA, 21–24 April 2022 ; Noroozi, O., Sahin, I., Eds.; ISTES Organization: Los Angeles, CA, USA, 2022; pp. 18–32. [ Google Scholar ]
Poe, M.A. A Phenomenological Study of the Educational Learning Experiences of African American College Students with Attention Deficit Hyperactivity Disorder (ADHD). Ph.D. Thesis, Capella University, Minneapolis, MN, USA, 2011. [ Google Scholar ]
Mills, M.C. The Learning Experiences in a College Environment for African American Students Diagnosed with Attention Deficit Hyperactivity Disorder (ADHD): A Qualitative Case Study. Ph.D. Thesis, Capella University, Minneapolis, MN, USA, 2015. [ Google Scholar ]
Young, E.W.D.M. Understanding the Psycho-Social and Cultural Factors that Influence the Experience of Attention-Deficit/Hyperactivity Disorder (ADHD) in Chinese American college students: A Systems Approach. Ph.D. Thesis, University of Southern California, Los Angeles, CA, USA, 2012. [ Google Scholar ]
Coon, H.L. Community College Students with Attention-Deficit/Hyperactivity Disorder (AD/HD): A Student Perspective. Ph.D. Thesis, Capella University, Minneapolis, MN, USA.
Flowers, L. Navigating and Accessing Higher Education: The Experiences of Community College Students with Attention Deficit Hyperactivity Disorder. Ph.D. Thesis, University of Southern California, Los Angeles, CA, USA, 2012. [ Google Scholar ]
Reaser, A.L. ADHD Coaching and College Students. Ph.D. Thesis, Florida State University, Tallahassee, FL, USA, 2008. [ Google Scholar ]
Parker, D.R.; Boutelle, K. Executive function coaching for college students with learning disabilities and ADHD: A new approach for fostering self-determination. Learn. Disabil. Res. Pract. 2009 , 24 , 204–215. [ Google Scholar ] [ CrossRef ]
Prevatt, F.; Smith, S.M.; Diers, S.; Marshall, D.; Coleman, J.; Valler, E.; Miller, N. ADHD coaching with college students: Exploring the processes involved in motivation and goal completion. J. Coll. Stud. Psychother. 2017 , 31 , 93–111. [ Google Scholar ] [ CrossRef ]
Kreider, C.M.; Medina, S.; Koedam, H.M. (Dis)ability-informed mentors support occupational performance for college students with learning disabilities and attention-deficit/hyperactivity disorders through problem-solving and a focus on strengths. Br. J. Occup. Ther. 2021 , 84 , 263–270. [ Google Scholar ] [ CrossRef ]
Melara, C.A. Factors Influencing the Academic Persistence of College Students with ADHD. Ph.D. Thesis, University of Southern California, Los Angeles, CA, USA, 2012. [ Google Scholar ]
Bartlett, R.; Rowe, T.S.; Shattell, M.M. Perspectives of college students on their childhood ADHD. MCN Am. J. Matern. Child Nurs. 2010 , 35 , 226–231. [ Google Scholar ] [ CrossRef ] [ PubMed ]
Davis-Berman, J.L.; Pestello, F.G. Medicating for ADD/ADHD: Personal and social issues. Int. J. Ment. Health Addict. 2010 , 8 , 482–492. [ Google Scholar ] [ CrossRef ]
Meaux, J.B.; Hester, C.; Smith, B.; Shoptaw, A. Stimulant medications: A trade-off? J. Spec. Ped. Nurs. 2006 , 11 , 214–226. [ Google Scholar ] [ CrossRef ]
Loe, M.; Cuttino, L. Grappling with the medicated self: The case of ADHD college students. Symb. Interact. 2008 , 31 , 303–323. [ Google Scholar ] [ CrossRef ]
Judd, A.D. Function, Visualization, and Mathematical Thinking for College Students with Attention Deficit Hyperactivity Disorder. Ph.D. Thesis, University of Northern Colorado, Denver, CO, USA, 2008. [ Google Scholar ]
Lee, K.S.; Osborne, R.E.; Carpenter, D.N. Testing accommodations for university students with AD/HD: Computerized vs. paper-pencil/regular vs. extended time. J. Educ. Comput. Res. 2010 , 42 , 443–458. [ Google Scholar ] [ CrossRef ]
Hood, M.R. A Phenomenological Study: How College Students with ADHD are Affected by Fragmentation and Dissassociation. Ph.D. Thesis, Concordia University, Portland, OR, USA, 2018. [ Google Scholar ]
Nash-Luckenbach, D. Exploring Learning Style Preferences of College Age Students with Attention Deficit Hyperactive Disorder (ADHD). Ph.D. Thesis, Seton Hall University, South Orange, NJ, USA, 2019. [ Google Scholar ]
Rodriguez, E. Time, Schedules, and the College Student with ADHD. Ph.D. Thesis, Syracuse University, Syracuse, NY, USA, 2020. [ Google Scholar ]
Fox, K.A., Jr. Attention Deficit Hyperactivity Disorder: Perceived Impact on College Students’ Motivation to Learn. Ph.D. Thesis, Grand Canyon University, Phoenix, AZ, USA, 2021. [ Google Scholar ]
Kreider, C.M.; Luna, C.; Lan, M.F.; Wu, C.T. Disability advocacy messaging and conceptual links to underlying disability identity development among college students with learning disabilities and attention disorders. Disabil. Health J. 2020 , 13 , 100827. [ Google Scholar ] [ CrossRef ]
Waite, R.; Tran, M. Explanatory models and help-seeking behavior for Attention-Deficit/Hyperactivity Disorder among a cohort of postsecondary students. Arch. Psychiat. Nurs. 2010 , 24 , 247–259. [ Google Scholar ] [ CrossRef ]
Driggers, J.A.G. Resiliency in Undergraduate College Students Diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). Ph.D. Thesis, Walden University, Saint Paul, MN, USA, 2013. [ Google Scholar ]
Roper, L.G. Self-Advocacy Among College Students with Learning Disabilities and/or Attention-Deficit Hyperactivity Disorders. Ph.D. Thesis, University of Kentucky, Lexington, KY, USA, 2016. [ Google Scholar ]
Webb, K. Self-Efficacy in College Students with Attention Deficit/Hyperactivity Disorder. Ph.D. Thesis, Massachusetts School of Professional Psychology, Boston, MA, USA, 2018. [ Google Scholar ]
Tse, M. Social Skills and Self-Esteem of College Students with ADHD. Ph.D. Thesis, University of Southern California, Los Angeles, CA, USA, 2012. [ Google Scholar ]
Haig, J.D. The Role of Self-Regulation Strategies on Two- and Four-Year College Students with ADHD. Ph.D. Thesis, University of Southern California, Los Angeles, CA, USA, 2012. [ Google Scholar ]

