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

Table 2 Detailed attention deficit hyperactivity disorder assessment tool limitations and recommendations

Aspect	Description	Proposed solution	Ref.
Limitations of common ADHD assessment tools	Common tools, such as ADHD-RS, are based on traditional symptom manifestations which do not account for gender identity diversity	Conduct further research to develop or revise ADHD assessment tools to better capture gender identity variations	[8,31]
Challenges due to psychological states and social role transitions	Gender nonconforming individuals may exhibit different symptoms due to varying psychological states and social role transitions during gender exploration	Adapt tools to consider fluctuations in symptoms related to gender identity exploration and transitions	[32]
Concealment of symptoms due to societal discrimination	Some individuals may suppress or conceal symptoms due to societal stigma, causing underreporting or misdiagnosis	Design tools to accommodate the potential for symptom concealment by gender nonconforming individuals	[33,34]
Exclusion of unique needs like psychological stress and identity uncertainty	Existing tools may not consider the psychological stress and uncertainty that gender nonconforming individuals face, in particular, during gender transition	Include psychological stress and identity uncertainty in assessment tools to reflect the experiences of gender nonconforming individuals	[35]
Inaccurate reflection of true symptom status	Bias in self-reported symptoms leads to an incomplete or inaccurate diagnosis, failing to capture the true symptomatology of individuals	Improve tools to enhance sensitivity and specificity, reducing the likelihood of bias and misdiagnosis	[33,34]
Need for specialized or revised ADHD assessment tools	Current tools require adaptation or the progression of new tools to better identify ADHD symptoms in gender nonconforming individuals	Develop specialized tools or adapt current ones to ensure ADHD symptoms in gender nonconforming individuals are accurately assessed	[32,35]
Diversity in gender identity and symptom manifestation	Gender identity diversity implies significant variations in symptom presentations, necessitating specialized attention in assessment tools	Ensure that assessment tools are inclusive of non-binary, transgender, and other gender identities by accounting for symptom diversity	[36,37]
Impact of gender exploration on ADHD symptoms	The exploration and affirmation of gender identity can impact attention, impulse control, and behavior, requiring an understanding of this in diagnosis	Develop tools that consider how gender identity exploration affects neurodevelopmental symptoms like ADHD	[38]
Importance of detailed classification for diagnosis	Accurate diagnosis requires detailed classification, focusing not only on symptoms but also on psychological and social experiences	Implement detailed analysis of symptom patterns in diverse gender identities to enhance diagnostic accuracy	[32,39]
Need for education and training on gender identity in healthcare	Healthcare professionals need better education and training on gender identity to lower bias and improve diagnostic outcomes	Healthcare and mental health professionals should undergo gender identity training to enhance diagnostic sensitivity and care	[29,39]

ADHD: Attention deficit hyperactivity disorder; ADHD-RS: Attention deficit hyperactivity disorder rating scale.