Reflections on the manifestation of attention-deficit hyperactivity disorder in girls from young adults with lived experiences: a qualitative study

Abstract

Background: Attention-deficit/hyperactivity disorder (ADHD) is more commonly missed or diagnosed later in females than males. One explanation is that diagnostic criteria have been informed by research primarily based on male samples and may not adequately capture the female presentation of ADHD. This study used a qualitative approach to better understand female ADHD in childhood from the perspective of young women and non-binary adults with ADHD.Methods: Twelve young adults (10 women and 2 non-binary individuals assigned female at birth, aged 18-25 years) with ADHD participated in interviews to describe their lived experiences of ADHD throughout childhood. Interviews were transcribed verbatim and qualitatively analysed using the framework method.Findings: Participants reported experiencing a range of ADHD symptoms, some of which are not included in current diagnostic criteria. Four core themes were identified; 1: socially-oriented and internalised symptoms, 2: social impacts, 3: masking and compensation, and 4: the importance of context. Theme one describes that girls with ADHD may experience symptoms as more socially-oriented (eg losing track of thoughts in a conversation), non-disruptive (eg doodling) and internalised (eg feelings of frustration) than those described by current diagnostic criteria. Theme two highlights the particular importance of social impacts of ADHD on friends, home, and school. Theme three describes the desire to fit in socially, behaviours and strategies used to mask symptoms and associated unfavourable consequences. Theme four highlights variability in symptoms across different environmental contexts.Interpretation: This study suggests that the presentation of ADHD symptoms in girls may be socially-oriented, internalised and especially influenced by the social context. Also, female ADHD symptoms may be less visible due to scaffolding, masking and context. Future research should consider whether current ADHD diagnostic criteria require adjustment, to aid earlier recognition and diagnosis of ADHD in children and young people, especially in females