Click here to enlarge figure

The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

Cohen, S.L.; Shavel, K.; Lovett, B.J. College Students with ADHD: A Selective Review of Qualitative Studies. Disabilities 2024 , 4 , 658-677. https://doi.org/10.3390/disabilities4030041

Cohen SL, Shavel K, Lovett BJ. College Students with ADHD: A Selective Review of Qualitative Studies. Disabilities . 2024; 4(3):658-677. https://doi.org/10.3390/disabilities4030041

Cohen, Shira L., Katie Shavel, and Benjamin J. Lovett. 2024. "College Students with ADHD: A Selective Review of Qualitative Studies" Disabilities 4, no. 3: 658-677. https://doi.org/10.3390/disabilities4030041

Article Metrics

Article access statistics, further information, mdpi initiatives, follow mdpi.

Subscribe to receive issue release notifications and newsletters from MDPI journals

Faculty and Disclosures

Disclosure of conflicts of interest, disclosure of unlabeled use.

Attention-deficit Hyperactivity Disorder (ADHD): Two Case Studies

Authors: Authors: Joseph Biederman, MD; Stephen V. Faraone, PhD
THIS ACTIVITY HAS EXPIRED FOR CREDIT

Target Audience and Goal Statement

This activity has been designed to meet the educational needs of pediatricians, family practitioners, child and adolescent psychiatrists, and general psychiatrists involved in the management of patients with ADHD.

Attention-deficit hyperactivity disorder (ADHD) is a chronic condition that affects 8% to 12% of school-aged children and contributes significantly to academic and social impairment. There is currently broad agreement on evidence-based best practices of ADHD identification and diagnosis, therapeutic approach, and monitoring. However, the increasing rate of diagnosis and treatment in the pediatric population has contributed to the significant public debate and misunderstanding of ADHD. Despite increased awareness, Attention-deficit hyperactivity disorder (ADHD) is a chronic condition that affects 8% to 12% of school-aged children and contributes significantly to academic and social impairment. There is currently broad agreement on evidence-based best practices of ADHD identification and diagnosis, therapeutic approach, and monitoring. However, the increasing rate of diagnosis and treatment in the pediatric population has contributed to the significant public debate and misunderstanding of ADHD. Despite increased awareness, ADHD remains underrecognized and may be undertreated by a factor of 10 to 1 in the US population. In order to educate the public and ensure optimal outcomes for ADHD patients, this continuing education activity has been developed to provide physicians and other healthcare providers with the most current information available on assessing and treating ADHD.

Upon completion of this activity, participants should be able to:

Discuss the incidence of ADHD in adolescents and adults.
Identify DSM-IV criteria used to make the diagnosis of ADHD in each age group.
List important comorbidities of ADHD and identify distinguishing features between ADHD and other psychiatric diagnoses with similar manifestations.
Describe a pharmacologic approach to ADHD treatment, including treatment goals and choice of medication.
Enumerate self-management skills to be recommended when coaching ADHD patients on how to get along at school, at work, and at home.

Disclosures

Accreditation statements, for physicians.

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME). The Postgraduate Institute for Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Postgraduate Institute for Medicine designates this educational activity for a maximum of 1.0 Category 1 credit toward the AMA Physician's Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.

Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board. This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. Follow these steps to earn CME/CE credit*:

Read the target audience, learning objectives, and author disclosures.
Study the educational content online or printed out.
Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. In addition, you must complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 5 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage. *The credit that you receive is based on your user profile.

Policy Statement for Documentation of Attention-Deficit/Hyperactivity Disorder in Adolescents and Adults (Revised). Princeton, NJ: Office of Disability Policy, Educational Testing Service; June 1999.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSM-IV). Washington, DC: APA, 2000.
Dulcan MK, Benson RS. AACAP Official Action. Summary of the practice parameters for the assessment and treatment of children, adolescents, and adults with ADHD. J Am Acad Child Adolesc Psychiatry. 1997;36:1311-7.
Elia J, Ambrosini PJ, Rapoport JL. Treatment of attention-deficit-hyperactivity disorder. N Engl J Med. 1999;340:780-8.
Wender PH. Pharmacotherapy of attention-deficit/hyperactivity disorder in adults. J Clin Psychiatry. 1998;59 Suppl 7:76-9.
Wilens TE, Biederman J, Lerner M; et al. Effects of once-daily osmotic-release methylphenidate on blood pressure and heart rate in children with attention-deficit/hyperactivity disorder: results from a one-year follow-up study. J Clin Psychopharmacol. 2004;24:36-41.
Searight HR, Burke JM, Rottnek F. Adult ADHD: evaluation and treatment in family medicine. Am Fam Physician. 2000;62:2077-86, 2091-2.
Biederman J, Faraone SV, Monuteaux MC, et al. Growth deficits and attention-deficit/hyperactivity disorder revisited: Impact of gender, development, and treatment. Pediatrics. 2003;111:1010-6.
Spencer T, Biederman J, Wilens T. Growth deficits in children with attention deficit hyperactivity disorder. Pediatrics. 1998;102:501-6.
Spencer T, Biederman J, Harding M, et al. Growth deficits in ADHD children revisited: evidence for disorder-associated growth delays? J Am Acad Child Adolesc Psychiatry. 1996;35:1460-9.
Hechtman L, Greenfield B. Long-term use of stimulants in children with attention deficit hyperactivity disorder: safety, efficacy, and long-term outcome. Paediatr Drugs. 2003;5:787-94.
Spencer T, Biederman, M, Coffey B, et al. The 4-year course of tic disorders in boys with attention-deficit/hyperactivity disorder. Arch Gen Psychiatry. 1999;56:842-7.
Biederman J, Faraone SV, Spencer T. Pharmacotherapy of attention-deficit/hyperactivity disorder reduces risk for substance use disorder. Pediatrics. 1999;104:e20.
Biederman J, Willens TE, Mick E, et al. Does attention-deficit hyperactivity disorder impact the developmental course of drug and alcohol abuse and dependence? Biol Psychiatry. 1998;44:269-73.
Greene RW, Biederman J, Faraone SV, et al. Adolescent outcome of boys with attention-deficit/hyperactivity disorder and social disability: results from a 4-year longitudinal follow-up study. J Consult Clin Psychol. 1997;65:758-67.
Wilens TE, Biederman J, Mick E, et al. Attention deficit hyperactivity disorder (ADHD) is associated with early onset substance use disorders. J Nerv Ment Dis. 1997 Aug;185:475-82.
Clure C, Brady KT, Saladin ME, et al. Attention-deficit/hyperactivity disorder and substance use: symptom pattern and drug choice. Am J Drug Alcohol Abuse. 1999;25:441-8.
Faraone SV, Biederman J, Mick E. The age-dependent decline of attention deficit/hyperactivity disorder: a meta-analysis of follow-up studies. Psychological Medicine. In press.
Kessler RC, Adler L, Barkley R, et al. The prevalence and correlates of adult ADHD in the United States: results from the national comorbidity survey replication. Am J Psychiatry. In press.
Biederman J, Faraone SV, Mick E, et al. Clinical correlates of ADHD in females: findings from a large group of girls ascertained from pediatric and psychiatric referral sources. J Am Acad Child Adolesc Psychiatry. 1999;38:966-75.
Weiss G, Hechtman L. Adult hyperactive subjects' view of their treatment in childhood and adolescence. In: G. Weiss and L. Hechtman, eds. Hyperactive Children Grown Up: ADHD in Children, Adolescents, and Adulthood, 2nd ed. New York, NY: The Guilford Press; 1993.
Mannuzza S, Klein RG, Bessler A, et al. Adult outcome of hyperactive boys: educational achievement, occupational rank, and psychiatric status. Arch Gen Psychiatry. 1993;50:565-76.
Biederman J. Impact of Comorbidity in Adults with ADHD. J Clin Psychiatry. 2004(Suppl 3);65:3-7.
Murphy K, Barkley RA. Attention deficit hyperactivity disorder adults: comorbidities and adaptive impairments. Compr Psychiatry. 1996;37:393-401.
Biederman J, Faraone SV, Spencer T, et al. Patterns of psychiatric comorbidity, cognition, and psychosocial functioning in adults with attention deficit hyperactivity disorder. Am J Psychiatry. 1993;150:1792-8.
Shekim WO, Asarnow RF, Hess E, et al. A clinical and demographic profile of a sample of adults with attention deficit hyperactivity disorder, residual state. Compr Psychiatry. 1990;31:416-25.
Hornig M. Addressing comorbidity in adults with attention-deficit/hyperactivity disorder. J Clin Psychiatry. 1998;59:769-75.
Angold A, Costello EJ, Erkanli A. Comorbidity. J Child Psychol Psychiatry. 1999;40:57-87.
Pliszka SR, Carlson CL, Swanson JM. ADHD With Comorbid Disorders: Clinical Assessment and Management. New York, NY: The Guilford Press; 1999.

