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Cited by 264Attention Deficit Hyperactivity DisorderDevelopmental and Educational NeuropsychologyAutism Spectrum Disorder Research

A Review of Attention-Deficit/Hyperactivity Disorder in Women and Girls: Uncovering This Hidden Diagnosis

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Quinn, Patricia O., Madhoo, Manisha·2014·The Primary Care Companion For CNS Disorders
DOI 10.4088/pcc.13r01596PMC PMC4195638
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Abstract

OBJECTIVE: To describe the clinical presentation of attention-deficit/hyperactivity disorder (ADHD) in women and girls and factors influencing proper diagnosis and treatment. DATA SOURCES: A PubMed search was conducted in April 9, 2012 for English-language publications from the previous 10 years. Search terms included attention deficit hyperactivity disorder, attention deficit/hyperactivity disorder, ADHD, and AD/HD combined with gender, girls, females, women, continuity, discontinuity, gap, treatment, untreated, and lack of treatment. STUDY SELECTION/DATA EXTRACTION: A total of 41 articles were reviewed for relevance. Reference lists from relevant articles were reviewed for additional publications; sources known to the authors were also included. RESULTS: Attitudes about ADHD among individuals with ADHD and knowledgeable informants (families, teachers, colleagues) vary on the basis of the diagnosed individual's gender. The ADHD prevalence rates are higher among boys than girls. A low index of clinical suspicion exists for girls; their presentation is considered "subthreshold" because inattentiveness is more prominent than hyperactivity/impulsivity. Females with ADHD may develop better coping strategies than males to mask their symptoms. Lastly, anxiety and depression, common comorbidities in female patients with ADHD, can lead to missed or misdiagnosis. If not properly diagnosed and treated, girls with ADHD experience the same negative consequences as boys, including poor academic performance and behavioral problems. Unique issues related to hormonal effects on ADHD expression and treatment response are also experienced by women and girls. CONCLUSIONS: Accurate ADHD diagnosis in women and girls requires establishing a symptom history and an understanding of its gender-specific presentation. Coexisting anxiety and depression are prominent in female patients with ADHD; satisfactory academic achievement should not rule out an ADHD diagnosis.

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  • Adults with ADHD can internalize relational difficulties and attribute them to personal failure and fundamental inadequacy.

    “Over time, adults with ADHD can internalize these relational difficulties and attribute them to personal failure and fundamental inadequacy (Quinn and Madhoo 2014).”

    From “I Felt Like a Burden”: An Exploration Into the Experience of Romantic Relationships for People With ADHD (2026) · cites this paper as Quinn and Madhoo 2014

    The section “Self-Esteem and Peer Relationships in Women and Girls With ADHD” reports interpersonal difficulties and a negative self-image among women with ADHD, with poorer self-esteem potentially persisting into adulthood. It does not say that adults attribute relational difficulties to personal failure or fundamental inadequacy, and its discussion is focused on women and girls rather than adults with ADHD generally. Page numbers are unavailable in our copy. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • There is a dire need for female-specific treatment options for ADHD expressed by many, including patients.

    “We developed this female-specific treatment option in response to the dire need expressed by many [1,17,19,23,24,25,26,28,41,55,85], including patients.”

    From A Female-Specific Treatment Group for ADHD—Description of the Programme and Qualitative Analysis of First Experiences (2024) · cites this paper as [24]

    The Abstract and Conclusions (pages not supplied) describe underdiagnosis and undertreatment of women and girls with ADHD and call for better recognition and care. The METHOD section also suggests that medication may need adjustment across the menstrual cycle. The review does not report that many people, including patients, expressed a dire need for female-specific treatment options. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • ADHD is underdiagnosed in women and girls due to a higher prevalence of internalizing symptoms compared to men and boys.

    “It has been widely documented that it is underdiagnosed in women and girls due to a more prevalence of internalizing symptoms (i.e. low self-esteem, inattention) compared to men and boys. 95”

    From Factors associated with gender and sex differences in anxiety prevalence and comorbidity: A systematic review (2022) · cites this paper as [95]

  • Men with ADHD demonstrate higher rates of substance use and externalizing behaviors.

    “In contrast, men demonstrate higher rates of substance use and externalizing behaviors [123,124].”

