ADHD in girls.
5 May 2020
A well-established feature of ADHD is the large sex difference in referral and diagnostic rates.

Population-based data reveal that the male: female sex ratio for ADHD in childhood approximates 3:1.

This gender-related disparity presumably results from, among other factors, males' greater genetic vulnerability as well as their propensity to respond negatively to a number of early life stressors.

This difference highlights the possibility that ADHD may be underdiagnosed in girls in clinical practice.

A common explanation for the observed sex differences in referral and diagnosis is that girls with ADHD are more likely to present with predominantly inattentive symptoms, rather than the more potentially disruptive hyperactive/impulsive symptoms, as well as greater levels of internalizing symptoms such as anxiety and depression which might lead to alternative diagnoses.

In contrast, boys with ADHD are often characterized as presenting with more hyperactivity/impulsivity, and co-occurring behavioral problems such as oppositional defiant and conduct disorder.

It has also been shown that proportionally more boys than girls with ADHD annoy or upset their teachers and that parents see the 'feminine' ADHD diagnostic items as less problematic than the 'masculine' ones.

In sum, girls with ADHD often show a difficult developmental course. The risk for self-injury — intensified by the presence of early maltreatment and mediated, during adolescence, by comorbidities, deficits in response inhibition, and maladaptive peer relationships — is substantial.

Persisting academic and vocational problems, as well as a strong likelihood of unplanned pregnancy, are other core outcomes.

Mowlem, F., Agnew-Blais, J., Taylor, E., & Asherson, P. (2018). Do different factors influence whether girls versus boys meet ADHD diagnostic criteria? Sex differences among children with high ADHD symptoms. Psychiatry Research. doi:10.1016/j.psychres.2018.12.128
Hinshaw, S. P. (2018). Attention Deficit Hyperactivity Disorder (ADHD): Controversy, Developmental Mechanisms, and Multiple Levels of Analysis. Annual Review of Clinical Psychology, 14(1), 291–316. doi:10.1146/annurev-clinpsy-050817-084917

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