Current Psychiatry Reports (2024) 26:151–156

https://doi.org/10.1007/s11920-024-01492-6

REVIEW

Sex Differences in ADHD: Review and Priorities for Future Research

Dara E. Babinski1

Accepted: 26 January 2024 / Published online: 7 February 2024

© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2024

Abstract
Purpose of review In childhood, attention-deficit/hyperactivity disorder (ADHD) is diagnosed three to 16 times more fre-
quently in males compared to females, yet in adulthood, nearly equivalent numbers of males and females are diagnosed with
ADHD. Relatively few studies have prioritized examination of sex differences in ADHD even though sex differences may
have critical implications for the identification and treatment of ADHD in females and males. This review highlights current
research on sex differences in ADHD across the lifespan that has emerged from cross-sectional and prospective longitudinal
studies of youth, adult-ascertained samples, and registry studies.
Recent findings Accumulating research suggests that both males and females with ADHD experience widespread impair-
ment across the lifespan. Some evidence of sex differences emerged, although effects have generally been modest in size.
Summary Continued research that includes females and males with ADHD is needed to clarify the nature of sex differences
in ADHD. Research that focuses on equitable identification of ADHD in males and females, disentangles the effects of sex
and gender, probes underlying mechanisms of sex differences, and addresses the clinical impact of sex differences in ADHD
must be prioritized.

Keywords Attention-deficit/hyperactivity disorder · ADHD · Sex · Sex differences

Introduction in the etiology and course of the disorder. Sex differences

in ADHD may have critical implications for the identifica-
Attention-deficit/hyperactivity disorder (ADHD) is one of tion and treatment of ADHD in females and males. Accu-
the most common childhood disorders, which is character- mulating research using various methodologies, including
ized by developmentally inappropriate levels of inattention child-ascertained studies, prospective longitudinal studies,
and/or hyperactivity/impulsivity and widespread impairment adult-ascertained studies, and registry studies, has explored
in academic and social domains [1]. At least 11% of chil- sex differences in ADHD. This review highlights current
dren in the United States are diagnosed with ADHD [2], and research on sex1 differences in ADHD in order to direct
although estimates vary considerably (i.e., 3:1–16:1 male to future research on this topic.
female prevalence ratios; [3, 4]), the majority of youth diag-
nosed with ADHD are male. Male youth with ADHD are more Cross‑Sectional Studies of Youth Diagnosed
likely than female youth to display hyperactive and impul- with ADHD in Childhood
sive behavior that may expedite referral and diagnosis [5,
6], and as a result, extant research on ADHD has histori- Some of the earliest studies of sex differences in ADHD
cally been based on samples comprised predominantly or have emerged from childhood-ascertained samples of youth
exclusively of male youth. Relatively little is known about with ADHD. These studies have generally included very few
females with ADHD and whether there are sex differences females and have often been underpowered to detect sig-
nificant sex effects. However, several meta-analytic reviews

1
* Dara E. Babinski Sex, rather than gender, is discussed as the differences between
[email protected] females and males with ADHD are posited to reflect a sex difference
[4, 43]. While these terms are often used interchangeably, sex refers
1
Department of Psychiatry and Behavioral Health, Penn to biological differences between males and females whereas gender
State College of Medicine, 22 Northeast Drive, Hershey, represents the social, cultural, and psychological traits of males and
PA 17033, USA females [47].