    From ADHD in Adulthood: Clinical Presentation, Comorbidities, and Treatment Perspectives (2025) · cites this paper as [124]

  • The narrative review also identified people with ADHD at risk of not being diagnosed, particularly women and girls.

    “The narrative review also identified people with ADHD at risk of not being diagnosed, particularly women and girls (Hinshaw et al., 2022; Quinn and Madhoo, 2014).”

    From The Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder (2023) · cites this paper as Quinn and Madhoo, 2014

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References 59 · Cited by 264

Research works printed but not linked: 53

  1. [1]Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. Washington, DC: American Psychiatric Association; 2013. American Psychiatric Association. Attention-deficit/hyperactivity disorder; pp. 59–61. [Google Scholar]
  2. [3]Novik TS, Hervas A, Ralston SJ, et al. Influence of gender on attention-deficit/hyperactivity disorder in Europe–ADORE. Eur Child Adolesc Psychiatry. 2006;(suppl 1):115–m. doi: 10.1007/s00787-006-1003-z. [DOI] [PubMed] [Google Scholar] · DOI
  3. [4]Kessler RC, Adler L, Barkley R, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006;163(4):716–723. doi: 10.1176/appi.ajp.163.4.716. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI · Paper page
  4. [5]Grevet EH, Bau CH, Salgado CA, et al. Lack of gender effects on subtype outcomes in adults with attention-deficit/hyperactivity disorder: support for the validity of subtypes. Eur Arch Psychiatry Clin Neurosci. 2006;256(5):311–319. doi: 10.1007/s00406-006-0639-5. [DOI] [PubMed] [Google Scholar] · DOI
  5. [6]Castle L, Aubert RE, Verbrugge RR, et al. Trends in medication treatment for ADHD. J Atten Disord. 2007;10(4):335–342. doi: 10.1177/1087054707299597. [DOI] [PubMed] [Google Scholar] · DOI
  6. [7]Gershon J. A. meta-analytic review of gender differences in ADHD. J Atten Disord. 2002;5(3):143–154. doi: 10.1177/108705470200500302. [DOI] [PubMed] [Google Scholar] · DOI · Paper page
  7. [9]Hinshaw SP. Preadolescent girls with attention-deficit/hyperactivity disorder, 1: background characteristics, comorbidity, cognitive and social functioning, and parenting practices. J Consult Clin Psychol. 2002;70(5):1086–1098. doi: 10.1037//0022-006x.70.5.1086. [DOI] [PubMed] [Google Scholar] · DOI
  8. [11]Coles EK, Slavec J, Bernstein M, et al. Exploring the gender gap in referrals for children with ADHD and other disruptive behavior disorders. J Atten Disord. 2012;16(2):101–108. doi: 10.1177/1087054710381481. [DOI] [PubMed] [Google Scholar] · DOI
  9. [12]Ohan JL, Visser TA. Why is there a gender gap in children presenting for attention-deficit/hyperactivity disorder services? J Clin Child Adolesc Psychol. 2009;38(5):650–660. doi: 10.1080/15374410903103627. [DOI] [PubMed] [Google Scholar] · DOI
  10. [13]Ohan JL, Johnston C. Positive illusions of social competence in girls with and without ADHD. J Abnorm Child Psychol. 2011;39(4):527–539. doi: 10.1007/s10802-010-9484-0. [DOI] [PubMed] [Google Scholar] · DOI
  11. [15]Biederman J, Faraone SV, Monuteaux MC, et al. Gender effects on attention-deficit/hyperactivity disorder in adults, revisited. Biol Psychiatry. 2004;55(7):692–700. doi: 10.1016/j.biopsych.2003.12.003. [DOI] [PubMed] [Google Scholar] · DOI · Paper page
  12. [16]Biederman J, Petty CR, O’Connor KB, et al. Predictors of persistence in girls with attention-deficit/hyperactivity disorder: results from an 11-year controlled follow-up study. Acta Psychiatr Scand. 2012;125(2):147–156. doi: 10.1111/j.1600-0447.2011.01797.x. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI · Paper page
