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

Abstract

Attention deficit hyperactivity disorder (ADHD) turns into a common neuro progressional disorder. Although gender identity has obtained increasing attention in ADHD researches, its role in ADHD presentation and treatment response remains underexplored. Our review seeks to mainly delve into the effect of gender identity on ADHD, exploring the unique needs of individuals with various gender identities in the context of ADHD symptoms, diagnostic assessment, and treatment, with the goal of supplying theoretical support and practical recommendations for future research and clinical practice. The primary content includes, specifically: (1) Symptom expression differences: Gender identity significantly affects ADHD symptoms; male-identified individuals commonly perform worse in task orientation and attention stability, while female-identified individuals may demonstrate more variability in attention control and executive functions; (2) Diagnosis and treatment: Clinical practice generally neglects the impact of gender identity on ADHD management, with personalized needs of gender-identified individuals frequently not adequately addressed, potentially, affecting treatment outcomes; and (3) Future research directions: Future studies should further assess how gender identity affects the specific mechanisms of ADHD, conduct researches in multicultural contexts, and engage in long-term follow-up studies to evaluate the long-term impact of gender identity on ADHD progression. Besides, enhanced funding and public education on the relationship between gender identity and ADHD are needed to advance the field.

Key Words: Gender identity; Attention deficit hyperactivity disorder; Neurodevelopmental disorders; Manifestation differences; Neuro progressional disorder; Diagnosis; Assessment

Core Tip: This review explores the impact of gender identity on the presentation of attention deficit hyperactivity disorder (ADHD). The article highlights that gender identity plays a significant role in ADHD symptom expression, diagnostic assessment, and treatment response. Research shows notable differences between male- and female-identifying individuals in task orientation and attention stability, with clinical practice often overlooking the influence of gender identity on ADHD management. The review calls for future research to further investigate how gender identity affects the specific mechanisms of ADHD, especially through long-term studies in multicultural contexts. Additionally, it advocates for increased funding and public education to support personalized and equitable ADHD treatment.

INTRODUCTION

In contemporary mental health researches, attention deficit hyperactivity disorder (ADHD) stands as a common neurodevelopmental disorder affecting both adults and children, affecting modifying behavior, learning, and social functioning[1]. The central symptoms of ADHD include inattention, hyperactivity, and impulsivity, which vitally significantly impact the quality of life of those affected[2]. ADHD patients commonly illustrate deficits in social cognition and prosocial behavior, in detail, such as difficulties with theory of mind, emotional self-regulation, and affective recognition, affecting their peer relationships and emotional bonding[3]. Besides, long-term evidence confirm that ADHD not only adversely affects academic achievement under childhood, but also persists into adulthood, causing low occupational achievement, emotional regulation difficulties, and challenges in social and familial relationships[4].

Gender identity, as a complex social construct and personal recognition process, involves an individual’s experience of self-perception and recognition of their own gender[5]. Lately, scholars have increasingly centered on the relationship between gender identity and mental health, in particular, during neurodevelopmental disorders, such as ADHD[6]. With the deepening investigation of gender identity, researches have examined how gender identity affects ADHD manifestations, diagnosis, and treatment responses[7,8]. Although existing literatures has explored gender differences in ADHD, research on the personalized needs and treatment responses of individuals with different gender identities remains relatively limited[7,8]. Furthermore, study indicated significant differences in ADHD manifestations between males and females, in detail, during symptom expression and internalization[9]. Consequently, our review primarily delves into the impact of gender identity on ADHD, exploring the specific needs of individuals with various gender identities in ADHD symptomatology, diagnostic evaluation, and treatment, to provide theoretical support and practical recommendations for future research and clinical practice.

GENDER IDENTITY AND DIFFERENCES IN ADHD PRESENTATION

Before investigating the specific strategies in which ADHD symptoms manifest across various gender identities, it is important to determine the broader context of how gender identity itself affects symptom expression. Gender identity, as a deeply personal and social construct, plays a vital role in comprising the behaviors, perceptions, and self-reports of individuals with ADHD. This section explores these variations in ADHD symptomatology, emphasizing the distinct challenges faced by male- and female-identifying individuals, as well as those experiencing gender transitions. Figure 1 illustrates impact of gender identity on ADHD symptom presentation and socio-cultural influences.

Figure 1 Impact of gender identity on attention deficit hyperactivity disorder symptom presentation and socio-cultural influences. This figure illustrates the impact of gender identity on the presentation of attention deficit hyperactivity disorder symptoms, revealing differences in attention difficulties, hyperactivity, and impulsivity between male-identifying, female-identifying, and gender-transitioning individuals. It also emphasizes the socio-cultural factors, such as societal expectations and stigma, that influence the perception, reporting, and treatment of attention deficit hyperactivity disorder across different gender identities[8-21]. ADHD: Attention deficit hyperactivity disorder.

