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Annual Research Review: Attention-deficit/hyperactivity disorder in girls and women: underrepresentation, longitudinal processes, and key directions
Journal of Child Psychology and Psychiatry ( IF 7.6 ) Pub Date : 2021-07-06 , DOI: 10.1111/jcpp.13480
Stephen P Hinshaw 1, 2 , Phuc T Nguyen 1 , Sinclaire M O'Grady 1 , Emily A Rosenthal 1
Affiliation  

Attention-deficit/hyperactivity disorder (ADHD) – and its underlying behavioral dimensions of inattention and hyperactivity–impulsivity – have been understudied in females. We first cover the conceptual issues of prevalence, diagnostic practices, diversity, comorbidity, and causal factors, plus forces limiting awareness of ADHD in females. After a narrative review of cross-sectional and longitudinal findings, we conclude the following. (a) Girls meet diagnostic criteria for ADHD at just under half the rates of boys, a ratio that becomes much closer to equal by adulthood. (b) Girls and women with ADHD show a predominance of inattention and associated internalizing problems; boys and men display greater levels of hyperactive–impulsive symptoms and associated externalizing problems. (c) Sex differences in ADHD symptoms and related outcomes depend heavily on the clinical versus nonreferred nature of the samples under investigation. (d) Females with ADHD experience, on average, serious impairments, with a particularly heightened risk for problems in close relationships and engagement in self-harm. (e) Clinicians may overlook symptoms and impairments in females because of less overt (but still impairing) symptom manifestations in girls and women and their frequent adoption of compensatory strategies. Our review of predictors and mediators of adult outcomes highlights (a) the potential for heterotypically continuous pathways in females with childhood ADHD and (b) developmental progressions to self-harm, intimate partner violence, unplanned pregnancy, and comorbid psychopathology. Focusing on ADHD in females is necessary to characterize causal and maintaining mechanisms with accuracy and to foster responsive interventions, as highlighted in our closing list of clinical implications and research priorities.

中文翻译:

年度研究回顾:女孩和妇女的注意力缺陷/多动障碍:代表性不足、纵向过程和关键方向

注意力缺陷/多动障碍(ADHD)——以及其潜在的注意力不集中和多动——冲动的行为维度——在女性身上尚未得到充分研究。我们首先涵盖了患病率、诊断实践、多样性、合并症和因果因素的概念问题,以及限制女性多动症意识的力量。在对横断面和纵向发现进行叙述性回顾后,我们得出以下结论。(a) 女孩符合 ADHD 诊断标准的比例略低于男孩的一半,这一比例在成年后变得更加接近平等。(b) 患有多动症的女孩和妇女主要表现出注意力不集中和相关的内化问题;男孩和男性表现出更高水平的多动冲动症状和相关的外化问题。(c) ADHD 症状和相关结果的性别差异在很大程度上取决于所调查样本的临床与非参考性质。(d) 平均而言,患有多动症的女性有严重的损伤,尤其是亲密关系中出现问题和参与自残的风险更高。(e) 临床医生可能会忽视女性的症状和损害,因为女孩和妇女的症状表现不那么明显(但仍有损害),而且她们经常采用补偿策略。我们对成人结果的预测因素和中介因素的回顾突出了(a)儿童多动症女性异型连续途径的潜力和(b)自残、亲密伴侣暴力、意外怀孕和共病精神病理学的发育进展。
更新日期:2021-07-06
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