Gender identity and its impact on attention deficit hyperactivity disorder manifestations: Challenges in diagnosis and assessment

Table 1 Split attention deficit hyperactivity disorder diagnostic challenges and recommendations

Aspect	Issue with existing approach	Impact on diagnosis	Recommended solutions	Ref.
Challenges in applicability of diagnostic criteria	Current ADHD diagnostic tools lack consideration for gender diversity	Leads to challenges in accurately diagnosing gender nonconforming individuals	Further research to improve tools that consider gender diversity	[22-24]
Behavioral patterns inconsistent with traditional ADHD descriptions	Gender-affirming individuals show behavioral patterns inconsistent with standard ADHD descriptions	Behavioral discrepancies cause misalignment with traditional symptom criteria, causing diagnostic errors	Develop ADHD criteria that reflect the behavioral shifts during gender transition	[9,23,24]
Gender-related differences in symptom presentation	Females commonly show attentional deficits instead of hyperactivity, which is overlooked in traditional assessments	Delayed diagnosis in females and gender nonconforming individuals due to inattentiveness toward unique symptoms	Better attention to gender-specific symptoms in diagnostic practices	[9,24]
Diagnostic bias and misdiagnosis risk	Clinical biases cause misdiagnosis due to gender-influenced symptom expression	Biases cause underdiagnosis or overdiagnosis, depending on gender identity	Lower clinical biases and improve tools to recognize gender-influenced symptoms	[9,24]
Need for promoted diagnostic sensitivity and specificity	Current tools do not account for unique symptom patterns in gender nonconforming individuals	Leads to inaccurate diagnosis and unmet needs for gender nonconforming individuals	Enhance diagnostic sensitivity and specificity through research on gender identities	[12,24]
Challenges in traditional assessment tools for gender nonconforming individuals	Traditional tools are not adapted to the processes of gender exploration and transition	Diagnostic inaccuracies are common due to lack of gender-adaptive tools	Create ADHD assessment tools that account for gender identity exploration	[9,24]
Societal prejudice and stigma impact	Societal stigma affects access to accurate diagnosis and treatment	Worsens the willingness and ability of individuals to seek diagnosis and treatment	Raise awareness and educate society to lower stigma and improve diagnosis	[25,26]
Concealment of symptoms due to social pressure	Social pressure causes concealment of symptoms, complicating diagnosis	Underdiagnosis or misdiagnosis due to hidden symptoms affected by societal pressures	Implement support mechanisms that allow for better self-reporting without societal pressure	[25,26]
Lack of professional training and sensitivity	Healthcare professionals lack adequate training to diagnose gender nonconforming individuals	Poor diagnostic outcomes due to lack of professional sensitivity	Provide targeted training for healthcare professionals to improve diagnosis	[27-30]
Recommendations for future research and enhancement	Current tools are not validated for diverse gender identities and lack precision	Research is needed to improve precision and fairness in ADHD diagnosis	Further research and validation studies to optimize tools for all gender identities	[12,24]

ADHD: Attention deficit hyperactivity disorder.