Cookie Preferences
By clicking, you agree to store cookies on your device to enhance navigation, analyze usage, and support marketing. More Info
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
September 30, 2025
Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental conditions, yet many young people, especially girls, receive a diagnosis late or not at all. This matters, because a delayed diagnosis often means missed opportunities for support, treatment, and improved long-term outcomes. A recent study by Barclay and colleagues (2024) sheds new light on why ADHD recognition is inconsistent, and what we can do about it.
Researchers analyzed data from nearly 10,000 children in the UK Millennium Cohort Study. They compared children whose ADHD was recognized early (ages 5–7), later (ages 11–14), or not recognized at all, despite evidence of symptoms. The team also looked at differences between boys and girls to better understand why diagnosis patterns vary by sex.
The study highlights the importance of looking beyond the “classic” hyperactive child stereotype when considering ADHD. Clinicians should:
If you’re a parent, it’s important to trust your observations. If your child struggles with focus, organization, or emotional regulation—even if they are doing well academically or socially—these could still be signs of ADHD. Advocating for an evaluation can make a big difference.
This study makes clear that ADHD is not one-size-fits-all. Recognition often depends on how symptoms show up, how disruptive they appear, and even the child’s gender. By broadening our awareness and refining our screening practices, we can ensure that fewer children slip through the cracks and more receive the support they need early in life.
Barclay I, Sayal K, Ford T, John A, Taylor MJ, Thapar A, Langley K, Martin J. Investigating the reasons behind a later or missed diagnosis of attention-deficit/hyperactivity disorder in young people: A population cohort study. JCPP Adv. 2024 Dec 18;5(3):e12301. doi: 10.1002/jcv2.12301. PMID: 40979729; PMCID: PMC12446718.
Boys are three times as likely as girls to be diagnosed with ADHD, and anywhere from three to sixteen times more likely to be referred for treatment.
An international team of experts recently published a consensus statement addressing this discrepancy and offering guidance to rectify the imbalance and improve diagnosis and care for girls and women with ADHD. Here are some key conclusions.
ADHD symptoms:
-Experts caution that ADHD behaviors typically express themselves differently in boys than in girls.
-That in turn leads to gender-based biases in teachers and parents. In two studies in which teachers were shown vignettes of individuals with typical ADHD behaviors, switching from female to male names and pronouns led to higher rates of referral for support and treatment.
Comorbidity:
-A major reason for this different expression of ADHD in boys is that they have much higher rates of comorbid externalizing disorders, such as the conduct disorder and oppositional defiant disorder, leading them to break rules and get into fights in school. This no doubt contributes to lower rates of referral for girls.
-On the other hand, females are more likely to have comorbid internalizing disorders, such as emotional problems, anxiety, and depression. These may be interpreted as primary conditions, and the link to ADHD is missed altogether.
-Because ADHD has come to be associated with many externalizing disorders, it is then easy to fail to identify it when it is associated with internalizing disorders such as eating disorders.
-Untreated ADHD in girls can increase the risk of substance use disorders.
Associated vulnerabilities:
Children with ADHD are more likely to be unpopular with their peers and to experience rejection. Whereas boys are more likely to experience that rejection in physical ways, girls are more likely to experience it in social ways and through cyberbullying. That, in turn, contributes to lower self-esteem, which could explain some comorbid internalizing disorders.
Symptoms of hyperactivity/impulsivity, one of the two key components of ADHD, are associated with higher rates of risk-taking behavior:
- Like males with ADHD, females with ADHD have higher injury rates.
-Both males and females with ADHD are more likely to underachieve in school or drop out altogether.
-Overall, adolescents with ADHD become sexually active earlier, have more sexual partners, and are more frequently treated for sexually transmitted diseases than their normally developing peers. That also leads to higher rates of teenage and unplanned pregnancies.
-As with males with ADHD, females with ADHD have higher rates of criminal behavior than normally developing peers. While females with ADHD are still half as likely to be convicted of a crime than males with ADHD, one study showed they nevertheless are eighteen times more likely to be convicted of a crime than normally developing females.
Compensatory or coping behaviors:
- Girls may turn to drink alcohol, smoking cannabis, smoking cigarettes, or vaping nicotine to cope with emotional anguish, social isolation, and rejection.
-Some girls may seek to build social support through high-risk activities such as joining a gang, becoming promiscuous, and engaging in criminal behavior.