An ADHD diagnosis in adulthood comes with challenges and benefits

For adults, undiagnosed ADHD symptoms can lead to chronic stress and low self-esteem

Vol. 54 No. 2 Print version: page 52

Perception and Attention

adult woman outside leaning on a wood fence

When Terry Matlen, a clinical social worker, was in her 40s, she was diagnosed with ADHD. “My entire life, there was something off,” Matlen said. This included significant anxiety as well as academic and behavioral issues, all of which started at a young age. Although Matlen was initially quite skeptical of her diagnosis, going so far as to seek out a second and third opinion, she eventually came to accept that she had ADHD.

“This makes sense now. I can’t concentrate; I can’t finish projects; my house is a disaster; I can’t get dinner on the table,” Matlen said. “Anxiety doesn’t explain the extent of my disorganization.”

Matlen was diagnosed in the mid-1990s, when many specialists still didn’t understand what ADHD looked like in either girls or adults. Matlen didn’t look like the stereotypical little boy who couldn’t sit still. Although she struggled a lot with her symptoms, which included being unable to pay attention in class or stay organized, no one recognized that the underlying issue was undiagnosed ADHD.

ADHD has three subtypes, which include hyperactive impulsive, primarily inattentive, and combined. With inattentive type, the restlessness is internal. “A lot of kids with inattentive ADHD get overlooked,” said Peter Jaksa, PhD, a psychologist who specializes in treating ADHD. “The behavioral problems get more attention.” For many with inattentive ADHD, they are the ones daydreaming in class rather than paying attention. However, since they aren’t being disruptive, their symptoms can easily go unnoticed.

This is especially true with women and girls, as ADHD is more often diagnosed and treated in males than females, due to differences in how symptoms look ( Skogli, E. W., et al., BMC Psychiatry , Vol. 13, 2013 ). As a number of studies show, untreated ADHD leads to adverse effects on long-term academic performance ( Arnold, L. E., et al., Journal of Attention Disorders , Vol. 24, No. 1, 2015 ). In addition, a number of studies show that those with untreated ADHD fare worse than those with treated ADHD or no ADHD ( Harpin, V., et al., Journal of Attention Disorders , Vol. 20, No. 4, 2013 ).

The process of diagnosing adults

For symptoms to be considered ADHD, they must have started before the age of 12. This makes diagnosing adults more complicated, as the process requires creating a timeline of when symptoms first appeared. In addition to talking with his patient, Jaksa finds that it can be helpful to look at old report cards, where comments such as “Struggles to pay attention during class,” “Often forgets homework at home,” or “Isn’t living up to potential” can help give him a sense of when symptoms started appearing.

“We have a much longer history to look at,” he said. “The best diagnostic indicator for ADHD is not test scores; it’s history.” For the diagnostic process, Jaksa conducts a very structured interview—one that delves into their social, emotional, and academic history. If possible, he interviews a family member who can provide perspective on childhood behaviors.

Jaksa said adults often have comorbidities, such as anxiety and depression. With these comorbidities, untreated ADHD can either cause them or make them worse. “When ADHD is not diagnosed—when it’s not treated effectively—over time, chronic stress and frustration lead to anxiety,” Jaksa said. “This has a very negative impact on self-esteem. It’s very common to see adults with ADHD grow up with a strong sense of underachievement.” Continually hearing messages like “try harder” or “you should be doing better,” can get internalized and lead to anxiety and/or depression, Jaksa said.

In some patients, providers may recognize signs right away, such as tardiness, forgetting valuable personal items, or fidgeting while in the waiting room. Although no one symptom can be definitive, all of this added up can paint a picture of what the symptoms look like, how long they have been going on, and the degree of functional impairment. “My mind is shifting constantly,” said Lisa Green, an oncology nurse who was diagnosed with ADHD in her 40s.

