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

Susan Young^{1

2}, Nicoletta Adamo^{3

4}, Bryndís Björk Ásgeirsdóttir⁵, Polly Branney⁶, Michelle Beckett⁷, William Colley⁸, Sally Cubbin⁹, Quinton Deeley^{10

11}, Emad Farrag¹², Gisli Gudjonsson^{5

13}, Peter Hill¹⁴, Jack Hollingdale¹⁵, Ozge Kilic¹⁶, Tony Lloyd¹⁷, Peter Mason¹⁸, Eleni Paliokosta¹⁹, Sri Perecherla²⁰, Jane Sedgwick^{3

21}, Caroline Skirrow^{22

23}, Kevin Tierney²⁴, Kobus van Rensburg²⁵, Emma Woodhouse^{11

26}

Affiliations

¹ Psychology Services Limited, PO 1735, Croydon, London, CR9 7AE, UK. suzyyoung@aol.com.
² Department of Psychology, Reykjavik University, Reykjavik, Iceland. suzyyoung@aol.com.
³ Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK.
⁴ Service for Complex Autism and Associated Neurodevelopmental Disorders, South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, London, UK.
⁵ Department of Psychology, Reykjavik University, Reykjavik, Iceland.
⁶ Oxford ADHD and Autism Centre, Oxford, UK.
⁷ ADHD Action, Harrogate, North Yorkshire, UK.
⁸ CLC Consultancy, Perth, UK.
⁹ Manor Hospital, Oxford, UK.
¹⁰ National Autism Unit, Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Beckenham, UK.
¹¹ Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, London, UK.
¹² South London & Maudsley NHS Foundation Trust, Maudsley Health, Abu Dhabi, UAE.
¹³ Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
¹⁴ Independent Consultant in Child and Adolescent Psychiatry, Private Practice, London, UK.
¹⁵ Michael Rutter Centre, South London and Maudsley Hospital, London, UK.
¹⁶ Koc University, Istanbul, Turkey.
¹⁷ ADHD Foundation, Liverpool, UK.
¹⁸ ADHD and Psychiatry Services Limited, Liverpool, UK.
¹⁹ Tavistock and Portman NHS Foundation Trust, London, UK.
²⁰ St Thomas' Hospital London, London, UK.
²¹ Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.
²² Cambridge Cognition, Cambridge, UK.
²³ School of Psychological Science, University of Bristol, Bristol, UK.
²⁴ Neuropsychiatry Team, National Specialist CAMHS, South London and Maudsley NHS Foundation Trust, London, UK.
²⁵ Adult ADHD and AS Team & CYP ADHD and ASD Service in Northamptonshire, Northampton, UK.
²⁶ Compass, London, UK.

PMID: 32787804
PMCID: PMC7422602
DOI: 10.1186/s12888-020-02707-9

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

Susan Young et al. BMC Psychiatry. 2020.

. 2020 Aug 12;20(1):404.

doi: 10.1186/s12888-020-02707-9.

Authors

Affiliations

¹ Psychology Services Limited, PO 1735, Croydon, London, CR9 7AE, UK. suzyyoung@aol.com.
² Department of Psychology, Reykjavik University, Reykjavik, Iceland. suzyyoung@aol.com.
³ Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK.
⁴ Service for Complex Autism and Associated Neurodevelopmental Disorders, South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, London, UK.
⁵ Department of Psychology, Reykjavik University, Reykjavik, Iceland.
⁶ Oxford ADHD and Autism Centre, Oxford, UK.
⁷ ADHD Action, Harrogate, North Yorkshire, UK.
⁸ CLC Consultancy, Perth, UK.
⁹ Manor Hospital, Oxford, UK.
¹⁰ National Autism Unit, Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Beckenham, UK.
¹¹ Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, London, UK.
¹² South London & Maudsley NHS Foundation Trust, Maudsley Health, Abu Dhabi, UAE.
¹³ Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
¹⁴ Independent Consultant in Child and Adolescent Psychiatry, Private Practice, London, UK.
¹⁵ Michael Rutter Centre, South London and Maudsley Hospital, London, UK.
¹⁶ Koc University, Istanbul, Turkey.
¹⁷ ADHD Foundation, Liverpool, UK.
¹⁸ ADHD and Psychiatry Services Limited, Liverpool, UK.
¹⁹ Tavistock and Portman NHS Foundation Trust, London, UK.
²⁰ St Thomas' Hospital London, London, UK.
²¹ Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.
²² Cambridge Cognition, Cambridge, UK.
²³ School of Psychological Science, University of Bristol, Bristol, UK.
²⁴ Neuropsychiatry Team, National Specialist CAMHS, South London and Maudsley NHS Foundation Trust, London, UK.
²⁵ Adult ADHD and AS Team & CYP ADHD and ASD Service in Northamptonshire, Northampton, UK.
²⁶ Compass, London, UK.

