Introduction
The attention deficit and hyperactivity disorder (ADHD) is a neurosviluppo disorder characterized by a persistent carelessness pattern, hyperactivity and impulsiveness, whose onset is typically placed in childhood.
Although the ADHD has been historically considered a predominantly pediatric and male disorder, in recent decades there has been a growing recognition of its persistence in adulthood and its manifestation also in the female population.
Numerous evidences suggest that the ADHD remains clinically significant in a percentage between 50% and 70% of cases diagnosed in evolutionary age, while in other subjects it can make or be recognized only in adulthood.
This shift of the focus has led to the need for greater understanding of the characteristics of the disorder in the adult population, also in light of gender differences that influence their clinical expression, diagnosis and treatment.
ADHD in adulthood
The ADHD in adulthood presents itself with an often less striking clinical picture than that of the evolutionary age, but can still result in a significant degree of functional impairment.
The difficulty of recognition is linked to the fact that the symptoms tend to take less evident forms or are masked by compensatory strategies learned over time.
In addition, comorbidity with other psychiatric disorders can obscure diagnosis.
In adult subjects, the main symptoms of the ADHD are frequently manifested through:
Inattention
- Difficulty maintaining attention on long or repetitive tasks.
- Tendency to make distraction errors, especially in activities that require precision.
- Frequent forgetfulness (appointments, deadlines, personal objects).
- Poor organization and time management.
- Difficulty in completing complex activities or that require sequential planning.
- Avoidance or procrastination of mentally demanding tasks.
Hyperactivity and impulsiveness
- Internal restlessness, constant feeling of tension or agitation.
- Difficulty in staying sitting for a long time or relaxing.
- Frequent interruption of the conversations of others.
- Marked impatience and difficulty waiting for your turn.
- Impulsive decisions, sometimes with negative consequences (e.g. non -weighted purchases, sudden work changes).
Emotional disregulation
- Quick mood swings and disproportionate emotional reactions.
- Intense frustration for small obstacles.
- Sensitivity to refusal and criticism.
These manifestations can significantly compromise:
- Interpersonal and family relationships.
- Working stability and professional performance.
- The management of everyday life (finance, health, responsibility).
Influence of the genre on the symptomatological presentation
However, the clinical manifestations of the ADHD in adulthood can vary significantly according to the genre, influencing both the presentation of the symptoms and the probability of receiving an accurate diagnosis.
Women tend to receive one more late diagnosis Compared to men, often only in adulthood or following the diagnosis of their children. This is due to both real differences in the symptoms and the persistence of cultural stereotypes.
Symptoms more frequently observed in adult men
- Greater presence of hyperactivity and impulsiveness.
- Tendency to outsourcing manifestations (disorganized, explosive, oppositional behaviors).
- Greater involvement in risk behaviors (substances abuse, dangerous guide, illegal activities, excessive financial expenses).
- More frequent work instability and frequent changes of employment.
- Conduct disorders and behavioral problems.
Symptoms more frequently observed in adult women
- Predominance of carelessness with respect to hyperactivity.
- High emotional disregulation: anxiety, floating mood, sensitivity to refusal.
- More internalizing behaviors: low self -esteem, sense of inadequacy, dysfunctional perfectionism.
- Greater probability of comorbidity with other psychiatric disorders: anxiety, depression, bipolar disorder, eating disorders.
- Greater difficulties in the organization and management of time.
- Tendency to mask symptoms and to internalize the discomfort to adapt to social expectations.
Factors that contribute to more early diagnosis in men
- The symptoms are more “outsourcing” and therefore tend to be more easily identifiable in childhood, leading to more early diagnosis.
Factors that contribute to subordinosis in women
- They tend to show more “internal” and less evident symptoms, such as inattention, organizational difficulties, inner restlessness.
- They often develop “masking” strategies to hide their difficulties, making the recognition of the ADHD more difficult.
- These symptoms can be exchanged for anxiety, depression or simply character traits, leading to late diagnosis or missed.