It also helps the diagnosis if there is a family history of ADHD, as it is a highly heritable disorder. For Matlen, the process of seeking a diagnosis for her younger daughter was when she realized that she also had the disorder. “It’s pretty well established that ADHD is about 70% to 80% heritable,” said Eugene Arnold, a professor emeritus at The Ohio State University whose research focuses on ADHD.

Difficulties with diagnosing

One of the challenging aspects of diagnosing an adult is the presence of other comorbidities, some of which can mimic ADHD symptoms. These comorbidities can either be due to a separate disorder or be caused by the ADHD. For many people with ADHD, Matlen included, the lack of early treatment, combined with symptoms of ADHD, can lead to developing mood disorders such as anxiety and depression. If their underlying ADHD is not diagnosed and treated, treatment for their other comorbidities is often ineffective. ( Ginsberg, Y., et al., Primary Care Companion for CNS Disorders , Vol. 16, No. 3, 2014 ). “My anxiety is triggered a lot by being disorganized, by not being prepared, by being constantly overwhelmed,” Matlen said.

There’s also an overlap between ADHD and autism spectrum disorder (ASD). “About half of people with autism also have ADHD,” Arnold said. With ADHD being more common than ASD, the reverse is not true—with a lower proportion of people with ADHD also having ASD.

Jon Stevens, MD, a psychiatrist based in Houston, compares the onset of symptoms as being like layers of an onion: The deepest layer is developmental disorders, such as autism; the second deepest layer is ADHD, for which the symptoms can be observed quite early, followed by mood disorders such as anxiety and depression, which can develop as early as middle or high school. Finally, the outermost layer is schizophrenia and bipolar disorder, which tend to emerge during college years or a little later.

“These conditions, in my experience, develop inside out,” Stevens said. Symptoms of developmental disorders such as autism show up the earliest, while ADHD symptoms will show up a little later. Some of the more noticeable symptoms, such as hyperactivity, parents will start noticing early on, while other symptoms, such as inattentiveness, will start becoming more noticeable once children start school.

Another major difference is the persistence of symptoms. “If you think about anxiety and depression, those disorders and the symptoms that flow from them, tend to be more situational and more cyclic,” said Will Canu, PhD, a professor of psychology at Appalachian State University. With a disorder like ADHD, the symptoms are always there, with the caveat that they can be exacerbated under certain conditions, such as during times of stress or from anxiety or depression.

The effect of Covid -19 on adults with ADHD

The Covid -19 pandemic was particularly hard on those with ADHD because of the disruption in routine. Routines are important for people with ADHD, as they can help with executive functioning issues, such as staying organized and staying on track. However, developing and maintaining these routines is harder, which means that major changes in working and home life have been particularly hard to navigate.

[ Related: Helping adults and children with ADHD in a pandemic world ]

In Stevens’ clinical practice, he has seen patients cope with stress from the pandemic in a number of ways. For adults who were actively receiving treatment, the shift to working from home offered some benefits. “Provided they kept taking their medication, they generally fared well,” he said. “A lot of my patients found [working from home] more helpful, because there were fewer distractions of the water cooler chatter or someone coming to your cubicle.” The big exception was if patients started self-medicating with alcohol or other substances.

Constant upheaval, combined with childcare disruptions, created extremely difficult conditions for women with undiagnosed ADHD and young children, Canu said. In addition to major disruptions in routines, the unpredictability of school and daycare closures has been particularly challenging for parents with young children.

The advantage of diagnosis and treatment

For many patients whose symptoms were overlooked during their early years, diagnosis can be both life changing, and bittersweet. In a 2020 study, researchers compared 444 adults with diagnosed ADHD with 1,055 adults who exhibited symptoms but had no formal diagnosis. After matching for age and gender, those with a diagnosis reported a higher quality of life, which included metrics for work productivity, self-esteem, and functional performance ( Pawaskar, M., et al., Journal of Attention Disorders , Vol. 24, No. 1, 2020 ).

Canu said being diagnosed helps people understand themselves better, which includes gaining perspective on the reasons for some of their struggles. “That can change the way they feel about themselves, which can cascade into a lot of positive things,” Canu said.

Treatments include behavioral strategies for managing their symptoms, for which working with an expert, such as a psychologist who is experienced in treating patients with ADHD, can be invaluable. This includes cognitive behavioral therapy for ADHD, which focuses on managing executive functioning difficulties such as time management, organizational skills, impulse control, and emotional self-regulation.

When necessary, medication can also help manage symptoms. For psychologists who do not have prescribing privileges, this can mean working in concert with integrated care teams, primary-care providers, or psychiatrists. For many patients, their most effective treatment regimen is a combination of behavioral strategies and medication. “With that in place, if it’s effective, they’re able to function better,” Canu said.

In a 2014 study, 250 previously nonmedicated adults who received the ADHD medication methylphenidate for the first time were followed for a full year, with those patients who either couldn’t tolerate or didn’t experience relief in symptoms switched to either an alternate stimulant medication or the nonstimulant medication atomoxetine. Compared with their peers who discontinued medication, those who were still on medication had reduced severity of symptoms ( Fredriksen, M., et al., European Neuropsychopharmacology , Vol. 24, No. 12, 2014 ). “Medication slows me down enough to breathe and to think,” Green said.

Dealing with late-life diagnosis

Receiving a diagnosis as an adult can often bring up some complicated emotions, whether it’s grief over lost opportunities, relief at finally understanding certain struggles, or anger over symptoms having been overlooked for so long. For Matlen, she felt an overwhelming sense of relief. “There was a concrete explanation,” she said.

For others, receiving a diagnosis later in life can lead to regrets about lost opportunities, whether it was failing out of school, struggling to establish a career, or experiencing relationship issues because of their ADHD symptoms going overlooked and untreated. “There is a lot of grief work that needs to be done to help work through the many years of struggling and not knowing why,” Matlen said. However, in her experience, “Once all those parts and pieces are looked at with this new understanding, people really take off, in a good way,” she said. Often, therapy is an important component of thriving after a diagnosis.

For Matlen, in addition to gaining a better understanding of why she was struggling so much, receiving a diagnosis and treatment changed her entire life. It ended up being the missing piece that helped ease her anxiety. Once she had a diagnosis and started treatment, her issues with anxiety started improving in a way that years of therapy and antianxiety medication had never been able to accomplish.