Vol.:(0123456789)

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152 Current Psychiatry Reports (2024) 26:151–156

have integrated cross-sectional findings across these stud- which had required symptoms to have emerged by age 7.
ies [5–7] and helped to advance understanding of sex dif- It is likely this diagnostic change has contributed to the
ferences in childhood ADHD. With the exception of males increasing numbers of female youth identified and treated
displaying more hyperactive/impulsive behavior and aggres- with ADHD in recent years [13], as symptoms of ADHD
sion relative to females, meta-analytic findings of childhood may become more obvious among females during social
ADHD have shown relatively few sex differences in symptom and educational transitions that occur later in childhood
severity or impairment based on parent and teacher ratings. [14]. Recent studies of female youth diagnosed with DSM-5
Overall, meta-analytic findings show that male and female ADHD may reflect a more heterogeneous presentation of
youth with ADHD demonstrate profound impairment across female ADHD compared to samples of female youth with
academic, cognitive, behavioral, and social domains. Interest- ADHD included in past meta-analyses from more than
ingly, some evidence also has emerged showing female youth 20 years ago. Thus, continued study of sex differences in
experience greater impairment relative to male youth in DSM-5 diagnosed youth is needed to clarify the nature of
other domains, including higher levels of inattention, lower sex differences in childhood ADHD.
intellectual functioning, and greater family adversity [5].
However, somewhat inconsistent findings have emerged in Prospective Longitudinal Studies of Youth
other areas of interest, including internalizing symptoms. A Diagnosed with ADHD in Childhood
small effect showing greater internalizing symptoms among
female versus male youth with ADHD emerged in one meta- Sex differences have also been studied in several prospec-
analysis [6], although in the earlier meta-analysis [5], male tive longitudinal studies following youth diagnosed with
youth from community samples demonstrated higher levels childhood ADHD into adolescence and adulthood. Initial
of internalizing symptoms relative to females within com- prospective longitudinal studies of ADHD have included
munity samples; a sex effect did not emerge among clinic- both female and male youth [15–17] and similar to cross-
referred youth. sectional studies, show ongoing ADHD symptoms and wide-
Referral status has emerged as a moderator of sex dif- spread impairment that persist across the lifespan for both
ferences in meta-analyses [5, 6]. A pattern emerged show- males and females. ADHD is a chronic disorder that persists
ing that ADHD was associated with less severe impairment into adulthood for the majority of individuals [18]. Addi-
in females relative to males within community samples, tionally, new age-specific problems have been identified
although in clinic-referred samples, females with ADHD among female and male youth as they age into adolescence,
demonstrated similar, if not more severe, impairment rela- including risky driving, intimate relationship problems, and
tive to males. This pattern of effects is consistent with the financial dependence [19]. While there is some evidence
gender paradox, which posits that neurodevelopmental disor- that externalizing problems and substance use problems may
ders, such as ADHD, while identified less frequently among be more relevant to males than females, these effects were
females than males, are associated with greater dysfunction not consistently reported [15, 20]. Similarly, there is also
in females relative to males [8]. The relatively greater dys- evidence that females diagnosed with ADHD in childhood
function reported among females with ADHD relative to demonstrate significantly greater internalizing problems
males with the disorder in clinic-referred samples also calls and suicidality relative to males with ADHD and females
attention to potential issues in the identification and diagno- without ADHD [16]. However, these effects have not always
sis of ADHD in female youth. There is evidence that females emerged [15] and may be affected by other clinical factors
with ADHD must demonstrate a relatively more severe pat- such as pubertal status [21]. Importantly, individuals in these
tern of symptoms and impairment compared to their male studies had been diagnosed with ADHD in the 1980s and
counterparts in order to be referred for diagnosis [9]. Par- 1990s and very few females were included in these studies,
ent and teachers, the primary informants for diagnosis of limiting statistical power to detect sex differences.
ADHD, have been shown to be less likely to identify ADHD Prospective longitudinal studies exclusively focused on
symptoms in female youth compared to males, even when females with and without childhood ADHD have also raised
females and males present with the same ADHD symptoms questions about potential sex differences in ADHD. These
[10, 11]. These sex-specific reporting issues may reflect lim- studies show that most females with childhood ADHD dem-
ited familiarity with the female ADHD phenotype among onstrate profound impairment into adolescence and adult-
parents and teachers, but also raise questions about whether hood relative to females without childhood ADHD and
current diagnostic criteria for ADHD are sufficiently sensi- have identified a number of areas of impairment that have
tive to detect ADHD in females [9, 12]. not emerged as consistently from earlier prospective stud-
According to the DSM-5-TR [1], diagnosis of ADHD ies that have included mostly males with ADHD [22, 23].
requires that symptoms have emerged prior to the age These impairments include very high rates of depression
of 12, a noted shift from previous editions of the DSM, and self-harm, earlier engagement in sexual behavior, and