- Distortion of clinical evaluation because diagnostic criteria are built on male models
- Prevailing comorbidity that obscure the underlying ADHD
Clinical and social consequences
- The late diagnosis in females can lead to an accumulation of stress and unrecognized school or work difficulties. When finally diagnosed, the ADHD in females is often more serious due to the delay in the intervention.
- Difficulty building personalized therapeutic paths
The treatment of the ADHD: towards a clinical approach sensitive to gender differences
Treatment in adulthood usually requires a multimodal approach, which may include:
- Stimulating drugs (e.g. methylfenida, lisdexamfetamine) or non -stimulating (e.g. atomoxetine, gloves).
- Psychotherapeutic interventions, in particular cognitive-behavioral therapy.
- Psychoeducation: provide clear information on the disorder to patients, parents and partners. This is essential to improve awareness and adherence to treatment.
The clinical-tractual approach sensitive to gender differences in the ADHD therapy is an increasingly relevant theme in modern medicine. Here are some key elements.
Pharmacotherapy
Stimulating drugs such as methylfenida are more commonly used in men. Females tend to respond differently to stimulating drugs than males.
In particular, females can show one slower response and greater sensitivity to side effects Like insomnia, loss of appetite or irritability. This could derive from biological differences, such as hormonal levels that influence the metabolization of drugs.
Hormonal fluctuations, in particular the levels of estrogen and progesterone, can have a significant impact on the symptoms of ADHD in women. Low levels of estrogen, such as those that occur in the premenstrual phase, in the post-parto period and during menopause, can exacerbate the symptoms of the ADHD as the difficulty of concentration, emotional discomfort and tiredness.
Understand theInteraction between hormones and ADHD It is essential to customize the treatment. In some cases, it may be useful to monitor symptoms in relation to the menstrual cycle and consider pharmacological adjustments or additional support strategies during the most critical phases.
Hormonal replacement therapy (Tos) in perimenopause or menopause could, in some cases, have a positive effect on the symptoms of the ADHD, but careful medical evaluation is necessary.
Cognitive-behavioral therapy (CBT)
CBT is a reference treatment for ADHD, particularly effective for improving symptoms management.
The approach should be adapted to the patient’s sex and specific needs.
For males: men with ADHD could benefit more than a most oriented approach to the management of behaviors. The CBT for males should focus on practical strategies to improve time management, concentration and impulsiveness.
For females: women with ADHD, who often also present symptoms of anxiety and low self -esteem, could benefit from an integrated CBT, which not only faces the symptoms of the ADHD but also emotional problems.
Mindfulness and relaxation techniques
Women with ADHD often experience high levels of anxiety and stress. Mindfulness and meditation can improve concentration and reduce impulsiveness.
Psychological support and support groups
Sharing experiences with other women with ADHD can be useful for developing practical strategies and feeling less sunshine in the management of the condition.
In conclusion
The evidence emerged underline the need to overcome a uniform and neutral clinical model.
A modern clinical approach to adult ADHD should:
- Use more inclusive diagnostic criteria that take into account the variety of symptomatological presentations.
- Encourageing future research to better understand the neurobiological and hormonal bases of gender differences in the ADHD and how these influence the response to treatment.
- Promote a personalized and sensitive therapeutic approach to the genre that recognizes the unique needs of men and women with ADHD.
Bibliography
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, Va: American Psychiatric Publishing.
- Faraone, sv, et al. (2021). Attention-Deposit/Hyperactivity Disorder. Nature Reviews Disease Primers, 7 (1), 1–21.
- Quinn, Po, & Madhoo, M. (2014). A Review of ADHD in Women and Girls. The Primary Care Companion for CNS Disorders, 16 (3).
- Rucklidge, JJ (2010). Gender Differences in ADHD. Psychiatric Clinics of North America, 33 (2), 357–373.
- Nussbaum, NL (2012). ADHD AND FEMALE SPECIFIC CONNERNS. Journal of Attention Disorders, 16 (2), 87–100.
- Mowlem F, et al. (2019). Sex Differences in Predicting ADHD Clinical Diagnosis and Pharmacological Treatment.
