Examining the differences between men and women with attention deficit hyperactivity disorder

In this blog, Tamara Williams, a Research Assistant, discusses her recently published systematic review paper looking at which symptoms differ between girls and women and boys and men with attention deficit hyperactivity disorder (ADHD). She also shares her area of interest and the next steps in her research journey.

Improving earlier and timelier diagnosis of ADHD

Hello, I’m Tamara Williams, a Research Assistant working in the Division of Psychological Medicine and Clinical Neurosciences at Cardiff University. My role is funded by a Health and Care Research Wales grant and aims to improve knowledge, awareness and diagnosis of ADHD in young people, particularly girls.

My role is exciting – I get to be involved in the planning, setting up and conducting of interesting research projects. It has also given me the opportunity to write and publish research papers on the results of these projects.

My main area of interest is ADHD, and how we can improve our knowledge about it to help aid clinical practice and policy.

An important step towards improving earlier and timelier diagnosis is getting a better understanding of what ADHD looks like in girls and women, and boys and men, to identify specific markers of ADHD in girls and women. However, there has been little research looking at this, with the focus instead on examining differences in total symptoms.

My first research paper looks at differences in ADHD symptoms between genders

I have recently had my first ever paper published: ‘An item-level systematic review of the presentation of ADHD in females’.

I am extremely proud of the paper as it is the first review paper to systematically look at item-level differences in ADHD symptoms between girls and women, and boys and men. ADHD is often diagnosed earlier, and more frequently, in boys and men compared to girls and women.

Previous studies looking at whether there are differences in ADHD in girls versus boys or women versus men have mainly looked at total number of ADHD symptoms (18 symptoms), and not at the individual nine inattentive and nine hyperactive-impulsive symptoms.

In our review paper, we wanted to determine if there were any differences in specific ADHD symptoms. Our aim was to see if there any symptoms that are especially important to the presentation of ADHD in girls and women.

To do this, we searched six research databases for previously published studies. We focused on studies that included results of specific ADHD symptoms, and how ADHD impacts on daily life. The comparisons we were interested in were girls and boys with ADHD, women and men with ADHD and females with versus females without ADHD.

We found 13 relevant studies, though only six of these compared ADHD symptoms in girls and women versus boys and men. The results showed that in childhood, girls with ADHD are more likely to display certain inattentive symptoms, for example ‘fails to sustain attention in tasks’.

On the other hand, boys with ADHD were more likely to display eight out of the nine hyperactive-impulsive symptoms, all except ‘talks excessively’ which showed no difference.

In adulthood, women with ADHD were more likely than men to report experiencing the symptoms ‘easily distracted’, ‘difficulty organising tasks’, ‘blurts out answers’ and ‘talks excessively’. Also, when looking at the impact of ADHD, girls and women were more likely than boys and men to experience impact from ADHD in their home life.

In summary, we conducted a study that suggests that girls and women with ADHD may present with a slightly different symptom profile than boys and men with ADHD.

The main limitation of our research is that only 13 studies provided information on specific symptoms and difficulties. Future research should examine in more detail what symptoms are most relevant to girls and women with ADHD, to help earlier recognition and diagnosis of ADHD.

Further research aims to help shape a new gender-inclusive ADHD assessment tool

Now that this paper is published, our next step is to finalise two ongoing qualitative research studies that aim to better understand female ADHD in childhood. In these studies, we spoke to young women and non-binary adults with ADHD, parents and carers, and healthcare and educational professionals who work with individuals with ADHD.

All this work will feed into the development of a new gender-inclusive ADHD assessment tool, that aims to identify children who may benefit from ADHD assessment, at an earlier age.

Related to this, I am extremely interested in masking, which is consciously or unconsciously suppressing ADHD symptoms to appear more neurotypical), as it may be a factor in delayed diagnosis, particularly in girls and young women.

My interest in masking has stemmed from the results of the research from the Health and Care Research Wales grant and speaking to young people with lived experiences of ADHD, who have stressed the importance of masking for their experience of ADHD.

Learn more

If you are interested in reading more about ADHD, I have also written a blog post for the National Centre for Mental Health (NCMH) with Isabella Barclay, a PhD student, debunking common myths and misconceptions around ADHD.