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Current Psychiatry Reports (2024) 26:151–156 153

intimate partner violence [23]. Additionally, higher rates and fathers. Maternal ADHD has been associated with
of academic underachievement, unplanned pregnancy, and ineffective parenting and negative child outcomes such as
employment problems were identified among females with conduct problems [28]. Among youth offspring of women
childhood ADHD compared to females without ADHD, and with ADHD, there is reduced efficacy of evidence-based
while these concerns have been identified in predominantly treatments for youth with ADHD [30]. Although negative
male samples, these problems may have differential conse- family outcomes have also been associated with paternal
quences for females with ADHD compared to males with the ADHD [28], there is some evidence that the effects of
disorder. Thus, continued study including males is needed to parental ADHD may be moderated by parental role. Moth-
clarify the effects of sex on the longitudinal course of ADHD. ers are more likely to shoulder the majority of parenting
responsibilities within their household. Thus, the burden
Adult‑Ascertained Studies of Women with ADHD of parenting may be substantially greater for mothers with
ADHD compared to fathers with ADHD. The effect of
In adulthood, nearly equivalent numbers of females and paternal ADHD on family functioning may be similar when
males are identified with ADHD [24], offering additional fathers are actively involved in daily caregiving, but may be
opportunities to examine sex differences in the disorder. minimal when not involved [30]. Although these caregiving
There has been an influx of popular books highlighting per- effects may be attributable to gender rather than sex, the
sonal accounts of women with ADHD, which have raised underlying biological changes that occur in the transition
questions about potentially unique difficulties associated to parenthood have received relatively little study among
with the disorder in females. However, empirical research on women with ADHD and may elucidate opportunities for
sex differences in adulthood is quite limited. Recent narra- treatment [31].
tive reviews exploring sex differences in adults with ADHD
suggest females with ADHD may have higher lifetime preva-
lence rates of anxiety, depression, somatic symptoms, and Registry Studies Including Males and Females
bulimia compared to males with ADHD; substance use dis- with ADHD
order and antisocial behavior may be more often reported
among males with ADHD compared to females with the Large registry studies of population-based health care reg-
disorder [20, 25]. There is also some evidence that females istries and insurance claims databases have also identified
with ADHD may be more likely to have a childhood history sex differences in ADHD, including higher rates of psychi-
of sexual abuse, higher rates of psychiatric admissions [20], atric burden and early mortality among females with ADHD
and report more functional impairment [25]. However, these relative to males [13, 32–34]. These studies are well pow-
sex differences have primarily emerged using self-report ered to detect sex differences in ADHD and offer notable
rating scales, and have not clearly emerged using objec- external validity as individuals with ADHD are included
tive ratings, raising questions about the robustness of these who do not necessarily self-select into traditional clinic- or
effects. It may be that the self-reported differences reported community-based research studies. Additionally, these large
between males and females reflect gender rather than sex registry studies allow for study of sex differences across
differences [20, 25]. Regardless of ADHD status, women are development. For example, a recent study using a Swedish
more likely than men to disclose distress and seek treatment population registry that included 37,591 females identified
[26], behavior that is differentially socialized in females rela- with a diagnosis of ADHD showed that females were diag-
tive to males [27]. nosed approximately four years later than males with the
Recent accounts of parents with ADHD also raise ques- disorder [34]. Females with ADHD had higher rates of psy-
tions about potential sex and/or gender differences in family chiatric comorbidity, pharmacological treatment, and health
functioning among mothers and fathers with ADHD. ADHD care utilization when compared with males with ADHD and
is highly heritable and it is estimated that at least 25–50% females without ADHD, and these effects were identified
of youth with ADHD have a parent with the disorder [28]. prior to being diagnosed with ADHD as well as after being
Parents may first identify their own ADHD after learning diagnosed with ADHD. As another exemplar, a recent report
about the disorder as their child is diagnosed, and this may from the Centers for Disease Control and Prevention using
be a particularly important opportunity for identification of insurance claims data showed that stimulant prescription use
adult females with ADHD, as mothers are more likely than rose exponentially from 2020 to 2021, particularly among
fathers to be seek out diagnosis and treatment for their child women [13]. These data may suggest improved access to
[29] and more likely to seek treatment for themselves [26]. care for females with ADHD, although insurance claims data
The majority of research on parental ADHD has focused lack important diagnostic and contextual detail raising ques-
on mothers with ADHD, while few studies have included tions about whether the women who received treatment for
samples sizes sufficient to test differences between mothers ADHD actually had a valid diagnosis of ADHD.