Triggers for possible referral
Ages 5-11:
-Bedwetting, nail-biting
Ages 5-16:
-Early sexualized behavior
Ages 5-18:
-Suspensions, expulsions, frequent detentions
-Poor attendance/truancy
-Consistent lateness, poor organization
-Academic difficulties, low academic self-esteem
-Conduct problems, conflicts with parents and peers
-Bullying (usually as victims)
-Regular tobacco and alcohol use
- Obesity and other eating disorders
- Repeated injuries
- Sleep difficulties
- Executive function difficulties
- Extreme emotional meltdowns
Ages 12 and above:
- Relationship problems, anxiety about relationships
- Social rejection, isolation
- Substance abuse, including alcohol
- Risky sexual behavior
- Underage or unwanted pregnancy
- Delinquency or criminal behavior (including shoplifting, vandalism)
- Low self-esteem
- Self-harm, suicidality
Ages 16 and above:
- Dropping out of school
- Losing jobs
- Parenting problems
- Criminality
- Financial difficulties
- Traffic crashes
- Internalizing conditions: depression, anxiety
Ages 18 and above:
- Gambling problems, compulsive shopping
- Personality disorder
- Chronic fatigue syndrome
- Fibromyalgia
The key message is not to disregard females because they do not present with the externalizing behavioral problems, or the disruptive, hard-to-manage boisterous, or loud behaviors typically associated with males with ADHD.
Diagnosis
The authors emphasize that "comprehensive assessment should be completed to accurately capture the symptoms of ADHD across multiple settings, their persistence over time, and associated functional impairments. High rates of comorbidity are typically present. The assessment process is typically tripartite, involving the use of rating scales, a clinical interview, and ideally objective information from informants or school reports."
Rating scales: Ideally rely on those that provide female norms, making them more sensitive to female presentation.
Clinical interviews:
-Be mindful of age-appropriate, common-occurring conditions in females with ADHD, including autistic spectrum disorder, tics, mood disorders, anxiety, eating disorders, fibromyalgia, and chronic fatigue syndrome.
- Be alert to signs of self-harming behaviors(especially cutting), which peak in adolescence and early adulthood.
-Given that heritability of ADHD is high, ranging between 70-80% in both children and adults, be mindful that informants who are family members may also have ADHD (possibly undiagnosed) which may affect their judgment of "typical" behavior. The assessor should obtain specific examples of behavior from the informant and use these to make clinically informed judgments, rather than relying upon the informants' perception of what is typical or atypical.
Treatment
Pharmacological:
- Recommendations for medication do not differ by sex, except that pharmacological treatment is generally not advised during pregnancy or breastfeeding.
- A systematic review and network meta-analysis recommended methylphenidate for children and adolescents and amphetamines for adults, taking into account both efficacy and safety. Larger confidence intervals about the tolerability and efficacy of bupropion, clonidine, and guanine were reported, indicating less conclusive results about the efficacy and tolerability of these oral medications. The use of medication should be followed up over time to verify if medications are effective and well-tolerated, and to manage the effects of related conditions(e.g. anxiety, depression) if they emerge.
Non-pharmacological:
- Cognitive behavioral therapy (CBT) together with psychoeducation (which can be provided to both patients and parent/guardians together or independently) are the best forms of psychological treatment.
- Parents and other guardians of teenage girls need to be shown how to identify deliberate self-harming or risky behavior.
- Adolescent girls may require assistance in addressing risky behavior (sexual risk, substance misuse) and improving self-management. Girls with ADHD are more vulnerable to sexual exploitation and have higher rates of early and unwanted pregnancy.
- Adults are more likely to require interventions to address employment problems, child-rearing, and parenting. Women with ADHD are also more vulnerable to sexual exploitation, including physical and sexual violence.
- Interventions should support attendance and engagement with education to avoid early school-leaving, diminished educational attainment, and associated vulnerabilities. While externalizing conditions have a greater impact on classroom behavior, internalizing conditions affect motivation and thus the ability to benefit from education.
Institutional outreach
- Educational, social care, occupational, and criminal justice system professionals should be trained to improve the detection and referral of ADHD in girls and women.
- Flexible learning systems and support with childcare can help women with ADHD return to education after having a baby.
- Depending on the country of residence, women who disclose their disability to their employer may be entitled to reasonable adjustments to the workplace to accommodate their condition.
- Low to no-cost apps are available to assist persons with ADHD with itineraries, lists, and reminders.
- Career planning should take into account that some occupations may provide a better fit for women with ADHD: "some individuals with ADHD show a preference for more stimulating environments, active, hands-on, or busy and fast-paced jobs."