  13. [17]Wilens TE, Biederman J, Faraone SV, et al. Presenting ADHD symptoms, subtypes, and comorbid disorders in clinically referred adults with ADHD. J Clin Psychiatry. 2009;70(11):1557–1562. doi: 10.4088/JCP.08m04785pur. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI · Paper page
  14. [18]Quinn PO, Nadeau KG, Littman EB. Understanding Girls With AD/HD. Silver Spring, MD: Advantage Books; 1999. [Google Scholar]
  15. [19]Quinn P. 100 Questions & Answers About Attention Deficit Hyperactivity Disorder (ADHD) in Women and Girls. Burlington, MA: Jones & Bartlett Learning; 2010. [Google Scholar]
  16. [20]Quinn P, Wigal S. Perceptions of girls and ADHD: results from a national survey. MedGenMed. 2004;6(2):2. [PMC free article] [PubMed] [Google Scholar]
  17. [21]Arcia E, Conners CK. Gender differences in ADHD? J Dev Behav Pediatr. 1998;19(2):77–83. doi: 10.1097/00004703-199804000-00003. [DOI] [PubMed] [Google Scholar] · DOI
  18. [22]Ek U, Westerlund J, Holmberg K, et al. Self-esteem in children with attention and/or learning deficits: the importance of gender. Acta Paediatr. 2008;97(8):1125–1130. doi: 10.1111/j.1651-2227.2008.00894.x. [DOI] [PubMed] [Google Scholar] · DOI
  19. [23]Rucklidge JJ, Tannock R. Psychiatric, psychosocial, and cognitive functioning of female adolescents with ADHD. J Am Acad Child Adolesc Psychiatry. 2001;40(5):530–540. doi: 10.1097/00004583-200105000-00012. [DOI] [PubMed] [Google Scholar] · DOI · Paper page
  20. [24]Blachman DR, Hinshaw SP. Patterns of friendship among girls with and without attention-deficit/hyperactivity disorder. J Abnorm Child Psychol. 2002;30(6):625–640. doi: 10.1023/a:1020815814973. [DOI] [PubMed] [Google Scholar] · DOI
  21. [25]Mikami AY, Lorenzi J. Gender and conduct problems predict peer functioning among children with attention-deficit/hyperactivity disorder. J Clin Child Adolesc Psychol. 2011;40(5):777–786. doi: 10.1080/15374416.2011.597089. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  22. [26]American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Text Revision. Fourth Edition. Washington, DC: American Psychiatric Association; 2000. [Google Scholar]
  23. [27]Elkins IJ, Malone S, Keyes M, et al. The impact of attention-deficit/hyperactivity disorder on preadolescent adjustment may be greater for girls than for boys. J Clin Child Adolesc Psychol. 2011;40(4):532–545. doi: 10.1080/15374416.2011.581621. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  24. [29]Fedele DA, Lefler EK, Hartung CM, et al. Sex differences in the manifestation of ADHD in emerging adults. J Atten Disord. 2012;16(2):109–117. doi: 10.1177/1087054710374596. [DOI] [PubMed] [Google Scholar] · DOI
  25. [30]DuPaul GJ, Power TJ, Anastopoulos AD, et al. ADHD Rating Scale-IV: Checklists, Norms, and Clinical Interpretation. New York, NY: Guilford Press; 1998. [Google Scholar]
  26. [31]Ohan JL, Johnston C. Gender appropriateness of symptom criteria for attention-deficit/hyperactivity disorder, oppositional-defiant disorder, and conduct disorder. Child Psychiatry Hum Dev. 2005;35(4):359–381. doi: 10.1007/s10578-005-2694-y. [DOI] [PubMed] [Google Scholar] · DOI
  27. [32]Rucklidge JJ, Kaplan BJ. Psychological functioning of women identified in adulthood with attention-deficit/hyperactivity disorder. J Atten Disord. 1997;2(3):167–176. [Google Scholar]
  28. [33]Diamantopoulou S, Rydell AM, Thorell LB, et al. Impact of executive functioning and symptoms of attention-deficit/hyperactivity disorder on children’s peer relations and school performance. Dev Neuropsychol. 2007;32(1):521–542. doi: 10.1080/87565640701360981. [DOI] [PubMed] [Google Scholar] · DOI
  29. [34]Young S, Heptinstall E, Sonuga-Barke EJ, et al. The adolescent outcome of hyperactive girls: self-report of psychosocial status. J Child Psychol Psychiatry. 2005;46(3):255–262. doi: 10.1111/j.1469-7610.2004.00350.x. [DOI] [PubMed] [Google Scholar] · DOI