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154 Current Psychiatry Reports (2024) 26:151–156

Conclusion social and affective domains. Notably, evidence of social and

affective dysfunction in female with ADHD has emerged
This review integrates studies of sex differences in ADHD across child- and adult-ascertained samples [6, 25], prospec-
that have emerged across child- and adult-ascertained stud- tive longitudinal work [16, 23, 39], and registry studies [13,
ies, prospective longitudinal, and large-scale registry studies. 32, 34]. However, it is possible social and affective distress
Despite marked variation in the methods used in these stud- among females in child focused studies reflect potentially
ies, converging findings highlight profound and widespread distinct processes from adult focused studies. For example,
impairment associated with ADHD in females and males higher rates of suicidal behavior among females with child-
challenging the historical notion that ADHD is a male dis- hood ADHD relative to males with the disorder may reflect
order. Some evidence of sex differences emerged, although a biological (i.e., sex-based) difference [40]. On the other
effects have generally been modest in size. Several clinical hand, high rates of depression in adult-ascertained samples
research priorities to advance sex differences research in of women with ADHD may reflect gender-based social
ADHD are described below. norms that emphasize seeking treatment in females rather
than males [26, 27] or demoralization related to being mis-
understood and/or misdiagnosed for years. It is critical that
Priority #1: Research on Identification of ADHD this work address unique female developmental milestones,
in Females including pubertal development, pregnancy, and menopause,
which have largely been unstudied among females with
Research focused on early detection of ADHD in females ADHD. Some emerging work suggests these developmental
must be prioritized. Although nearly equivalent numbers milestones may impact the expression of ADHD symptoms
of males and females are diagnosed with ADHD by adult- and related impairment in females [21, 41].
hood [24], males are identified at least three to 16 times
more frequently than females in childhood [3, 4]. ADHD is Priority #3: Mechanisms Underlying Sex Differences
a disorder purported to emerge prior to the age of 12 years
old [1]. Thus, opportunities for early intervention may be The majority of studies reviewed examined sex differences
disproportionately missed for females. The consequences of in symptoms and psychosocial impairment measured using
later diagnosis are not well understood. However, emerging self-report questionnaires, collected from parents, teachers,
research on the adult functioning of females with ADHD and individuals with ADHD themselves. However, self-
suggest profound social dysfunction, low self-esteem, and report methodology is limited in advancing understanding of
depression [35]. These co-occurring problems may emerge mechanisms underlying potential sex differences in ADHD.
as a result of missed opportunities to address ADHD earlier Neurocognitive, genetic, brain imagining, and hormonal
in development. These co-occurring issues may also co- mechanisms have been proposed to as potential mecha-
occur with ADHD in females across development, compli- nisms underlying sex differences in ADHD. To date, there
cating diagnosis of ADHD. has been a lack of consistent findings in studies examining
The sudden uptick in stimulant use for adult females sex differences in neurocognitive, genetic, brain imaging,
[13, 36] in 2020–2021 during the height of the COVID-19 and hormonal mechanisms [42]. However, this work has the
pandemic has also raised questions about accurate assess- potential to advance sex differences research in ADHD. For
ment of ADHD in females. During that time, digital startups example, Arnett and colleagues [43] found that sex differ-
prescribing stimulants online emerged prominently, and it ences in the prevalence of ADHD can be explained by dif-
is unknown whether evidence-based practices were used ferences in the mean and variance of cognitive performance
to diagnose ADHD [37]. A rise in relatable social media between female and male youth. More research examining
content emerging from the neurodiversity movement may sex differences across levels of analysis may help to further
have also led females to self-identify with ADHD and sub- clarify the nature of sex differences in ADHD.
sequently advocate for diagnosis and treatment. Yet misin-
formation about ADHD is rampant online [38], which may Priority #4: Clinical Translation of Sex
propagate misdiagnosis. Differences Research