- Persons with ADHD, both male and female, make up roughly a quarter of the prison population: "Evidence indicates that ADHD treatment is associated with reduced rates of criminality, is tolerated and effective in prison inmates, and improves their quality of life and cognitive function. This has led to speculation that effective identification and treatment of ADHD may help to reduce re-offending."
The authors concluded, "To facilitate identification, it is important to move away from the previously predominating disruptive boy stereotype of ADHD and understand the more subtle and internalized presentation that predominates in girls and women."
.png)
ADHD (Attention-Deficit/Hyperactivity Disorder) has often been seen as a condition that mainly affects boys, especially when it comes to hyperactivity. However, a new study challenges this idea by showing that hyperactivity is also common in women with ADHD, pointing out the need for better diagnoses.
The study included 13,179 adults with ADHD and 1,910 adults without it. Researchers measured how active participants were using a special test, looking at both "provoked" activity (activity triggered by specific tasks that puts the brain “online”) and "basal" activity (resting or natural activity levels when the brain is “offline”). The study included almost an equal number of men and women, with the goal of finding out if there were any differences between the sexes in ADHD diagnosis, particularly in hyperactivity.
The results were eye-opening. Although men generally showed higher levels of activity when the brain was online, both men and women with ADHD had much higher levels of both offline and online activity compared to people without ADHD. Specifically, those with ADHD had about twice the resting activity and three times the provoked activity compared to those without the disorder.
A key finding was that women with ADHD had hyperactivity levels similar to men with ADHD. This goes against the common belief that women with ADHD don’t show hyperactivity or show it less. It suggests that hyperactivity in women may be missed or misunderstood due to societal expectations or differences in behavior.
These findings have big implications. They suggest that the way we currently understand ADHD, especially hyperactivity in women, might be wrong. By recognizing that women with ADHD can have significant hyperactivity, doctors can diagnose ADHD more accurately. This could lead to earlier treatment and better management of ADHD in women, which might also lower the chances of related problems like anxiety or depression.
The study highlights the importance of thinking about gender differences when diagnosing and treating ADHD. By realizing that hyperactivity isn't just a "male" trait, we can better support everyone with ADHD and ensure they get the right care. As research on ADHD continues, it’s important to challenge old assumptions and take a more inclusive approach to understanding and treating the disorder.
Swedish researchers examined outcomes for adult women who sought treatment at the Stockholm Center for Eating Disorders over two years and nine months. Out of 1,517 women who came to the clinic, 1,143remained eligible for the study, after excluding women whose symptoms did not fulfill the DSM-IV criteria for eating disorders or had incomplete records.
Of these, seven hundred patients could not be reached or declined to participate, leaving 443 for follow-up. To guard against the possibility that the follow-up group might not be representative of the overall treatment group, researchers compared to age, body mass index, and scores on tests for depression, anxiety, compulsively, inattention, and hyperactivity. The only statistically significant differences were small ones. The median age of the group lost to follow-up was one year younger, they were less likely to be living alone, and on average scored a single point higher on the depression test. Otherwise, they were broadly similar.
The one-year follow-up on the study group found a substantial difference in the rate of recovery from eating disorders between those with and without comorbid ADHD. Almost three out of four patients (72%) who scored lower (between 0-17) on the World Health Organization adult ADHD self-report scale had recovered from their eating disorder. Among those scoring18 and higher, on the other hand, it was less than half (47%). This difference was extraordinarily unlikely (one chance in one thousand) to be due to chance(p=.001).
Another way of expressing this is through odds ratios. Those scoring 18 and up on the ADHD self-report scale were about two and a half times less likely to recover from their eating disorders following treatment. More specifically, thy were about three times less likely to recover from the loss of control and binging, and almost three and a half times less likely to recover from purging.
To improve outcomes, the researchers suggest "identifying concomitant ADHD symptoms and customizing treatment interventions based on this." They specifically propose controlled clinical trials to explore the effect of combining stimulant medications with standard treatment for eating disorders
Managing high blood pressure requires more than just getting a prescription; it means taking medication consistently, day after day, often for years. For people with ADHD, that kind of routine can be genuinely difficult. In our new study, published in BMC Medicine, we set out to understand just how much ADHD affects whether people stick with their blood pressure medication, and whether ADHD treatment itself might make a difference.