  30. [35]Thurber JR, Heller TL, Hinshaw SP. The social behaviors and peer expectation of girls with attention deficit hyperactivity disorder and comparison girls. J Clin Child Adolesc Psychol. 2002;31(4):443–452. doi: 10.1207/S15374424JCCP3104_4. [DOI] [PubMed] [Google Scholar] · DOI
  31. [36]Greene RW, Biederman J, Faraone SV, et al. Social impairment in girls with ADHD: patterns, gender comparisons, and correlates. J Am Acad Child Adolesc Psychiatry. 2001;40(6):704–710. doi: 10.1097/00004583-200106000-00016. [DOI] [PubMed] [Google Scholar] · DOI
  32. [37]Nadeau KG, Quinn PO. Rethinking DSM-IV. In: Nadeau KG, Quinn PO, editors. Understanding Women with ADHD. Silver Spring, MD: Advantage Books; 2002. pp. 2–19. [Google Scholar]
  33. [38]Nadeau KG, Quinn PO. Gender and history of ADHD: an unexamined gender bias. In: Quinn PO, Nadeau KG, editors. Gender Issues and ADHD: Research, Diagnosis, and Treatment. Silver Spring, MD: Advantage Books; 2002. pp. 2–19. [Google Scholar]
  34. [40]Waite R. Women and attention deficit disorders: a great burden overlooked. J Am Acad Nurse Pract. 2007;19(3):116–125. doi: 10.1111/j.1745-7599.2006.00203.x. [DOI] [PubMed] [Google Scholar] · DOI · Paper page
  35. [45]Babinski DE, Pelham WE, Jr, Molina BS, et al. Late adolescent and young adult outcomes of girls diagnosed with ADHD in childhood: an exploratory investigation. J Atten Disord. 2011;15(3):204–214. doi: 10.1177/1087054710361586. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  36. [46]Huggins SP, Rooney ME, Chronis-Tuscano A. Risky sexual behavior among college students with ADHD: is the mother-child relationship protective [published online ahead of print October 9, 2012]? J Atten Disord. 2012 doi: 10.1177/1087054712459560. [DOI] [PubMed] [Google Scholar] · DOI
  37. [47]Hosain GM, Berenson AB, Tennen H, et al. Attention-deficit/hyperactivity symptoms and risky sexual behavior in young adult women. J Womens Health (Larchmt) 2012;21(4):463–468. doi: 10.1089/jwh.2011.2825. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI · Paper page
  38. [48]Lehti V, Niemelä S, Heinze M, et al. Childhood predictors of becoming a teenage mother among Finnish girls. Acta Obstet Gynecol Scand. 2012;91(11):1319–1325. doi: 10.1111/j.1600-0412.2012.01517.x. [DOI] [PubMed] [Google Scholar] · DOI
  39. [49]Küppers E, Ivanova T, Karolczak M, et al. Estrogen: a multifunctional messenger to nigrostriatal dopaminergic neurons. J Neurocytol. 2000;29(5–6):375–385. doi: 10.1023/a:1007165307652. [DOI] [PubMed] [Google Scholar] · DOI
  40. [51]Dreher JC, Schmidt PJ, Kohn P, et al. Menstrual cycle phase modulates reward-related neural function in women. Proc Natl Acad Sci U S A. 2007;104(7):2465–2470. doi: 10.1073/pnas.0605569104. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI · Paper page
  41. [52]Riccardi P, Zald D, Li R, et al. Sex differences in amphetamine-induced displacement of [(18)F]fallypride in striatal and extrastriatal regions: a PET study. Am J Psychiatry. 2006;163(9):1639–1641. doi: 10.1176/ajp.2006.163.9.1639. [DOI] [PubMed] [Google Scholar] · DOI
  42. [53]Justice AJ, de Wit H. Acute effects of d-amphetamine during the follicular and luteal phases of the menstrual cycle in women. Psychopharmacology (Berl) 1999;145(1):67–75. doi: 10.1007/s002130051033. [DOI] [PubMed] [Google Scholar] · DOI · Paper page
  43. [55]Justice AJ, de Wit H. Acute effects of estradiol pretreatment on the response to d-amphetamine in women. Neuroendocrinology. 2000;71(1):51–59. doi: 10.1159/000054520. [DOI] [PubMed] [Google Scholar] · DOI