It is important that studies examining sex differences in

Priority #2: Disentangling the Effects of Sex ADHD inform interventions for females and males with
and Gender ADHD. To date, studies that have examined potential sex
differences in response to evidence-based treatment for
When sex differences in ADHD have emerged, they have ADHD have not identified meaningful differences [44, 45].
been relatively modest in size, and have often emerged in However, accumulating research showing higher rates of

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Current Psychiatry Reports (2024) 26:151–156 155

psychiatric comorbidity and treatment utilization among 11. Ohan JL, Visser TAW. Why is there a gender gap in children
females with ADHD, yet lower rates of treatment for ADHD presenting for attention deficit/hyperactivity disorder services? J
Clin Child Adolesc Psychol. 2009;38(5):650–60. https://​doi.​org/​
[13, 34], suggest additional research is needed to enhance 10.​1080/​15374​41090​31036​27.
existing interventions for females with ADHD [46]. Par- 12. Babinski D, Shroff DM, Cao VT, Waschbusch DA. Sex-Specific
ticipatory research may hold particular promise in ensur- Norms for Diagnosing Attention-Deficit/Hyperactivity Disorder in
ing that sex differences research is clinically meaningful. Childhood: A Receiver Operating Characteristic (ROC) Analysis.
Evidence-Based Pract Child Adolesc Ment Heal. 2021;6(2):290–301.
Participatory research seeks to actively involve stakeholders https://​doi.​org/​10.​1080/​23794​925.​2021.​18753​43.
in research planning and design to ensure that research is 13. Danielson ML, et al. Trends in Stimulant Prescription Fills Among
aligned with and reflects the values, priorities, and interests Commercially Insured Children and Adults – United States, 2016–
of those being studied. 2021. MMWR Morb Mortal Wkly Rep. 2023;72(13):327–32.
https://​doi.​org/​10.​15585/​mmwr.​mm721​3a1.
Acknowledgements This work was supported by R21-MH125052 and 14. Young S, et al. Females with ADHD: An expert consensus state-
R21-MH124027. ment taking a lifespan approach providing guidance for the iden-
tification and treatment of attention-deficit/ hyperactivity disorder
Author Contributions DEB completed all aspects of this manuscript. in girls and women. BMC Psychiatry. 2020;20(1):1–27. https://​
doi.​org/​10.​1186/​s12888-​020-​02707-9.
Data Availability Not applicable as this is a review. 15. Babinski DE, et al. Women with childhood ADHD: Comparisons
by diagnostic group and gender. J Psychopathol Behav Assess.
2011;33(4):420–9. https://​doi.​org/​10.​1007/​s10862-​011-​9247-4.
Declarations 16. Chronis-Tuscano A, et al. Very early predictors of adolescent
depression and suicide attempts in children with attention-deficit/
Competing Interests DEB has received research support from Super- hyperactivity disorder. Arch Gen Psychiatry. 2010;67(10):1044–
nus Pharmaceuticals, Inc. unrelated to this work. 51. https://​doi.​org/​10.​1001/​archg​enpsy​chiat​ry.​2010.​127.
17. Lee SS, Lahey BB, Owens EB, Hinshaw SP. Few preschool boys
and girls with ADHD are well-adjusted during adolescence. J
Abnorm Child Psychol. 2008;36(3):373–83. https://​doi.​org/​10.​
References 1007/​s10802-​007-​9184-6.
18. Sibley MH, et al. When diagnosing ADHD in young adults
1. American Psychiatric Association, Diagnostic and Statistical emphasize informant reports, DSM items, and impairment. J Con-
Manual of Mental Disorders, Fifth Edition, Text Revision (DSM- sult Clin Psychol. 2012;80(6):1052–61. https://​doi.​org/​10.​1037/​
5-TR). 2022. a0029​098.
2. Visser SN, et al. Trends in the parent-report of health care pro- 19. Barkley RA. Attention-deficit/hyperactivity disorder: A handbook