PMID: 32787804
PMCID: PMC7422602
DOI: 10.1186/s12888-020-02707-9

Abstract

Background: There is evidence to suggest that the broad discrepancy in the ratio of males to females with diagnosed ADHD is due, at least in part, to lack of recognition and/or referral bias in females. Studies suggest that females with ADHD present with differences in their profile of symptoms, comorbidity and associated functioning compared with males. This consensus aims to provide a better understanding of females with ADHD in order to improve recognition and referral. Comprehensive assessment and appropriate treatment is hoped to enhance longer-term clinical outcomes and patient wellbeing for females with ADHD.

Methods: The United Kingdom ADHD Partnership hosted a meeting of experts to discuss symptom presentation, triggers for referral, assessment, treatment and multi-agency liaison for females with ADHD across the lifespan.

Results: A consensus was reached offering practical guidance to support medical and mental health practitioners working with females with ADHD. The potential challenges of working with this patient group were identified, as well as specific barriers that may hinder recognition. These included symptomatic differences, gender biases, comorbidities and the compensatory strategies that may mask or overshadow underlying symptoms of ADHD. Furthermore, we determined the broader needs of these patients and considered how multi-agency liaison may provide the support to meet them.

Conclusions: This practical approach based upon expert consensus will inform effective identification, treatment and support of girls and women with ADHD. It is important to move away from the prevalent perspective that ADHD is a behavioural disorder and attend to the more subtle and/or internalised presentation that is common in females. It is essential to adopt a lifespan model of care to support the complex transitions experienced by females that occur in parallel to change in clinical presentation and social circumstances. Treatment with pharmacological and psychological interventions is expected to have a positive impact leading to increased productivity, decreased resource utilization and most importantly, improved long-term outcomes for girls and women.

Keywords: Attention-deficit/hyperactivity disorder (ADHD); Comorbidity; Consensus; Female; Girls; Identification; Interventions; Treatment; UKAP; Women.

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Conflict of interest statement

In the last 5 years: SY has received honoraria for consultancy and educational talks years from Janssen, HB Pharma and/or Shire. She is author of the ADHD Child Evaluation (ACE) and ACE+ for adults; and lead author of R&R2 for ADHD Youths and Adults. PH has received honoraria for consultancy and educational talks in the last 5 years from Shire, Janssen and Flynn. He has acted as an expert witness for Lilly. PM has received honoraria for consultancy and educational talks from Shire and Flynn. KvR has received honoraria for educational talks from Shire, Lilly, Janssen, Medici and Flynn. In addition SY, PB, WC, PH, PM and EW are affiliated on a full-time basis with consultancy firms/private practices. CS is employed by Cambridge Cognition. JS has received speakers’ honoraria from Shire, is in receipt of an educational grant from the Royal College of Nursing (RCN) Foundation Trust for a contribution towards PhD tuition & conference fees/ costs and is an Executive Committee Member of the UK Adult ADHD Network (UKAAN.org). The remaining authors have no disclosures.

References

1. American Psychiatric Association . Diagnostic and statistical manual of mental disorders. 5. Washington DC: American Psychiatric Association; 2013.
1. World Health Organization . International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10): Version 2019. 2019. - PubMed
1. Asherson P. ADHD across the lifespan. Medicine (Baltimore). 2016;40:623–627.
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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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical