The prevalence of attention-deficit hyperactivity disorder (ADHD) can vary with gender, with evidence suggesting that the prevalence of ADHD is greater in males compared with females (Figure).1
Male:female ratios in child and adolescent ADHD (n=1478) by European country1
This gender imbalance in ADHD has also been found in adults with the disorder.2 A worldwide meta-regression analysis of studies of adults with ADHD (n=14,081 participants) found that although the ratio of males:females with ADHD decreased with age, gender imbalance was still present in adults aged ≥19 years (1.6:1).3
Symptoms of ADHD
Further research has suggested that the symptoms of ADHD presented in female children and adolescents are different from male, which may explain the lower prevalence rates of ADHD in females; some studies have indicated that girls with ADHD may be up to twice as likely as boys to have the inattentive type of ADHD and may suffer more from internalising symptoms and inattention, in contrast with the hyperactive and aggressive symptoms shown by boys.4-7 However, the large European ADORE (Attention-deficit/hyperactivity Disorder Observational Research in Europe) study of clinically referred children (n=1478; mean age girls=8.8 years, boys=9.0 years) found no evidence to suggest that core ADHD symptomatology differed between genders.1 Similarly, research in adults with ADHD has indicated that both genders have similar phenotypic features following adolescence.8
ADHD persists from childhood to adulthood in an estimated 50–66% of individuals.9-12 A meta-analysis of persistence data indicated that rate of persistence was low (15%) in patients who met full criteria for ADHD at the age of 25 years; however, persistence rates in adults with ADHD in “partial remission” were ~65%.11 Two follow-up studies (one in males, one in females), which examined the persistence of ADHD in patients who had received an initial diagnosis when aged 6–17 years, reported that 11 years after the initial diagnosis, 35% of males and 33% of females continued to meet Diagnostic and Statistical Manual of Mental Disorders – 4th edition (DSM-IV)§ criteria for ADHD; indicating that persistence is similar between genders.13,14 Predictors for persistence over the long-term can included psychosocial adversity and psychiatric comorbidity.13,14
Despite the apparent gender differences for ADHD, research has mainly focussed on ADHD in males; the pool of research into ADHD in females is slowly increasing, yet is still limited.15
§These studies were conducted prior to publication of the Diagnostic and Statistical Manual of Mental Disorders – 5th Edition (DSM-5TM).
- Nøvik TS, Hervas A, Ralston SJ, et al. Influence of gender on attention-deficit/hyperactivity disorder in Europe--ADORE. Eur Child Adolesc Psychiatry 2006; 15 Suppl 1: I15-I24.
- Murphy K, Barkley RA. Attention deficit hyperactivity disorder adults: comorbidities and adaptive impairments. Compr Psychiatry 1996; 37: 393-401.
- Willcutt EG. The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics 2012; 9: 490-499.
- Barkley RA, DuPaul GJ, McMurray MB. Comprehensive evaluation of attention deficit disorder with and without hyperactivity as defined by research criteria. J Consult Clin Psychol 1990; 58: 775-789.
- Biederman J, Mick E, Faraone SV, et al. Influence of gender on attention deficit hyperactivity disorder in children referred to a psychiatric clinic. Am J Psychiatry 2002; 159: 36-42.
- Biederman J, Faraone SV. The Massachusetts General Hospital studies of gender influences on attention-deficit/hyperactivity disorder in youth and relatives. Psychiatr Clin North Am 2004; 27: 225-232.
- Newcorn JH, Halperin JM, Jensen PS, et al. Symptom profiles in children with ADHD: effects of comorbidity and gender. J Am Acad Child Adolesc Psychiatry 2001; 40: 137-146.
- Biederman J, Faraone SV, Monuteaux MC, et al. Gender effects on attention-deficit/hyperactivity disorder in adults, revisited. Biol Psychiatry 2004; 55: 692-700.
- Barkley RA, Fischer M, Smallish L, et al. The persistence of attention-deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder. J Abnorm Psychol 2002; 111: 279-289.
- Ebejer JL, Medland SE, van der Werf J, et al. Attention deficit hyperactivity disorder in Australian adults: prevalence, persistence, conduct problems and disadvantage. PLoS One 2012; 7: e47404.
- Faraone SV, Biederman J, Mick E. The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychol Med 2006; 36: 159-165.
- Lara C, Fayyad J, de Graaf R, et al. Childhood predictors of adult attention-deficit/hyperactivity disorder: results from the World Health Organization World Mental Health Survey Initiative. Biol Psychiatry 2009; 65: 46-54.
- Biederman J, Petty CR, Clarke A, et al. Predictors of persistent ADHD: An 11-year follow-up study. J Psychiatr Res 2011; 45: 150-155.
- 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: 147-156.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 2013.