vider-diagnosed and medicated attention-deficit/hyperactivity for diagnosis and treatment. 4th ed. New York: Guilford Press;
disorder: United States, 2003–2011. J Am Acad Child Adolesc 2015.
Psychiatry. 2014;53(1):34-46.e2. https://​doi.​org/​10.​1016/j.​jaac.​ 20. Rucklidge JJ. Gender Differences in Attention-Deficit/Hyperac-
2013.​09.​001. tivity Disorder. Psychiatr Clin North Am. 2010;33(2):357–73.
3. Nøvik TS, et al. Influence of gender on attention-deficit/hyperac- https://​doi.​org/​10.​1016/j.​psc.​2010.​01.​006.
tivity disorder in Europe – ADORE. Eur Child Adolesc Psychiatry. 21. Babinski DE, Waschbusch DA, Waxmonsky JG. Sex and Pubertal
2006; 15 SUPPL. 1. https://​doi.​org/​10.​1007/​s00787-​006-​1003-z. Status Moderate the Association between ADHD and Depression
4. Hartung CM, Lefler EK. Sex and gender in psychopathology: Symptoms: An Examination From Preadolescence Through Late
DSM-5 and beyond. Psychol Bull. 2019;145(4):390–409. https://​ Adolescence. J Clin Psychiatry. 2019;80(3):19404. https://d​ oi.o​ rg/​
doi.​org/​10.​1037/​bul00​00183. 10.​4088/​JCP.​18m12​548.
5. Gaub M, Carlson CL. Gender differences in ADHD: A meta- 22. Biederman J, et al. Clinical correlates of ADHD in females: Find-
analysis and critical review. J Am Acad Child Adolesc Psy- ings from a Large Group of Girls Ascertained from Pediatric and
chiatry. 1997;36(8):1136–9. https://​doi.​org/​10.​1097/​00004​583-​ Psychiatric Referral Sources. J Am Acad Child Adolesc Psychia-
19970​8000-​00023. try. 1999;38:966–75.
6. Gershon J. Gender Differences in ADHD Meta-Analytic Review of 23. Hinshaw SP, Nguyen PT, O’Grady SM, Rosenthal EA. Annual
Gender differences in ADHD. J. Atten Disord. pp. 143–154, 2013. Research Review: Attention-deficit/hyperactivity disorder in
https://​doi.​org/​10.​1177/​10870​54702​00500​302. girls and women: underrepresentation, longitudinal processes,
7. LoyerCarbonneau M, Demers M, Bigras M, Guay MC. Meta- and key directions. J Child Psychol Psychiatry Allied Discip.
Analysis of Sex Differences in ADHD Symptoms and Associated 2022;63(4):484–96. https://​doi.​org/​10.​1111/​jcpp.​13480.
Cognitive Deficits. J Atten Disord. 2021;25(12):1640–56. https://​ 24. Kessler RC, et al. The Prevalence and Correlates of Adult ADHD
doi.​org/​10.​1177/​10870​54720​923736. in the United States: Results From the National Comorbidity Sur-
8. Eme RF. Selective Female Affliction in the Developmental Dis- vey Replication. Am J Psychiatry. 2006;163(4):716–23. https://​
orders of Childhood: A Literature Review. J Clin Child Psychol. doi.​org/​10.​1176/​appi.​ajp.​163.4.​716.
1992;21(4):354–64. 25. Williamson D, Johnston C. Gender differences in adults with attention-
9. Waschbusch DA, King S. Should sex-specific norms be used to deficit/hyperactivity disorder: A narrative review. Clin Psychol Rev.
assess attention-deficit/hyperactivity disorder or oppositional defi- 2015;40:15–27. https://​doi.​org/​10.​1016/j.​cpr.​2015.​05.​005.
ant disorder? J Consult Clin Psychol. 2006;74(1):179–85. https://​ 26. Saunders EFH, et al. Gender differences in transdiagnostic
doi.​org/​10.​1037/​0022-​006X.​74.1.​179. domains and function of adults measured by DSM-5 assessment
10. Bruchmüller K, Margraf J, Schneider S. Is ADHD diagnosed scales at the first clinical visit: a cohort study. BMC Psychiatry.
in accord with diagnostic criteria? Overdiagnosis and influ- 2023;23(1):709. https://​doi.​org/​10.​1186/​s12888-​023-​05207-8.
ence of client gender on diagnosis. J Consult Clin Psychol. 27. Garside RB, Klimes-Dougan B. Socialization of discrete nega-
2012;80(1):128–38. https://​doi.​org/​10.​1037/​a0026​582. tive emotions: Gender difference and links with psychological

