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The persistent disparity between male and female diagnosis and treatment of ADHD was once viewed as a neurobiological propensity for males to have ADHD. However, contemporary research suggests that this observation is actually related to a lack of recognition and referral bias when evaluating female patients for ADHD. 

This consensus statement, published in BMC Psychiatry, sought to improve our understanding of ADHD in girls and women and better support ADHD diagnosis and treatment for these long-overlooked demographics.

One critical point of this paper was that while most of the psychiatric literature supports using the same diagnostic criteria for females and males, the criteria were designed using predominantly male samples. In actuality, signs and symptoms of ADHD often present less severely in females, likely due to social conditioning and socially adaptive behavior. 

Notably, it has been found that when presenting teachers with vignettes of ADHD in children, changing the pronouns from male to female led to lower diagnostic recognition and referral. This finding implies that even if signs and symptoms of ADHD present the same in females and males, a referral bias still exists.

It was also noted that, especially among females, signs and symptoms of ADHD might not become noticeable until later in life when the individual is faced with periods of major social or educational transition. As a result, signs and symptoms that may have been masked or self-managed often expose themselves in adolescence or early adulthood. This finding is important for providers to note, as it often prompts a woman’s decision to seek psychiatric services for ADHD symptoms.

Lastly, women with ADHD are unique from men with ADHD in their psychiatric comorbidities. As opposed to the antisocial behaviors commonly comorbid in men with ADHD, women with ADHD frequently experience internalizing comorbid psychiatric disorders such as anxiety, depression, self-harm, substance abuse, and disordered eating.

The researchers concluded that the key to ensuring women equitable referral and treatment for ADHD is to bring awareness to the ADHD gender bias and gender differences in ADHD presentation. ADHD stereotypes and stigmas persist, even among clinicians. Overcoming these biases can help alleviate ADHD diagnosis and treatment disparities [1].

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[1] 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., . . . 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). https://doi.org/10.1186/s12888-020-02707-9

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