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Female athletes with ADHD: time to level the playing field

British journal of sports medicine, 2024-04, p.bjsports-2024-108068 [Peer Reviewed Journal]

Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ. ;2024 Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ. ;ISSN: 0306-3674 ;EISSN: 1473-0480 ;DOI: 10.1136/bjsports-2024-108068 ;PMID: 38688694

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  • Title:
    Female athletes with ADHD: time to level the playing field
  • Author: Collins, Kelly
  • Subjects: Athletes ; Attention deficit hyperactivity disorder ; Editorial ; Female ; Females ; Mental disorders ; Self esteem
  • Is Part Of: British journal of sports medicine, 2024-04, p.bjsports-2024-108068
  • Description: ADHD can impact recovery from concussion, be influenced by hormonal fluctuations and affect mental health and social relationships, particularly in females.3 4 The purpose of this editorial is to raise awareness of the often-overlooked topic of ADHD in female athletes and encourage more investigation in this field. Females with ADHD are less likely to be identified by parents, teachers and healthcare professionals, with one study showing that girls required a higher symptom burden than boys to meet diagnostic criteria and were more likely to be diagnosed and treated for an alternative disorder before receiving a diagnosis of ADHD.6 Bruchmüller et al also demonstrated that when presented with a clinical vignette, therapists were twice as likely to diagnose ADHD when the patient described was a boy compared with a girl, even though the history in the vignette did not meet the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV or International Classification of Diseases-10 criteria for ADHD.5 Mothers of children with ADHD reported that the DSM-IV better described boys than girls, particularly on items relating to aggression.7 Waschbusch and King reported on a subset of girls who did not meet the DSM criteria for ADHD or oppositional defiant disorder but were identified using sex-specific norms and that these girls were more significantly impaired than other girls.8 It has also been suggested that part of the reason females remain undiagnosed is that they may be more adept at developing coping strategies that render their symptoms less evident to other.6 Table 1 summarises the presenting features of ADHD in females, and table 2 contrasts the presenting symptoms of males and females. Table 1 ADHD symptomatology commonly seen in females4 8 Symptom domain (from DSM-V criteria for ADHD) Common manifestation in females Hyperactivity Hyperactivity is primarily internalised Less aggressive, impulsive and disruptive features Higher symptom burden required for diagnosis Inattention Predominance of inattentive features: forgetful, distractible, disorganised, ‘dreamy’ May experience cyclical fluctuations with menstrual cycle Impact on social/behavioural function Adolescent cigarette smoking and pregnancy Poor self-esteem, external locus of control Relationship challenges (eg, with family, peers) Emotional dysregulation Academic and career underachievement Misdiagnosis with an alternative psychiatric disorder Coping and masking behaviours (eg, people pleasing) Vulnerability to sexual exploitation, harassment and abuse Comorbidities Anxiety and depression Substance misuse Compulsive disorder and perfectionism Eating disorders ADHD, attention deficit hyperactivity disorder; DSM, Diagnostic and Statistical Manual of Mental Disorders. Historically, research has focused on the recognition of ADHD in children, perhaps initially because ADHD was not thought to be prevalent or persistent in adults or due to the irrefutable importance of early diagnosis and implementation of strategies to support those with the condition.9 It must be acknowledged, however, that ADHD does indeed persist into adulthood, and many of our female athletes have yet to be diagnosed and stand to benefit from the validation and treatment fostered by an adult diagnosis.9 Improving care for female athletes Neurodivergent people encounter several barriers to involvement in sports, including difficulties with planning and time management, sensorimotor challenges, social problems and behavioural issues.3 People with ADHD are at increased risk of sports injury, complicated concussion with prolonged recovery10 11 and inadequate nutrition, particularly relevant to females as a risk factor for relative energy deficiency in sports (RED-S) and sleep disturbances.12 13 Proper nutrition and sleep are crucial for athletic training and performance and, if impaired, may exacerbate ADHD symptoms.10 In addition, pharmacological treatment in athletes may carry an increased risk of complications such as hyperthermia and cardiac dysrhythmias, and stimulants are on the prohibited list of drugs in competitive sport.2 No studies exist exploring the specific challenges females face from ADHD in the sporting context.
  • Publisher: England: BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine
  • Language: English
  • Identifier: ISSN: 0306-3674
    EISSN: 1473-0480
    DOI: 10.1136/bjsports-2024-108068
    PMID: 38688694
  • Source: ProQuest Central
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