Identifying Diagnostic Bias to Improve Outcomes of Women With ADHD

Women are 3 times more likely to be treated for a mood disorder, depression, or anxiety than for ADHD compared with men.

The following article is a part of conference coverage from the American Psychiatric Nurses Association (APNA) 34th Annual Conference, held online from September 30 to October 4, 2020. The team at the Clinical Advisor will be reporting on the latest news and research conducted by leading nurses in psychiatry. Check back for more from APNA 2020.


Women with attention deficit hyperactivity disorder (ADHD) are one-third less likely to be diagnosed than men, even though the disorder is equally prevalent between the sexes and causes more impaired function in women,  according to a study presented at the American Psychiatric Nurses Association (APNA) 34th Annual Conference, held online from September 30 to October 4, 2020.

Women with ADHD show a significantly higher risk of comorbid anxiety and mood disorders, including severe depression and suicidal ideation, compared with men, reported the study author Brynne Calleran, PMHN/RN-BC, at New York-Presbyterian/Westchester, White Plains, NY. Delaying ADHD diagnosis can lead to dangerously poorer outcomes in women.

The current study was designed to increase diagnoses and improve outcomes by providing nurses with evidence-based information on the phenotypic expression of ADHD in women. Gender differences in phenotypic expression of ADHD may explain the higher diagnosis rate in men.  For example, the current diagnostic criteria for ADHD are largely based on samples of boys who present with more disruptive symptoms than the phenotype for girls and women who are more likely to present with inattentive-type ADHD and are socialized to use strategies to hide and overcompensate for symptoms. As referrals are driven by externalizing behaviors and severity of outward symptoms drives diagnosis, girls are far less likely to be referred or diagnosed.

In addition to a higher prevalence of comorbid mood and anxiety disorders among women with ADHD, comorbid depression emerges earlier, recurs more often, and is more severe compared with the depression experienced by men with ADHD, noted Ms Calleran. Nearly half of women with ADHD will consider suicide, and half of those with comorbid anxiety will consider it seriously.

Women with ADHD face increased intellectual impairment, mortality rates, and perceived mental health impairment compared with men. Due to culture and gender socialization, women with ADHD are more likely to be judged negatively for being gender atypical. The many challenges faced by these women result in a 3-times greater likelihood of being treated for depression, anxiety, or a mood disorder rather than for the root issue of ADHD.

The study author concluded, “Failing to recognize ADHD symptoms in women leads to significant undertreatment and poorer outcomes. As patient advocates, it’s critically important we improve our understanding of ADHD in women in order to provide high-quality, potentially lifesaving, nursing care.” Regarding future research, she stated, “Though research is beginning to explore gender differences in ADHD symptomology and neurobiology, women remain largely neglected in the literature. A paradigm shift in our understanding of ADHD in women is needed.”

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Calleran B. Attention deficit/hyperactivity disorder and women: closing the gender gap. Presented at: APNA 34th Annual Conference; September 30-October 4, 2020. Poster 8.

This article originally appeared on Clinical Advisor