Given how life-changing her diagnosis was, combined with the lack of information and resources available, especially for women, Matlen ultimately made a career switch, combining her own experience of growing up with undiagnosed ADHD with her background as a clinical social worker. She went on to write the books The Queen of Distraction and Survival Tips for Women With AD/HD . She also founded a Facebook group for women with ADHD, which now has over 36,000 members, and she often consults with specialists on the realities of living with ADHD.

Now, almost 30 years after her initial diagnosis, Matlen still hasn’t seen nearly as much progress in the field as she had hoped, especially for girls and women. “I see the same stories even now,” she said.

Speaking of Psychology

Subscribe to APA’s audio podcast series highlighting some of the most important and relevant psychological research being conducted today.

Subscribe to Speaking of Psychology and download via:

Contact APA

Adult attention-deficit Hyperactivity disorder: From clinical reality toward conceptual clarity

Jyoti prakash.

Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India

K. Chatterjee

1 Private Consultant Psychiatrist, Sr Lecturer UQ School of Medicine and Griffith University School of Medicine, Australia

K. Srivastava

2 Department of Clinical Psychologist, Armed Forces Medical College, Pune, Maharashtra, India

V. S. Chauhan

There is ambiguity about the clinical picture and concept of attention-deficit hyperactivity disorder (ADHD) in adults. Relevant literature was extracted from various search engines, analyzed, and interpreted. Available literature suggests a significant prevalence of ADHD in the adult population affecting the quality of socio-occupational functioning. Inattentiveness was more commonly present than hyperactivity–impulsivity. Frequent comorbidities with other psychiatric disorders like anxiety disorders and substance use disorders were noted. Pharmacological management and psychotherapy have been found effective in its management. ADHD is a disorder across the lifespan and fairly prevalent among adults. Greater awareness and more research are required for a better understanding of Adult ADHD and its effective management.

Etiological and clinic-phenomenological paradigms in psychiatry have been changing, with newer scientific revelations and clinical consensus. The paradigm shift in attention-deficit hyperactivity disorder (ADHD) appears to have been swifter than the others. From a relatively uncommon hyperkinetic reaction and a disorder of children, it has come a long way to now be seen as a widely prevalent, significantly comorbid, highly heritable disorder across the entire lifespan. Here, we follow its evolution as a clinical entity, review concerns which led researchers to a wider exploration of the construct, and the evolving treatment guidelines.

REVISITING ATTENTION-DEFICIT HYPERACTIVITY DISORDER: EVOLUTION OF THE CONSTRUCT

Early in the 20 th century, ADHD was described as an abnormal defect in moral control of children.[ 1 ] Subsequent research characterized ADHD as stemming from minimal brain dysfunction, leading to qualitative changes in the behavior of children.[ 2 ] DSM II in 1968, gave it nosological legitimacy as “Hyperkinetic reaction of childhood.”[ 3 ] As late as DSM IV, ADHD was described as a disorder diagnosed in infancy, childhood, or adolescence.[ 1 ] Subsequent research led DSM V describing ADHD as a disorder across the lifespan.[ 4 ] From there arose the term Adult ADHD, which clinicians are still uncomfortable or unfamiliar with. Till DSM IV-TR, ADHD was recognized as a triad of symptom-clusters of inattention, hyperactivity, and impulsivity, with onset before 7 years of age and causing impairment in social, academic, and occupation functioning. The subtypes were predominantly inattentive, predominantly hyperactive–impulsive, and combined type.[ 5 ]

DISQUIET WITH THE EXISTING PARADIGM

Clinicians and researchers noticed that many patients with ADHD carried symptoms over into adulthood, which affected their socio-occupational functioning adversely. Cherkasova et al . described that 60% of the children with ADHD continued to be symptomatic into adulthood.[ 6 ] Researchers found the prevalence of ADHD in adults to be 4.4%–5.2% in the age group of 18–44 years and 2.8%–3.5% in older adults.[ 7 , 8 , 9 , 10 ] Das et al . found the prevalence of Adult ADHD to be 2.2% in the age group of 68–74 years in comparison to 6.2% in the age group of 48%–52%.[ 11 ] Kessler reported that 45.7% of children who had ADHD continued to meet the criteria in their adulthood, with 94.9% of them having the inattention symptom cluster and 34.6% having the hyperactivity–impulsivity symptom cluster.[ 12 ] Decadal trend in a cohort study reported that the prevalence of Adult ADHD in the general population has risen from 0.43% in 2007 to 0.96% in 2016, and incidence rose from 9.43 per 100,000 person-year in 2007 to 13.49 per 100,000 person-year.[ 13 ] A ten-country study of ADHD among adult population showed the mean prevalence of Adult ADHD to be 3.5%, ranging from 0.9% in Lebanon to 6.3% in France.[ 14 ]

Causes of concern:

Increasing prevalence: Adult ADHD appears to be fairly prevalent in the general population (2.5%–5%) and is progressively increasing over the years[ 8 , 10 , 15 , 16 ]
Underdiagnosed entity: Being a poorly understood and hardly explored by clinicians; many individuals with adult ADHD remain undiagnosed and continue to experience suffering. Studies have indicated that <20% of ADHD in adults is diagnosed or treated.[ 10 , 17 , 18 ] About 17%–22% of adults reporting to psychiatric services reporting for other mental conditions have been found to have ADHD[ 19 , 20 , 21 ]
High comorbidity: ADHD in adults is significantly comorbid with other psychiatric and medical conditions, which may lead to masking of either of the illnesses or adverse implications on the course of illness and treatment outcomes. Some studies have found comorbidity to be as high as 90% in Adult ADHD.[ 22 ] Common psychiatric comorbidities are depression, substance use disorders, generalized anxiety disorder, social phobia, specific phobia, panic disorder, bipolar disorder, dysthymia, obsessive-compulsive disorder, intermittent explosive disorder, and eating disorders. Among personality disorders, borderline, histrionic, narcissistic, and antisocial personality disorders are commonly comorbid. In the arena of medical comorbidities, hypertension, type II diabetes, obesity, asthma, and migraine are common.[ 8 , 19 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ] The presence of ADHD as a comorbid condition often adversely affects the course and outcome of these illnesses by way of early onset, increased severity, prolonged duration, increased complications, and chronicity or relapses.[ 38 , 39 , 40 , 41 , 42 ] However, studies do suggest that timely appraisal and management of ADHD has affected the course and outcome of comorbid illness favorably[ 9 ]
Socio-occupational dysfunction: Presence of ADHD in an adult, with or without comorbidity, can lead to significant socio-occupational dysfunction. It has been seen that adults with ADHD have lower educational attainment, inability to gain or maintain employment, and lesser productivity owing to poor management of time, procrastination, distraction, or absenteeism.[ 43 ] An adult with ADHD is at an increased risk of colliding, over-speeding, violating traffic rules, and risk-taking behavior while driving.[ 44 , 45 ] When Adult ADHD is comorbid with substance use disorder or antisocial personality disorder, increased criminality or problems with the law have been noted[ 46 ]
High heritability: ADHD in adults has been found to have high heritability ranging from 75% to 91%.[ 8 , 47 ] There is a 25.6% greater risk in parents, of children with ADHD, and 20.8% greater risk in a sibling.[ 47 ]

