Debunking ADHD Stereotypes: It’s Not Just a Boy Thing

By Jessica Flannery, PhD

Adult ADHD in Women

woman looking up and thinking while holding her laptop in one hand and coffee in other hand

For many years, ADHD has been seen as primarily affecting boys and men

However, current research suggests a more complex picture. While the stereotype of a hyperactive young boy persists, we now understand ADHD is not bound by sex or gender. Below we’ll explore the evolving understanding on the prevalence of ADHD.

Prevalence Across Age

So, is ADHD more common in men than women? Turns out, the answer might depend on the age group being assessed. As researchers dig more into the reasons for the discrepancy in rates of ADHD between men and women, they are learning that ADHD in women is more common than we previously believed. In childhood, there is a significantly higher proportion of boys that are diagnosed than girls, anywhere from 1.5-2.5 times higher prevalence in childhood and adolescence (Hinshaw et al., 2022), but these rates become more similar across men and women by mid-adulthood (Kok et al., 2020).

4 Reasons Prevalence Rates Change for Women Across Age

  1. Less disruptive presentations during school-age years

    Girls are more likely to present with symptoms of ADHD that are less “visible” or disruptive to their environment in school-aged years, contributing to fewer evaluations or diagnoses resulting in an ADHD diagnosis (Young et al., 2020).

  2. Hormonal differences across development for males and women

    One hypothesis for higher rates of ADHD in boys is that the onset of ADHD symptoms may be later for girls. One study found girls show an increase in hyperactivity and impulsivity symptoms during puberty (Murray et al., 2019), potentially associated with the significant hormonal changes that occur during this time.

  3. Adults can report their own symptoms

    More similar rates of ADHD for men and women in adulthood may also be due to adults reporting their own symptoms. For example, studies suggest that parent and teacher reports of ADHD ratings are more likely to over-rate boy symptoms of ADHD and under-rate girl symptoms of ADHD (Mowlem et al., 2019). As women get older, they can self-evaluate and present to clinics for evaluation.

  4. Change in symptom impairment

    Inattentive symptoms of ADHD persist into adulthood, whereas hyperactivity symptoms are thought to decrease with age. Given the sex and gender differences in hyperactive/impulsive symptoms, on average men experience fewer symptoms of ADHD with age, but the symptoms persist for women (Hinshaw et al., 2022). In other words, rates of ADHD are more likely to decrease for men than women in adulthood (Hinshaw et al., 2022; Young et al., 2020).

    In order to better understand the true prevalence rates between men and women across age, it requires a more accurate assessment of ADHD symptoms for women across the lifespan. Gender norms and expectations have often influenced how ADHD symptoms are perceived, diagnosed, and even displayed (Young et al., 2020). It’s essential to acknowledge and challenge these gender biases to ensure that everyone, regardless of sex or gender, receives the appropriate evaluation and treatment they need. In the quest for more accurate ADHD diagnoses, there’s a growing emphasis on gender-sensitive or gender-neutral diagnostic criteria (Hinshaw et al., 2022).The goal is to recognize the diversity of ADHD presentations and ensure that diagnosis and treatment are tailored to the unique needs of each person.

Note, while this article predominantly discusses differences in terms of men and women, it is important to note that there are both sex and gender influences on ADHD presentation. Scientific papers vary on which term they use.

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References

  1. Hinshaw, S. P., Nguyen, P. T., O'Grady, S. M., & Rosenthal, E. A. (2022). Annual Research Review: Attention-deficit/hyperactivity disorder in girls and women: underrepresentation, longitudinal processes, and key directions. Journal of child psychology and psychiatry, and allied disciplines, 63(4), 484–496. https://doi.org/10.1111/jcpp.13480
  2. Mowlem, F. D., Rosenqvist, M. A., Martin, J., Lichtenstein, P., Asherson, P., & Larsson, H. (2019). Sex differences in predicting ADHD clinical diagnosis and pharmacological treatment. European child & adolescent psychiatry, 28(4), 481–489. https://doi.org/10.1007/s00787-018-1211-3
  3. Murray, A. L., Booth, T., Eisner, M., Auyeung, B., Murray, G., & Ribeaud, D. (2019). Sex differences in ADHD trajectories across childhood and adolescence. Developmental science, 22(1), e12721. https://doi.org/10.1111/desc.12721
  4. Kok, F. M., Groen, Y., Fuermaier, A. B. M., & Tucha, O. (2020). The female side of pharmacotherapy for ADHD-A systematic literature review. PloS one, 15(9), e0239257. https://doi.org/10.1371/journal.pone.0239257
  5. Young, S., Adamo, N., Ásgeirsdóttir, B. B., Branney, P., Beckett, M., Colley, W., Cubbin, S., Deeley, Q., Farrag, E., Gudjonsson, G., Hill, P., Hollingdale, J., Kilic, O., Lloyd, T., Mason, P., Paliokosta, E., Perecherla, S., Sedgwick, J., Skirrow, C., Tierney, K., … Woodhouse, E. (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. BMC psychiatry, 20(1), 404. https://doi.org/10.1186/s12888-020-02707-9