Women diagnosed with ADHD five years later than men

Women are diagnosed with attention deficit hyperactivity disorder (ADHD) five years later than men, despite their symptoms appearing at the same age, findings presented at an international congress suggest.

The research, presented at the ECNP (European College of Neuropsychology) Congress in Amsterdam this month, showed that women with ADHD also suffer worse emotional and functional difficulties than men with the condition.

Lead researcher for the study published in European Psychiatry, Dr Silvia Amoretti, said the delays to women being diagnosed with ADHD can lead to a series of worse clinical outcomes including depression, anxiety and functional impairment.

‘A notable percentage of cases of females seeking psychiatric care for a mood disorder might have undiagnosed ADHD.

‘Indeed, in many cases, patients receive treatment for anxiety or depression while ADHD remains undiagnosed, leading to suboptimal therapeutic responses,’ Dr Amoretti said.

Related Article: CPD: How to support management of ADHD in primary care

‘Males on the other hand showed a higher level of involvement in delinquent behaviours such as legal problems and driving-related difficulties.

‘We believe that a better understanding of these sex-based differences might improve diagnosis and treatment,’ Dr Amoretti explained.

The researchers analysed 900 adults who were 54.9% male and 45.1% female, with an average age of 36.94 and had been diagnosed for the first time at a specialist outpatient programme in Barcelona.

They explored the differences between males and females in terms of age diagnosis, ADHD symptom severity, psychiatric comorbidities, psychosocial functioning, and disability.

The analysis revealed that women had been diagnosed with ADHD at an average age of 28.96 years, while males were diagnosed at 24.13 years on average.

This is despite symptoms appearing in men and women at approximately the same age.

ADHD ‘unnoticed’ in women

Women presented with more severe symptoms than the men did by the time of their diagnosis, the findings revealed.

This includes worse functioning in daily life and higher rates of depression and anxiety.

Related Article: Adults with ADHD ‘living shorter lives than they should’, study suggests

‘This is important because it shows that ADHD often goes unnoticed in women until it becomes a serious problem.

‘Our findings suggest that we may be missing the early signs in girls and women, especially when their symptoms are less disruptive but still impactful. This has clear implications for earlier screening and sex-sensitive diagnostic tools’, Dr Amoretti said.

Women are likely diagnosed with ADHD later than men because their symptoms appear differently, the researchers suggested.

‘Boys are more likely to be hyperactive or impulsive, and this behaviour is more visible to parents, teachers and clinicians.

‘On the other hand, girls with ADHD are more likely to seem inattentive and generally less disruptive,’ Dr Amoretti explained.

Dr Amoretti said this is ‘clinically important’ as it means women are not only not treated early enough, but may not be diagnosed at all.

Related Article: Primary care ‘needs more support’ with care of ADHD patients

Commenting on the findings, Professor Sandra Kooijm, founder and chair of the European Network Adult ADHD, said: ‘Different presentation of symptoms, lack of awareness among clinicians that women have ADHD too, and the hormonal changes leading to severe mood instability in the last week of the cycle are all responsible for the gender differences in time to diagnosis of ADHD.

‘Increasing awareness in both society and medicine helps girls and women to get earlier help when they need it.’

Nursing in Practice has previously explored the role of school nurses in supporting children with ADHD to safely access their medication in schools.