Study Offers Practical Recommendations to Improve Diagnosis and Care for Women With ADHD
As recent research has shown, women and girls with attention-deficit/hyperactivity disorder (ADHD) go undiagnosed longer than boys and men. A new mixed-methods study published in the Journal of Attention Disorders confirms this research and investigates the barriers to care women diagnosed with ADHD face, as well as what practical changes clinicians can make to create more accessible care and more timely diagnoses.
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“Failure to accurately diagnose and treat ADHD earlier in development may have profound consequences, potentially contributing to lower self-esteem and relationship difficulties, limiting income potential, and increasing risk for psychiatric comorbidity and early mortality,” authors Dara E. Babinski, PhD, and Erin J. Libsack, PhD, Penn State College of Medicine, Hershey, Pennsylvania, noted. “However, very little research has examined how women with ADHD eeventually obtain a diagnosis of ADHD in adulthood, limiting opportunities for providers to improve clinical care for this underserved population.”
Researchers conducted 2 focus groups virtually with 14 women (Mage = 39.43, SD = 6.37). Participants were asked about the costs and benefits of obtaining their diagnosis as well as things that hindered or helped with facilitating the identification, assessment, or subsequent treatment of ADHD.
Many participants reported that receiving an ADHD diagnosis brought benefits like validation, self-compassion, improved coping strategies, and social support. Some faced challenges, however, including difficulty accessing care, treatment burden, limited evidence-based options, and stigma. Many did not initially recognize their symptoms, and diagnostic complexity often made identification difficult. Participants also described varying assessment procedures and significant self-advocacy efforts in order to have their ADHD considered by health care providers.
Study authors made some recommendations to clinicians to improve psychiatric care for this group based on the information received from participants. Suggestions included:
- Increasing awareness and screening in younger girls
- Using a stepped-care approach to diagnosis
- Higher consideration of contextual factors that may mask ADHD presentation (such as “people pleasing,” which could hide ADHD symptoms)
- Treating ADHD alongside other comorbidities as opposed to prioritizing other co-occurring disease states
- Using integrated or team-based care to help patients reduce treatment burden
- Integrating non-pharmacological options into treatment (such as cognitive behavioral therapy)
- Encouraging patients to seek neurodiversity-affirming care and communities; “Women viewed ADHD affirming social media content as invaluable in the absence of other available supports and indicated that the potential therapeutic utility of social media should not be overlooked by providers and researchers.”
Researchers noted that the study does have a few limitations, including its small sample size, limiting the generalizability of its findings. Further limiting generalizability, most participants had ADHD Combined Presentation with high rates of co-occurring anxiety. Only 14 of the 31 eligible women attended the focus group, and self-selection may have influenced results, with limited details on how diagnoses were made.
“This is a notable advancement in the study of ADHD in women, as the majority of research on ADHD has prioritized school-aged boys,” authors concluded. “Our research group intends to use the themes identified from these focus groups to conduct one-on-one interviews with women with ADHD. Individual interviews may provide even more fine-grained detail on women’s experiences with ADHD beyond the findings that emerged from the focus groups.”