ADULT ATTENTION-DEFICIT HYPERACTIVITY DISORDER: THE CURRENT CONSTRUCT

Studies have shown ADHD in adults to differ from ADHD in children, in some aspects. It has been observed that, with increasing age, inattentiveness tends to persist and has considerably lesser reduction than the hyperactivity–impulsivity symptom cluster.[ 2 ] Inattention was clinically manifest as paying less attention to detail or being unable to manage time effectively. Hyperactivity was manifest as not being able to sit through meetings or frequent changes in jobs. Inattentiveness was seen as interrupting people, readiness to anger, and frequent job turnover.[ 46 , 47 , 48 , 49 , 50 ] In addition, adults with ADHD have difficulty in modulating emotional responses, which may manifest as mood instability or liability.[ 8 ] Many of these individuals choose an organized spouse, select work of less potential or rigorously structure their schedule to cope better. These may mask the diagnosis, thus highlighting the importance of eliciting these compensatory behaviors in psychosocial history.[ 48 , 51 ]

DSM V has modified the criteria to include older adolescents and adults in the ambit of ADHD, giving it a lifespan perspective. It has increased the age of onset from “before 7 years of age” to “before 12 years of age;” has lowered the required number of criteria from “6 out of 9” to “5 out of 9” for patients of age 17 and older; converted “evidence of impairment” to “evidence of symptoms in more than two settings;” and removed autistic spectrum disorder from the exclusion criteria.[ 4 ]

ADULT-ONSET OR CHILDHOOD-ONSET ADULT ATTENTION-DEFICIT HYPERACTIVITY DISORDER: THE DEBATE

Although most research finds a considerable amount of Childhood ADHD continuing to adulthood; there is some research which suggests the onset of ADHD in adults, without any evidence of its presence in childhood. Pelota's birth cohort study found that only 17% of childhood ADHD continued into adulthood and only 13% of young adults had onset of their ADHD in childhood.[ 52 ] The New Zealand longitudinal cohort study indicated that 90% of adults with ADHD have no history of ADHD in their childhood and 85% of childhood ADHD did not extend into adulthood. The study contemplated the condition representing two almost nonoverlapping groups.[ 53 ] E-risk longitudinal twin study found that two-third of ADHD patients diagnosed at 18 years of age did not have ADHD in their early childhood. Studies found adult-onset ADHD to have female preponderance, in comparison to equivocal preponderance in childhood-onset Adult ADHD.[ 54 ] The current research has failed to reach a consensus on regarding this variability in presentation across the lifespan. Evidence-based research is likely to provide greater clarity in future.

Both screening and diagnostic instruments are available for the assessment of Adult ADHD. As a large number of individuals with Adult ADHD remain undiagnosed, the need for screening and training of primary-care physicians in identification, early intervention, and timely referral to mental health professionals cannot be overemphasized.

Available screening and diagnostic instruments are as brought out in Table 1 .[ 12 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 ] More robust clinician-friendly tools, with higher specificity and validity, need to be scoped through a better understanding of the Adult ADHD construct across various phenomenological domains. False positivity in diagnosis remains a difficulty encountered by busy clinicians, which possibly leads to therapeutic nihilism from less than optimistic treatment outcomes.

Instruments of assessment of adult attention-deficit hyperactivity disorder

Name of instruments	Type of instrument	Characteristics
Kooij screening questions[ ]	Screening	4 questions
ASRS[ ]	Screening	WHO compiled
		18 items
		6 item version available
		Specificity 96%
		Sensitivity 91.4%
WURS[ ]	Screening	25 Items Scale
		Sensitivity 96%
		Specificity 96%
		Assesses ADHD and associated symptoms such as mood
		Provides retrospective account of childhood ADHD
		Often used in conjunction with ASRS
Conners Adult ADHD Rating Scale[ ]	Screening	Sensitivity >90%
		Specificity >90%
		Overall discriminant validity was 69%
Adult ADHD Investigator Rating Scale[ ]	Screening	18 item semi structured interview
DIVA 2.0[ ]	Diagnostic	Sensitivity - 90%
		Specificity - 83.3%
ACE+[ ]	Diagnostic	Semi structured interview
		Comprehensive interview for ADHD and co existing conditions
CAADID[ ]	Diagnostic	Structured interview
		Good reliability and validity
Adult ADHD Clinical Diagnostic Scale[ ]	Diagnostic	Semi structured interview

ADHD – Attention deficit hyperactivity disorder; ASRS – ADHD Self-Report Scale; CAADID – Conners adult ADHD diagnostic interview of DSM IV; ACE+ – ADHD child evaluation+; WURS – Wender Utah Rating Scale; DIVA – Diagnostic instruments of adult ADHD

For the management of Adult ADHD, the major considerations which need to be addressed are the comorbidities, which are quite common. In addition, the treatment of ADHD has significant ramifications on the comorbid illness as well.[ 63 ]

Disorder-specific approach primarily includes pharmacological intervention. The commonly used medication groups are stimulants with which up to 75% immediate improvement has been noted. These medications are however avoided in patients with comorbid substance abuse or recent-onset tics or seizures.[ 64 , 65 ] Nonstimulant medication takes longer for optimum effect.[ 64 , 65 , 66 ] Various medication used for Adult ADHD is as brought out in Table 2 .

Medications for adult attention-deficit hyperactivity disorder

Medication	Types of formulations	Dosage
Stimulants
Methylphenidate	Immediate release/short acting Sustained release/intermediate acting Extended release/long acting (pills/capsule) MPH patch	0.3-1.5 mg/kg/day Maximum 108 mg/day
Dextroamphetamine	Immediate release Sustained release Extended release (pills/capsules)	0.3-1.5 mg/kg Maximum 60 mg/day 20-60 mg/day
Nonstimulants
Atomoxetine	Capsules	0.5-1.2 mg/kg/day Maximum 100 mg/day
Bupropion	Plain and extended release tablets	150-300 mg/day Maximum 450 mg/day
Desipramine	Tablet	1.5 mg/kg/day Maximum 300 mg/day
Clonidine	Plain and extended release tablets	0.1-0.3 mg/day
Guanfacine	Plain and extended release tablets	1-7 mg/day
Modafinil	Tablet	200 mg/day

ADHD – Attention deficit hyperactivity disorder; MPH – Methylphenidate

Many nonpharmacological methods have been found useful. Recommended available methods are as per Table 3 .

