This narrative review covered research on ADHD in girls and women, from childhood to adulthood. The authors do not say how studies were chosen. Key groups included referred children aged 6 to 17 in mostly White hospital studies, and a diverse Berkeley group of girls with ADHD followed from ages 6 to 12 into their twenties.
Boys are diagnosed more often than girls in childhood (2 to 2.5 times as often). By adulthood the gap is much smaller. Girls and women more often show inattention and inward problems. Boys and men show more hyperactive and impulsive behavior. Clinicians may miss symptoms in females because they are less obvious and often masked by coping strategies.
The authors concluded that females with ADHD have serious impairments, with a heightened risk of problems in close relationships and of self-harm. In the Berkeley group, by early adulthood, 22% of girls with the combined type of ADHD and 8% with the inattentive type had attempted suicide, compared with 6% of a matched comparison group of girls. Moderate to severe self-harm without suicidal intent was also more common (51% and 29%, compared with 19%). Most girls in each group had not attempted suicide. These are rates in one research group, not a prediction for any one person, and help is available. If you're in crisis in the US, call or text 988.
Unplanned pregnancy was also more common with ADHD (43%, compared with 11% of the comparison group). In the hospital follow-up, half or fewer girls still met full criteria as young adults. Most still had raised symptoms and daily problems (over two-thirds).
Treatment response did not clearly differ by sex. But female samples in most studies were too small to test this. The authors suggest thorough evaluation covering related emotional, behavior and learning issues, subtle inattention, coping strategies, life transitions and developmental history, as matters to raise with a qualified clinician.
Source: Hinshaw S, Nguyen P, O’Grady S, et al.. Annual Research Review: Attention‐deficit/hyperactivity disorder in girls and women: underrepresentation, longitudinal processes, and key directions. Journal of Child Psychology and Psychiatry (2021). doi:10.1111/jcpp.13480