Content courtesy of Springer Nature, terms of use apply. Rights reserved.

156 Current Psychiatry Reports (2024) 26:151–156

distress. Sex Roles. 2022;47:115–28. https://​doi.​org/​10.​1023/A:​ Females. J Am Acad Child Adolesc Psychiatry. 2008;47(4):426–34.
10210​90904​785. https://​doi.​org/​10.​1097/​CHI.​0b013​e3181​6429d3.
28. Johnston C, Mash EJ, Miller N, Ninowski JE. Parenting in adults with 40. Beauchaine TP, Hinshaw SP, Bridge JA. Nonsuicidal Self-Injury
attention-deficit/hyperactivity disorder (ADHD). Clin Psychol Rev. and Suicidal Behaviors in Girls: The Case for Targeted Prevention
2012;32(4):215–28. https://​doi.​org/​10.​1016/j.​cpr.​2012.​01.​007. in Preadolescence. Clin Psychol Sci. 2019;7(4):643–67. https://​
29. Fabiano GA. Father Participation in Behavioral Parent Training doi.​org/​10.​1177/​21677​02618​818474.
for ADHD: Review and Recommendations for Increasing Inclu- 41. Camara B, Padoin C, Bolea B. Relationship between sex hor-
sion and Engagement. J Fam Psychol. 2007;21(4):683–93. https://​ mones, reproductive stages and ADHD: a systematic review. Arch
doi.​org/​10.​1037/​0893-​3200.​21.4.​683. Womens Ment Health. 2022;25(1):1–8. https://​doi.​org/​10.​1007/​
30. Chronis-Tuscano A, Wang CH, Woods KE, Strickland J, Stein s00737-​021-​01181-w.
MA. Parent ADHD and Evidence-Based Treatment for Their 42. Greven JK, Richards CU, Buitelaar JS. Sex differences in ADHD.
Children: Review and Directions for Future Research. J Abnorm In: Banaschewski T, Coghill D, Zuddas A, editors. Oxford text-
Child Psychol. 2017;45(3):501–17. https://​d oi.​o rg/​1 0.​1 007/​ book of attention deficit hyperactivity disorder. Oxford: Oxford
s10802-​016-​0238-5. Academic; 2018. p. 154–60.
31. Hantsoo L, Kornfield S, Anguera MC, Epperson CN. Inflam- 43. Arnett AB, Pennington BF, Willcutt EG, Defries JC, Olson RK.
mation: A Proposed Intermediary Between Maternal Stress and Sex differences in ADHD symptom severity. J Child Psychol Psy-
Offspring Neuropsychiatric Risk. Biol Psychiatry. 2019;85(2):97– chiatry Allied Discip. 2015;56(6):632–9. https://​doi.​org/​10.​1111/​
106. https://​doi.​org/​10.​1016/j.​biops​ych.​2018.​08.​018. jcpp.​12337.
32. Babinski DE, Neely KA, Ba DM, Liu G. Depression and sui- 44. Pelham WE, Walker JL, Sturges J, Hoza J. Comparative Effects