Why This Question Matters
Hypertension affects nearly a third of adults worldwide and is one of the leading drivers of heart disease and stroke. At the same time, ADHD, long thought of as a childhood disorder, affects around 2.5% of adults and is increasingly recognized as a risk factor for cardiovascular problems, including high blood pressure. Yet no large-scale study had ever examined whether having ADHD affects how well people follow through with their blood pressure treatment. We wanted to fill that gap.
What We Did
We analyzed health records from over 12 million adults across seven countries, Australia, Denmark, the Netherlands, Norway, Sweden, the UK, and the US, who had started antihypertensive (blood pressure-lowering) medication between 2010 and 2020. About 320,000 of them had ADHD. We tracked two things: whether they stopped their blood pressure medication entirely within five years, and whether they were taking it consistently enough (covering at least 80% of days) over one, two, and five years of follow-up.
What We Found
Across nearly all countries, adults with ADHD were more likely to stop their blood pressure medication and less likely to take it consistently. Overall, those with ADHD had about a 14% higher rate of discontinuing treatment within five years, and were 45% more likely to have poor adherence in the first year, a gap that widened to 64% by the five-year mark. These patterns were most pronounced in middle-aged and older adults.
Interestingly, young adults with ADHD were actually slightly less likely to discontinue treatment than their peers without ADHD, a finding we think may reflect the fact that younger people with ADHD are often more actively engaged with healthcare systems, especially given the cardiovascular monitoring that comes with ADHD medication use.
Perhaps the most encouraging finding was this: among people with ADHD who were also taking ADHD medication, adherence to blood pressure treatment was substantially better. Those on ADHD medication were about 38% less likely to have poor adherence at one year, and nearly 50% less likely at five years. While we can't establish causation from this type of study, one plausible explanation is that treating ADHD, reducing inattention and impulsivity, makes it easier to maintain the routines that consistent medication use requires. It's also possible that people on ADHD medication simply have more regular contact with healthcare providers, which keeps other health problems better monitored and managed.
What This Means in Practice
The core ADHD symptoms of inattention and poor organization are precisely the traits that make long-term medication adherence difficult. Add in the complexity of managing multiple disorders and medications, and it's easy to see why people with ADHD face extra challenges. Our findings suggest that clinicians treating adults with ADHD for cardiovascular disorders should be aware of these challenges and consider tailored support strategies, things like regular follow-up appointments, patient education, and tools that help with routine and organization.
There's also a broader message here about the potential ripple effects of treating ADHD well. Supporting someone in managing their ADHD may not just improve their attention and daily functioning; it may also help them take better care of their physical health, including disorders as serious as hypertension.
Future research should explore which specific support strategies are most effective, and whether these findings hold in lower- and middle-income countries where the data don't yet exist.
If you or someone you know has ADHD, you may be familiar with the challenge of staying on medication. Stimulants like methylphenidate (Ritalin) are the most common and effective treatment for ADHD, but a surprisingly large number of people stop taking them within the first year. In our new study, published in Translational Psychiatry, we sought to determine whether a person's genetic makeup plays a role in the development of the disorder.
What We Did
We analyzed data from over 18,000 people with ADHD in Denmark, all of whom had started stimulant medication. We tracked whether they stopped treatment within the first year, defined as going more than six months without filling a prescription. Nearly 4 in 10 (39%) had discontinued by that point. We then looked at their genetic data to see whether DNA differences could help explain who was more likely to stop.
What We Found
The short answer is: genetics does play a role, but it's modest. No single gene had a dramatic effect. Instead, we found that a collection of small genetic influences—distributed across the genome—contributed to the likelihood of stopping treatment early.
One of the most consistent findings was that people with a higher genetic predisposition for psychiatric disorders like schizophrenia, depression, or general mental health difficulties were more likely to discontinue their medication. This was true across all age groups. Interestingly, having a higher genetic risk for ADHD itself was not associated with stopping treatment, suggesting that the genetics of having ADHD and the genetics of staying on medication are quite different things.
We also found that the genetic picture looks different depending on age. In children under 16, body weight genetics (BMI) played a surprising role, children with a genetic tendency toward higher weight were actually less likely to stop, possibly because stimulant-related appetite suppression is less of a problem for them. In older adolescents and adults, higher genetic potential for educational attainment and IQ was linked to staying on treatment, possibly reflecting better access to information and healthcare support.
On the rare variant side, we found a tentative signal that people who stopped treatment had fewer disruptive variants in genes involved in dopamine, the brain chemical that stimulants work on. This might mean that those who continue on medication genuinely have more disruption in their dopamine system and benefit more from stimulant treatment.
