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

Tamara Williams Orcid Logo, Isabella Barclay, Rhys Bevan-Jones Orcid Logo, Lucy A. Livingston Orcid Logo, Sharifah Shameem Agha, Tamsin Ford Orcid Logo, Ann John Orcid Logo, Kapil Sayal Orcid Logo, Anita Thapar, Joanna Martin Orcid Logo

The British Journal of Psychiatry, Pages: 1 - 8

Swansea University Author: Ann John Orcid Logo

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DOI (Published version): 10.1192/bjp.2025.10376

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. Thi...

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Published in: The British Journal of Psychiatry
ISSN: 0007-1250 1472-1465
Published: Royal College of Psychiatrists 2025
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URI: https://cronfa.swan.ac.uk/Record/cronfa70029
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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. 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NIHR-FS(A)-2022). T.F.&#x2019;s research group received funds for research methods consultation with Place2Be, a third-sector organisation providing mental health interventions and training within schools. R.B.-J. was supported by a NIHR/HCRW post-doctoral fellowship programme (no. 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spelling 2025-10-02T12:28:43.3505942 v2 70029 2025-07-24 Reflections on the manifestation of attention-deficit hyperactivity disorder in girls from young adults with lived experiences: a qualitative study ed8a9c37bd7b7235b762d941ef18ee55 0000-0002-5657-6995 Ann John Ann John true false 2025-07-24 MEDS 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. Journal Article The British Journal of Psychiatry 0 1 8 Royal College of Psychiatrists 0007-1250 1472-1465 Attention-deficit hyperactivity disorders; qualitative research; childhood experience; child and adolescent psychiatry; diagnosis and classification 22 9 2025 2025-09-22 10.1192/bjp.2025.10376 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee This study was funded by the Welsh Government through Health and Care Research Wales (HCRW) via a National Institute for Health and Care Research (NIHR) Advanced Fellowship (no. NIHR-FS(A)-2022). T.F.’s research group received funds for research methods consultation with Place2Be, a third-sector organisation providing mental health interventions and training within schools. R.B.-J. was supported by a NIHR/HCRW post-doctoral fellowship programme (no. NIHR-PDF-2018) 2025-10-02T12:28:43.3505942 2025-07-24T12:55:44.4044751 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Tamara Williams 0009-0000-1492-6160 1 Isabella Barclay 2 Rhys Bevan-Jones 0000-0001-8976-9825 3 Lucy A. Livingston 0000-0002-8597-6525 4 Sharifah Shameem Agha 5 Tamsin Ford 0000-0001-5295-4904 6 Ann John 0000-0002-5657-6995 7 Kapil Sayal 0000-0002-2050-4316 8 Anita Thapar 9 Joanna Martin 0000-0002-8911-3479 10 70029__35226__7d51ba47d441458a8fd2c82ae10d7407.pdf 70029.VoR.pdf 2025-10-02T12:20:11.5315521 Output 306325 application/pdf Version of Record true © The Author(s), 2025. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence. true eng https://creativecommons.org/licenses/by/4.0/
title Reflections on the manifestation of attention-deficit hyperactivity disorder in girls from young adults with lived experiences: a qualitative study
spellingShingle Reflections on the manifestation of attention-deficit hyperactivity disorder in girls from young adults with lived experiences: a qualitative study
Ann John
title_short Reflections on the manifestation of attention-deficit hyperactivity disorder in girls from young adults with lived experiences: a qualitative study
title_full Reflections on the manifestation of attention-deficit hyperactivity disorder in girls from young adults with lived experiences: a qualitative study
title_fullStr Reflections on the manifestation of attention-deficit hyperactivity disorder in girls from young adults with lived experiences: a qualitative study
title_full_unstemmed Reflections on the manifestation of attention-deficit hyperactivity disorder in girls from young adults with lived experiences: a qualitative study
title_sort Reflections on the manifestation of attention-deficit hyperactivity disorder in girls from young adults with lived experiences: a qualitative study
author_id_str_mv ed8a9c37bd7b7235b762d941ef18ee55
author_id_fullname_str_mv ed8a9c37bd7b7235b762d941ef18ee55_***_Ann John
author Ann John
author2 Tamara Williams
Isabella Barclay
Rhys Bevan-Jones
Lucy A. Livingston
Sharifah Shameem Agha
Tamsin Ford
Ann John
Kapil Sayal
Anita Thapar
Joanna Martin
format Journal article
container_title The British Journal of Psychiatry
container_volume 0
container_start_page 1
publishDate 2025
institution Swansea University
issn 0007-1250
1472-1465
doi_str_mv 10.1192/bjp.2025.10376
publisher Royal College of Psychiatrists
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
active_str 0
description 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.
published_date 2025-09-22T12:35:06Z
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