cidal behavior in young adult men and women with ADHD: Evi- of Methylphenidate on ADD Girls and ADD Boys. J Am Acad
dence from claims data. J Clin Psychiatry. 2020;81(6):19m13130. Child Adolesc Psychiatry. 1989;28(5):773–6. https://​doi.​org/​10.​
https://​doi.​org/​10.​4088/​JCP.​19m13​130. 1097/​00004​583-​19890​9000-​00021.
33. Dalsgaard S, Ostergaard SD, Leckman JF, Mortensen PB, 45. Mikami AY, Cox DJ, Davis MT, Wilson HK, Merkel RL, Burket
Pedersen MG. Mortality in children, adolescents, and adults with R. Sex differences in effectiveness of extended-release stimulant
attention deficit hyperactivity disorder: A nationwide cohort medication among adolescents with attention-deficit/hyperactivity
study. Lancet. 2015;385(9983):2190–6. https://​doi.​org/​10.​1016/​ disorder. J Clin Psychol Med Settings. 2009;16(3):233–42. https://​
S0140-​6736(14)​61684-6. doi.​org/​10.​1007/​s10880-​009-​9165-8.
34. Skoglund C, et al. Time After Time: Failure to Identify and Sup- 46. Babinski DE, Mills Huffnagle S, Bansal PS, Breaux RP, Waschbusch
port Females With ADHD – A Swedish population register study. J DA. Behavioral Treatment for the Social-Emotional Difficulties of
Child Psychol Psychiatry. 2023. https://​doi.​org/​10.​1111/​jcpp.​13920. Preadolescent and Adolescent Girls with ADHD. Evidence-Based
35. Babinski DE, Libsack EJ. A Participatory Research Approach to Pract Child Adolesc Ment Heal. 2020;5(2):1–16. https://​doi.​org/​10.​
Improve Clinical Care for Women with ADHD. Penn State Col- 1080/​23794​925.​2020.​17594​70.
lege of Medicine: Manuscript submitted for publication; 2024. 47. Potter AS, et al. Measurement of Gender and Sexuality in the Adoles-
36. Sibley MH, Faraone SV, Nigg JT, Surman CBH. Sudden Increases cent Brain Cognitive Development (ABCD) Study. Dev Cogn Neu-
in U.S. Stimulant Prescribing: Alarming or Not? J Atten Disord. rosci. 2022;53:101057. https://​doi.​org/​10.​1016/j.​dcn.​2022.​101057.
2023;27(6):571–4. https://​doi.​org/​10.​1177/​10870​54723​11641​55.
37. Sibley MH, Mitchell JT, Becker SP. Method of adult diagnosis influ- Publisher's Note Springer Nature remains neutral with regard to
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39. Biederman J, et al. New Insights Into the Comorbidity Between
ADHD and Major Depression in Adolescent and Young Adult

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