Psychotherapy and other intervention in adult attention deficit hyperactivity disorder

Intervention	Salient features
Cognitive retraining[ ]	Effect size was larger for inattention and impulsivity domains than for hyperactivity
Brain stimulation techniques[ ]	Preliminary evidence is promising for transcranial magnetic stimulation and direct current stimulation; but needs replication
Psychotherapy[ , ]	Cognitive behavior therapy has been found to be an useful adjunct to pharmacotherapy
Yoga; meditation and mindfulness-based therapy[ ]	They have been found useful; but have not been replicated adequately
Nature therapy[ ]	Green outdoor activities had more significantly reduction in symptoms than other settings
Nutritional supplements[ ]	Fish oil; zinc; iron; and magnesium and complex carbohydrates; can improve brain function and reduce mood swings
Exercise[ ]	Improves executive functions
ADHD coach[ ]	Addresses unique challenges with the condition and helps acquisition of skills to overcome these
Neurobiofeedback[ ]	Being used in some setups with significant benefits. Reseach evidence inadequate

ADHD – Attention-deficit hyperactivity disorder

Growing evidence from research has shown a large number of cases of ADHD among the adult population, which are comorbid with psychiatric illnesses, affecting their course and outcome. The phenomenology of Adult ADHD reflects greater attentional impairment than involvement of the hyperactivity–impulsive symptom cluster. Adult ADHD can significantly affect the quality of socio-occupational functioning. Better awareness of this entity, its timely identification and effective management, will significantly impact those suffering from Adult ADHD, as well as the comorbidities. The debate regarding childhood versus adult onset of Adult ADHD remains to be clarified through further research.

Financial support and sponsorship

Conflicts of interest.

There are no conflicts of interest.

IMAGES

case study child with adhd
ADHD report case study
Case Study Children With Adhd
(PDF) Understanding and Management of Attention Deficit Hyperactivity
adhd child case study slideshare
Inclusion Case Study: ADHD

VIDEO

The Teen Years with ADHD: A Practical, Proactive Parent’s Guide with Thomas E. Brown, Ph.D
Case Study: ADHD
Tips to Regain Focus and Increase Productivity
Takeda Attention on ADHD: Case Study Video (Jenny)
Case study on ADHD (attention deficiat hyperactive disorder) // psychiatric nursing
Adhd Music