What This Means
Our findings suggest that stopping ADHD medication early isn't simply a matter of willpower or forgetting to take a pill. Biology matters. A person's broader genetic vulnerabilities, particularly for other psychiatric disorders, may make it harder to stay on treatment, perhaps because of side effects, poor response, or the complexity of managing multiple mental health challenges at once.
We're still far from being able to use genetics to predict who will stop their medication, the effects we found are real but small, and much of the variation in treatment persistence remains unexplained. But this work is a step toward understanding the biological foundations of treatment challenges in ADHD, and hopefully toward more personalized approaches to care in the future.
Larger studies and research that can distinguish why people stop (side effects versus poor response versus practical barriers), will be the next steps.
ADHD affects both individuals and society in many ways. Children and adolescents with ADHD often struggle with focusing, controlling impulses, and staying organized, which leads to problems with schoolwork, learning, and taking tests. These challenges can cause academic failure and make it harder for them to stay in school.
ADHD symptoms often continue into adulthood, affecting jobs, relationships, and increasing risks for substance abuse and legal problems.
Families of children and adolescents with ADHD face extra stress, with parents more likely to experience depression, anxiety, and relationship difficulties. The economic impact is also large, with billions spent each year on medical care, special education, lost productivity, and other related costs.
Current treatments for ADHD mostly include medication, behavioral therapy, and educational support. While medications like stimulants can help control ADHD symptoms in the short term, they often cause side effects such as loss of appetite, trouble sleeping, slowed growth, cardiovascular risks, and potential substance dependence. These issues can make it hard for children and adolescents to stay on their medication, and about a third either don’t respond well or can’t tolerate the side effects. Once medication is stopped, the benefits fade quickly and do not lead to lasting improvements in executive functions (thinking skills).
Behavioral therapy and parent training can help with behavior problems, but have limited effects on core mental skills like planning and self-control. These approaches also tend to be expensive, require a lot of support from parents and teachers, and are hard to use widely in schools and communities that lack resources.
Recently, exercise interventions have attracted growing interest as a non-pharmacological option. They provide several benefits: no drug-related side effects, easy accessibility, low cost, simple implementation in schools and communities, and enhanced physical and mental health.
Previous meta-analyses examining how exercise interventions affect children and adolescents with ADHD have used traditional univariate models, which treat each study as if it only offers one independent effect size. In contrast, this study used multilevel meta-analysis — a more advanced statistical method modelling both between-study and within-study effects. This approach results in more accurate estimates and more dependable conclusions.
Eligible studies were randomized controlled trials (RCTs) with usual care, no intervention, or waitlist controls, involving children and adolescents aged 5–18 diagnosed with ADHD by internationally recognized diagnostic criteria, and reporting inhibitory control outcomes.
Eleven studies combining 512 children and adolescents met these inclusion standards.
The analysis between experimental and control groups indicated that the exercise intervention group had significantly improved inhibitory control performance compared to the control group, with a medium-to-large effect size. There was very little variation (heterogeneity) in outcome between the studies, and no sign of publication bias.
Within-group analyses showed that experimental groups had significant improvements after the intervention compared to baseline, with large effect sizes and moderate heterogeneity.
By comparison, analyzing control groups over the same period revealed no significant differences, indicating that inhibitory control abilities in these groups remained largely unchanged throughout the observation period. There was little heterogeneity.
Nevertheless, only one of the studies was rated low risk of bias, nine had some concerns, and two were rated high risk of bias. The greatest shortcomings were a lack of blinding and preregistration.
The study authors therefore concluded that the overall evidence quality of this meta-analysis is low, limiting confidence in the results. While exercise interventions seem to improve inhibitory control abilities in children and adolescents with ADHD, significant methodological limitations create uncertainty about the effect size. These require more rigorous future studies to clarify these effects. Despite these caveats, they noted that all included studies reported statistically significant, consistent benefits from exercise interventions, offering preliminary support for their use as an adjunctive approach.
Takeaway
This study lands in the same conversation as the adult ADHD exercise meta-analysis, and together they start to form a coherent picture: exercise appears to support attention and impulse control across the lifespan for people with ADHD, not just in one age group. The honest caveat is that the research quality in this field is still catching up to the enthusiasm — most studies have design weaknesses that limit confidence in the exact size of the effect. But the consistency of findings across studies, age groups, and now two separate meta-analyses is hard to dismiss.
_logo%201.svg)
