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Research advances and future directions in female ADHD : the lifelong interplay of hormonal fluctuations with mood, cognition, and disease
Abstract
INTRODUCTION: Attention-Deficit/Hyperactivity Disorder (ADHD) in girls and women is under-recognised and under-researched, despite increasing awareness of clinical challenges and unmet needs. This review by the Eunethydis Special Interest Group on Female ADHD, addresses current knowledge and identifies research gaps for future work. Issues in women with ADHD across the lifespan such as late diagnosis, pubertal development, sexual health, hormonal birth control, executive function difficulties, and gynaecological disorders associated with ADHD are highlighted. METHODS: The review synthesises existing literature and self-reported experiences of women with ADHD to explore the impact of hormonal fluctuations [puberty, menstrual cycle, pregnancy, (peri)menopause] on ADHD symptoms and mood disturbances. It examines the interplay of oestrogen and progesterone with dopaminergic pathways, when periods of lower oestrogen may affect cognition, as well as the manifestation of executive function deficits, and the intersection of ADHD with reproductive health. RESULTS: Hormonal transitions exacerbate ADHD symptoms and mood disturbances, yet pharmacological research and tailored treatments are lacking. Executive function deficits manifest differently in girls and women with ADHD and are influenced by neuropsychological and neurobiological profiles. Diagnostic practices and sociocultural factors contribute to delayed diagnoses, increasing the risk of comorbidities, impaired functioning, and diminished quality of life. Undiagnosed women have increased vulnerability to premenstrual dysphoric disorder, postpartum depression, and cardiovascular disease during perimenopause. DISCUSSION: Longitudinal, sex-specific studies incorporating hormonal status and lived experience are needed. Individualised interventions should be developed to address the unique needs of girls and women with ADHD. Addressing these gaps will advance more equitable diagnosis, management, and support for girls and women with ADHD, improving outcomes across the female lifespan.
Author
Kooij, J J Sandra
de Jong, Maxime
Agnew-Blais, Jessica
Amoretti, Silvia
Bang Madsen, Kathrine
Barclay, Isabella
Bölte, Sven
Borg Skoglund, Charlotte
Broughton, Thomas
Carucci, Sara
van Dijken, Dorenda K E
Ernst, Julia
French, Blandine
Frick, Matilda A
Galera, Cédric
Groenman, Annabeth P
Kopp Kallner, Helena
Kerner Auch Koerner, Julia
Kittel-Schneider, Sarah
Manor, Iris
Martin, Joanna
Matera, Emilia
Parlatini, Valeria
Philipsen, Alexandra
Ramos-Quiroga, Josep Anthoni
Rapoport, Iris L
Remnélius, Karl Lundin
Sénéquier, Amandine
Thorell, Lisa
Wittekoek, Janneke M E
Wynchank, Dora
de Jong, Maxime
Agnew-Blais, Jessica
Amoretti, Silvia
Bang Madsen, Kathrine
Barclay, Isabella
Bölte, Sven
Borg Skoglund, Charlotte
Broughton, Thomas
Carucci, Sara
van Dijken, Dorenda K E
Ernst, Julia
French, Blandine
Frick, Matilda A
Galera, Cédric
Groenman, Annabeth P
Kopp Kallner, Helena
Kerner Auch Koerner, Julia
Kittel-Schneider, Sarah
Manor, Iris
Martin, Joanna
Matera, Emilia
Parlatini, Valeria
Philipsen, Alexandra
Ramos-Quiroga, Josep Anthoni
Rapoport, Iris L
Remnélius, Karl Lundin
Sénéquier, Amandine
Thorell, Lisa
Wittekoek, Janneke M E
Wynchank, Dora
Citations
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Date
2025
Type
Article
Subject
Attention deficit disorder with hyperactivity, Hormones, Cognition
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Citation
Kooij, J. J. S., de Jong, M., Agnew-Blais, J., Amoretti, S., Bang Madsen, K., Barclay, I., Bölte, S., Borg Skoglund, C., Broughton, T., Carucci, S., et al. (2025). Research advances and future directions in female ADHD : the lifelong interplay of hormonal fluctuations with mood, cognition, and disease. Frontiers in Global Women's Health, 6, pp.1613628.
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DOI
PMID
Publisher
Frontiers Media
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Publisher’s statement
© 2025 Kooij, de Jong, Agnew-Blais, Amoretti,
Bang Madsen, Barclay, Bölte, Borg Skoglund,
Broughton, Carucci, van Dijken, Ernst, French,
Frick, Galera, Groenman, Kopp Kallner, Kerner
auch Koerner, Kittel-Schneider, Manor, Martin,
Matera, Parlatini, Philipsen, Ramos-Quiroga,
Rapoport, Remnélius, Sénéquier, Thorell,
Wittekoek and Wynchank. This is an open access article distributed under the terms of
the Creative Commons Attribution License
(CC BY). The use, distribution or reproduction
in other forums is permitted, provided the
original author(s) and the copyright owner(s)
are credited and that the original publication in
this journal is cited, in accordance with
accepted academic practice. No use,
distribution or reproduction is permitted
which does not comply with these terms.
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