COMMENTS

PDF Case Study 1
Case Study 1 - JackC. se Study 1 - Jack Jack is a 7 year old male Grade 1 student who lives in Toron. o with his parents. He is the only child to two parents, both of whom have completed post. graduate education. There is an extended family history of Attention Deficit/Hyperactivity Disorder (ADHD), mental health concerns as well as.
A Case Study in Attention-Deficit/Hyperactivity Disorder: An Innovative
The use of neurofeedback in interventions for ADHD began in 1973, although the first study with positive results was published in 1976 . Since then, various studies have reported benefits from using neurofeedback in infants, with improvements in behavior, attention, and impulsivity control (e.g., [18,19,20,21,22]).
Patient Case #1: 19-Year-Old Male With ADHD
OK, let's move on to the case presentation. This first patient is a 19-year-old male, who presented to his psychiatrist after being referred by his primary care provider, PCP for ADHD consultation, during the interview, he noted he was a sophomore in college and is taking 17 credits. This semester chief complaint includes a lack of ability to ...
ADHD Case Study: Real-Life Insights & Treatments
His case study reveals the unique challenges of adult ADHD in professional settings and the effectiveness of workplace accommodations, such as flexible schedules and task management tools. John's experience underscores the importance of mastering life with ADHD in professional contexts. Case 2: ADHD in a Gifted Child.
Case Report: Treatment of a Comorbid Attention Deficit Hyperactivity
Most of these studies were performed in child and adolescent populations, and as far as we know, only one was conducted in an adult population . Some of the case reports described obsessive-compulsive symptoms as a side effect of MPH treatment in patients with ADHD (12-14, 29-32).
The lived experiences of adults with attention-deficit/hyperactivity
Studies reporting original peer-reviewed qualitative data on the lived experience of adults with ADHD, including mixed-methods studies, were eligible for inclusion. "Adult" was defined as being 18 years of age or older; studies that included adolescent and young adult participants were only included if results were reported separately by age.
Attention deficit/hyperactivity disorder in adults: A case study
Attention deficit/hyperactivity disorder in adults: A case study. Keith O. Plowden, PhD, PMHNP-BC, CARN-AP, ... Use of drugs for ADHD among adults—A multinational study among 15.8 million adults in the Nordic countries. European Journal of Clinical Pharmacology. 2016; 72:1507-1514. Crossref. Scopus (45)
Adult Attention Deficit-Hyperactivity Disorder
ADHD was initially considered to be solely a childhood disorder, and the diagnosis of adult ADHD 2 was controversial. 3 However, long-term follow-up studies revealed that in 40 to 60% of children ...
Attention Deficit Hyperactivity Disorder (ADHD): A Case Study and
The male to female ratio of ADHD is 4:1. This chapter on ADHD provides a wide perspective on understanding, diagnosis and treatment for ADHD. It relies on a neurodevelopmental perspective of ADHD. Signs and symptoms of ADHD are described through the DSM-V criteria. A...
Attention-deficit Hyperactivity Disorder (ADHD): Two Case Studies
Despite increased awareness, Attention-deficit hyperactivity disorder (ADHD) is a chronic condition that affects 8% to 12% of school-aged children and contributes significantly to academic and social impairment. There is currently broad agreement on evidence-based best practices of ADHD identification and diagnosis, therapeutic approach, and ...
Attention deficit/hyperactivity disorder in adults: A case study
Characteristics of ADHD seen in children tend to persist into adulthood, but they are often overlooked. This means the prevalence might be higher in adults than reported (Katzman, Bilkey, Chokka, Fallu, & Klassen, 2017). Studies have shown that characteristics seen in children change when individuals enter their late teens or early adulthood.
Attention deficit/hyperactivity disorder in adults: A case study
In adult ADHD, the symptoms may be comorbid or mimic other conditions making diagnosis and treatment difficult. Adults with ADHD require an in-depth assessment for proper diagnosis and treatment. The presentation and treatment of adults with ADHD can be complex and often requires interdisciplinary care.
Attention deficit/hyperactivity disorder in adults: A case study
ADHD can result in profound impairments in cognitive and social functioning. For example, impaired short-term memory was higher in college students with ADHD (Dudukovic, Gottshall, Cavanaugh, & Moody, 2014); adults with ADHD are more likely to procrastinate in ... Attention deficit/hyperactivity disorder in adults: A case study ...
Clinician's guide to adult ADHD comorbidities: Case studies
There is a need for a clear and concise approach to a complex disorder such as attention deficit hyperactivity disorder (ADHD). Understanding the diagnosis and management of ADHD is incomplete without understanding comorbidities and how to manage them. This guide uses a case-based approach to explain how to diagnose and manage ADHD in presence of comorbid disorders. Despite the complexity of ...
Females with ADHD: An expert consensus statement taking a lifespan
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 .
Cognitive-Behavioral Therapy for Adult ADHD: A Case Study of Multi
Second, we discuss a case study to exemplify how clinicians can measure and track EF symptoms in a clinic setting using a multi-method approach. Self-report and collateral-report questionnaire data provided initial support for adaptation of Cognitive-Behavioral Therapy for Adult ADHD: Targeting Executive Dysfunction to an individual format.
College Students with ADHD: A Selective Review of Qualitative Studies
Denson's qualitative case study of eight students with ADHD transitioning to college involved two interviews: one at the beginning of the college transition, focused on high school preparation, and another towards the end of the first year, about the college experience. Students looked forward to the increased independence but had room to ...
Attention-deficit Hyperactivity Disorder (ADHD): Two Case Studies
Despite increased awareness, Attention-deficit hyperactivity disorder (ADHD) is a chronic condition that affects 8% to 12% of school-aged children and contributes significantly to academic and social impairment. There is currently broad agreement on evidence-based best practices of ADHD identification and diagnosis, therapeutic approach, and ...
An ADHD diagnosis in adulthood comes with challenges and benefits
In a 2020 study, researchers compared 444 adults with diagnosed ADHD with 1,055 adults who exhibited symptoms but had no formal diagnosis. After matching for age and gender, those with a diagnosis reported a higher quality of life, which included metrics for work productivity, self-esteem, and functional performance ( Pawaskar, M., et al ...
Adult attention-deficit Hyperactivity disorder: From clinical reality
The New Zealand longitudinal cohort study indicated that 90% of adults with ADHD have no history of ADHD in their childhood and 85% of childhood ADHD did not extend into adulthood. The study contemplated the condition representing two almost nonoverlapping groups. E-risk longitudinal twin study found that two-third of ADHD patients diagnosed at ...
A review on ADHD disorder, diagnosis and therapeutic approach in
The diagnosis of ADHD is based on a scale used in a clinical manner. The symptoms of patient severity impairment, possible co-morbidity, family history, and their psychological condition during the patient and parent interview [Citation 6].The clinician also observed interaction between parent and child to observe the behaviors of the patient, as well as his medical and neurological condition ...
Attention deficit/hyperactivity disorder in adults: A case study
Characteristics of ADHD seen in children tend to persist into adulthood, but they are often overlooked. This means the prevalence might be higher in adults than reported (Katzman, Bilkey, Chokka, Fallu, & Klassen, 2017). Studies have shown that characteristics seen in children change when individuals enter their late teens or early adulthood.
High level of immunoglobulin G targeting mycoplasma or cytomegalovirus
We conducted a case-control study comparing 1679 newborns later being diagnosed with ADHD without comorbid ASD with 2948 controls that at the age of 10 did not have a diagnosis with ADHD nor ASD. All serology data was first log-transformed to approximate normal distribution and subsequently plate normalized using Z-transformation (mean centered ...

Patient Case #1: 19-Year-Old Male With ADHD

EP: 1 . Prevalence of Adult ADHD

EP: 3 . Diagnosing Adults With ADHD Based on Patient Presentation

EP: 4 . Unmet Needs in the Treatment of Adult ADHD

EP: 5 . Efficacy and Safety of Treatment Options Utilized in Adult ADHD

EP: 8 . Patient Case #1: Prompting an ADHD Consultation

ADHD Case Study: Unveiling Real-Life Experiences and Treatment Approaches

Understanding ADHD Through Case Studies

Case Study on ADHD: The Story of Sarah

ADHD Case Study Examples: Diverse Presentations

Analyzing Treatment Approaches in ADHD Case Studies

Lessons Learned from ADHD Case Studies

Similar Posts

Understanding the Default Mode Network in ADHD: Implications for Diagnosis and Treatment

Is ADHD Testing Covered by Insurance? A Comprehensive Guide to Coverage and Costs

UF ADHD Testing: A Comprehensive Guide to Diagnosis and Support at the University of Florida

ADHD Computer Tests: A Comprehensive Guide to Digital Assessments for Adults

Understanding ADHD Testing: Duration, Process, and What to Expect

QB Test for ADHD: A Comprehensive Guide with Examples

Leave a Reply Cancel reply

Attention Deficit Hyperactivity Disorder (ADHD): A Case Study and Exploration of Causes and Interventions

Cite this chapter

Access this chapter

Similar content being viewed by others

Psychological Treatments in Adult ADHD: A Systematic Review

Attention-Deficit Hyperactivity Disorder

ADHD and Its Therapeutics

Author information

Editor information

Rights and permissions

Copyright information

About this chapter

Download citation

Share this chapter

Save citation to file

Add to My Bibliography

Attention deficit/hyperactivity disorder in adults: A case study

Similar articles

Related information

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

Conclusions

Results and consensus outcome

ADHD symptoms

Associated features, functional problems and impairments

Triggers for referral

Rating Scales

The clinical interview

Objective assessments

Interventions and Treatments

Pharmacological management

Non-pharmacological management

Primary age

Secondary age

Multi-agency liaison

Educational considerations and adjustments

Occupational considerations and adjustments

Health and social care

Criminal justice system

Availability of data and materials

Abbreviations

Acknowledgements

Author information

Contributions

Corresponding author

Ethics declarations

Consent for publication

Competing interests

Additional information

Rights and permissions

About this article

Share this article

BMC Psychiatry

Information

Initiatives

Article Menu

JSmol Viewer

1. Introduction

Share and Cite

Article Metrics

Faculty and Disclosures