Miss. Diagnosis: A Systematic Review of ADHD in Adult Women

“Using techniques of thematic analysis (Braun & Clarke, 2006), eight articles were reviewed.”

“A flow chart created by Preferred Reporting Items for Systematic Reviews (PRISMA; Moher et al., 2009) was used to visually track the number of articles at each step in the review process (see Figure 1).”

“Relationships with others are an important part of life; high quality close relationships and feeling socially connected to those in one’s life have been associated with decreased mortality and disease morbidity (Holt-Lunstad et al., 2017).”

“, 2020), impacting 2% to 6% of the global population (Song et al., 2021).”

“Women with ADHD are also at a higher risk of engaging in risky sexual behavior, unplanned pregnancy, and are more likely to be coerced into having sex than women without ADHD (Young et al., 2020).”

“Mowlem et al. (2018) found that females referred for and diagnosed with ADHD exhibited symptoms that were a significant deviation from their typical behaviors, suggesting that females may have a slightly higher threshold for symptom severity for referral and diagnosis.”

“Assigning meaning to diagnosis can affect hope and self-esteem (Yanos et al., 2010), while receiving a diagnosis provides an individual with a model in which to compare themselves and can help them to form their identity.”

“Hartung and Widiger (1998) examined 243 empirical studies published in the Journal of Abnormal Child Psychology over the 6-year period between publication of the Diagnostic and Statistical Manual of Mental Disorders (DSM) DSM-III-R (1987) and the publication of the DSM-IV (1994).”

“…include differences in symptom presentation, decreased self-esteem, more difficulty in peer relationships, increased likelihood of anxiety and other affective disorders, the development of coping strategies that mask symptoms of ADHD, and gender based societal expectations (Quinn & Madhoo, 2014).”

“Women are more likely to present with inattentive symptoms than hyperactive symptoms, which may be less easily noticed and less likely to trigger a referral for diagnosis (Williamson & Johnston, 2015).”

“Rucklidge and Tannock (2001) found that when comparing females with ADHD to males with ADHD, females were more psychosocially impaired than males.”

“Quinn (2005) found that 14% of girls with ADHD were prescribed antidepressants before being treated for ADHD compared to only 5% of boys.”

“Theme 3: Lack of Control Feeling a sense of control is integral for wellbeing and life satisfaction and has been found to be a protective factor for mental health outcomes (Keeton et al., 2008).”

“This inaccurate diagnosis may be due to diagnostic criteria being developed primarily on the behavioral presentation of males (Green et al., 2019).”

“Biederman et al. (2006) stress the importance of early intervention and prevention strategies for girls with ADHD considering the high morbidity associated with ADHD in females found in their study.”

“For example, Faraone et al. (2004) conducted a medical review of adults with ADHD and reported that only 25% of adult ADHD cases were diagnosed in childhood or adolescence.”

“Many women seeking treatment for mood and emotional problems may have unrecognized ADHD (Quinn, 2008).”

“When Fuller-Thomson et al. (2016) compared women aged 20 to 39 years with ADHD to women without ADHD, they found that the women with ADHD had twice the prevalence of substance abuse, current smoking, depressive disorders, severe poverty, and childhood physical abuse as well as triple the prevalence…”

“Robison et al. (2008) looked at gender differences in ADHD symptoms, psychological functioning, physical symptoms, and treatment response.”

“Ohan and Visser (2009) asked parent and teacher participants to read a vignette describing a child displaying symptoms of ADHD.”

“Diagnosis can help an individual make sense of their past and relieve uncertainty (Schmitz et al., 2003).”

“Women in these studies often turned to recreational drugs, alcohol, nicotine, and sex to self-medicate for symptoms of undiagnosed ADHD (Bartlett et al., 2005; Pinkhardt et al., 2009; Rucklidge, 1997; Stenner et al., 2019).”

“Lynch and Davison (2022) found that teachers and clinicians struggled to identify symptoms of potential ADHD in young women.”

“Research has consistently shown that females are underdiagnosed in childhood (Mowlem et al., 2018; Quinn, 2004; Waite, 2010); however, there is little research looking at the impact of this underdiagnosis.”

“Early intervention can reduce academic and professional underachievement, relationship difficulties, and psychiatric comorbidities (Sassi, 2010).”

“Results may indicate the development of maladaptive behaviors to cope with undiagnosed ADHD (Bartlett et al., 2005; Pinkhardt et al., 2009; Stenner et al., 2019).”

“In girls, on the other hand, internalized symptoms; more inwardness, shyness, and inattention are observed (Attoe and Climie, 2023).”

“Furthermore, girls may be more likely, than males, to be misdiagnosed or have a late diagnosis because of the co-occurrence with mental health conditions such as depression and anxiety which are often treated fi rst (Attoe & Climie, 2023; Young et al., 2020).”

“Tourette syndrome (TS) is the most severe form of TD. Specifically, TS can be defined as a chronic NDD that typically begins in childhood and is characterized by motor and phonic tics, which can significantly reduce the quality of life of affected individuals [208,209].”

“…as dyslexia, Attention De fi cit Hyperactivity Disorder (ADHD), and autism, and the application of these classi fi cation labels across varying contexts has shown a marked rise on a global scale, notable within the adult population (Attoe & Climie, 2023; Werkhoven et al., 2022; Wissell et al., 2021).”