  44. [56]Alvarez-Pedrerol M, Ribas-Fitó N, Torrent M, et al. TSH concentration within the normal range is associated with cognitive function and ADHD symptoms in healthy preschoolers. Clin Endocrinol (Oxf) 2007;66(6):890–898. doi: 10.1111/j.1365-2265.2007.02871.x. [DOI] [PubMed] [Google Scholar] · DOI
  45. [57]Vanderpump MP, Tunbridge WM, French JM, et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham survey. Clin Endocrinol (Oxf) 1995;43(1):55–68. doi: 10.1111/j.1365-2265.1995.tb01894.x. [DOI] [PubMed] [Google Scholar] · DOI · Paper page
  46. [58]Argumedo GS, Sanz CR, Olguín HJ. Experimental models of developmental hypothyroidism. Horm Metab Res. 2012;44(2):79–85. doi: 10.1055/s-0031-1297941. [DOI] [PubMed] [Google Scholar] · DOI
  47. [59]Weiss RE, Tunca H, Knapple WL, et al. Phenotype differences of resistance to thyroid hormone in two unrelated families with an identical mutation in the thyroid hormone receptor beta gene (R320C) Thyroid. 1997;7(1):35–38. doi: 10.1089/thy.1997.7.35. [DOI] [PubMed] [Google Scholar] · DOI
  48. [60]Rucklidge J, Brown D, Crawford S, et al. Attributional styles and psychosocial functioning of adults with ADHD: practice issues and gender differences. J Atten Disord. 2007;10(3):288–298. doi: 10.1177/1087054706289942. [DOI] [PubMed] [Google Scholar] · DOI
  49. [61]Retz-Junginger P, Rösler M, Jacob C, et al. Gender differences in self- and investigator-rated psychopathology in adult attention-deficit/hyperactivity disorder. Atten Defic Hyperact Disord. 2010;2(2):93–101. doi: 10.1007/s12402-010-0024-0. [DOI] [PubMed] [Google Scholar] · DOI
  50. [62]Graetz BW, Sawyer MG, Baghurst P. Gender differences among children with DSM-IV ADHD in Australia. J Am Acad Child Adolesc Psychiatry. 2005;44(2):159–168. doi: 10.1097/00004583-200502000-00008. [DOI] [PubMed] [Google Scholar] · DOI
  51. [64]Egger HL, Costello EJ, Erkanli A, et al. Somatic complaints and psychopathology in children and adolescents: stomach aches, musculoskeletal pains, and headaches. J Am Acad Child Adolesc Psychiatry. 1999;38(7):852–860. doi: 10.1097/00004583-199907000-00015. [DOI] [PubMed] [Google Scholar] · DOI
  52. [65]de Graaf R, Kessler RC, Fayyad J, et al. The prevalence and effects of adult attention-deficit/hyperactivity disorder (ADHD) on the performance of workers: results from the WHO World Mental Health Survey Initiative. Occup Environ Med. 2008;65(12):835–842. doi: 10.1136/oem.2007.038448. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI · Paper page
  53. [67]Murray DW, Arnold LE, Swanson J, et al. A clinical review of outcomes of the multimodal treatment study of children with attention-deficit/hyperactivity disorder (MTA) Curr Psychiatry Rep. 2008;10(5):424–431. doi: 10.1007/s11920-008-0068-4. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI

Authors
Quinn, P. O., & Madhoo, M.
Corresponding author
Quinn, Patricia O.
Venue
The Primary Care Companion For CNS Disorders
Publisher
Physicians Postgraduate Press, Inc
Published
2014-05-15
Volume
16
Issue
3
ISSN
  • 2155-7772 (ISSN-L)
  • 2155-7780
DOI
10.4088/pcc.13r01596
PMC
PMC4195638
OpenAlex
W2032160792
Cited by
264
References
59
Citations by year
2026: 46 · 2025: 43 · 2024: 37 · 2023: 46 · 2022: 20 · 2021: 14 · 2020: 18 · 2019: 15 · 2018: 9 · 2017: 3 · 2016: 12 · 2015: 1
FWCI
4.07
Type
journal article
Language
en
Open access
Locations
  • The Primary Care Companion For CNS Disorders (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Developmental and Educational Neuropsychology
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
Keywords
attention deficit hyperactivity disorder, women, girls, gender differences, ADHD diagnosis, underdiagnosis, symptom masking, anxiety comorbidity, comorbid depression, endocrine effects, treatment response, academic performance, continuity of care

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