Symptom presentation by gender

Comparison of attention difficulties across different gender identities: One of the core symptoms undergone by individuals with ADHD turns into difficulty maintaining attention[10]. Notably, nonetheless, there are significant differences in how this symptom manifests across different gender identities. Evidence on ADHD symptoms in children and adolescents confirms that gender significantly affects the presentation of attention deficits and hyperactivity[11]. Individuals who identify as male typically exhibit poorer performance in task-oriented activities and attention stability, while those who identify as female may demonstrate greater variability in attention control and executive function[9,11]. Besides, there are notable gender differences in attention-related issues and behavioral symptoms in ADHD[12], especially female-identifying ADHD patients may demonstrate higher levels of cognitive and emotional disturbances linked to internalizing symptoms, and are more likely to be underestimated or misdiagnosed compared to their male-identifying counterparts[8,12].

Differences in hyperactivity and impulsive behaviors among gender identities: Another primary feature of ADHD is hyperactivity and impulsive behavior, which also varies significantly among different gender identities. For example, evidence found that boys are generally more likely to exhibit significant hyperactivity and impulsive behaviors, while girls tend to show symptoms of inattention, causing gender bias in diagnosis. This results in boys being diagnosed earlier, while girls may experience delays in diagnosis due to less obvious symptoms[13]. Study showed that male-identifying individuals commonly present with more pronounced symptoms of physical activity and impulsivity, whereas female-identifying individuals may illustrate more covert impulsivity, such as internal restlessness and emotional instability[14]. Furthermore, individuals experiencing gender transition may exhibit various patterns of hyperactivity and impulsivity during gender affirmation and identity exploration stages, affected by both internal identity changes and external social interactions[15].

Influence of socio-cultural factors

The impact of gender identity on the perception and reporting of ADHD symptoms: Gender identity significantly affects the perception and reporting of ADHD symptoms. Evidences have uncovered that individuals of different gender identities may show marked differences in perceiving and describing ADHD symptoms, due to variations in self-identity and social roles[8,16]. Individuals undergoing gender transition may experience bias or overemphasis in the perception of ADHD symptoms, due to differences in gender identity exploration and social acceptance[8,16]. For instance, studies have suggested that after transitioning to align with their gender identity, certain individuals might lower emphasis on ADHD symptoms, potentially due to enhanced confidence and social support in their new gender role[12,16]. Besides, gender affects the diagnostic and treatment processes for ADHD. Study has observed that females commonly report lower scores for ADHD symptoms, partly due to biases and cognitive distortions of medical professionals concerning female ADHD symptoms[9]. Consequently, these gender differences may necessitate more personalized and sensitive approaches in ADHD treatment, and support strategies to adequately consider an individual’s gender identity and social role.

Societal acceptance and understanding of ADHD symptoms in different gender identities: Socio-cultural factors significantly affect how individuals of different gender identities face ADHD symptoms[17]. In particularly, study showed that individuals with different gender identities may encounter varying degrees of societal pressure and expectations, due to differences in gender expression and social roles, which can cause different responses and choices regarding ADHD symptoms[16].

For male-identifying individuals, societal pressure and expectations commonly support the display of hyperactive and impulsive symptoms, as these behaviors are perceived as congruent with male roles[8,18]. Conversely, female-identifying individuals may face more societal constraints and norms, leading them to be more likely to conceal or control their ADHD symptoms to prevent negative social evaluation[19,20]. Besides, individuals undergoing gender transition may experience uncertainty under their gender affirmation process, which can affect their self-perception and social interactions concerning ADHD symptoms[21]. These complex socio-cultural dynamics not only affect individuals’ understanding, acceptance of their symptoms, but also present significant challenges and opportunities for enhancement in the diagnosis, treatment, and support strategies for ADHD[16,20].

CHALLENGES OF GENDER IDENTITY IN ADHD DIAGNOSIS AND ASSESSMENT

Applicability of diagnostic criteria

As we explore the applicability of current ADHD diagnostic criteria, it is essential to determine that these tools were developed based on broad population studies that commonly do not account for the complexity of gender identity. This limitation poses unique challenges for diagnosing ADHD in individuals who do not indicate to conventional gender roles. The following section delves deeper into how these criteria may fall short when assessing gender nonconforming individuals, stressing the need for a more inclusive approach to ADHD diagnosis. Table 1 illustrates ADHD diagnostic challenges and recommendations.

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.

Assessment of current ADHD diagnostic criteria for gender nonconforming individuals: Although ADHD diagnostic criteria, notably, are generally based on extensive population studies and clinical practice, their applicability and effectiveness may pose challenges for gender nonconforming individuals[22]. Evidences have confirmed that current ADHD diagnostic tools and assessment criteria, in detail, may not fully account for the diversity of gender identities and the process of gender identity exploration[23,24]. In practice, gender nonconforming individuals might exhibit behavioral patterns inconsistent with traditional ADHD symptom descriptions, due to changes in gender identity and social roles[9]. For instance, in the context of gender affirmation, notably, individuals may demonstrate varying levels of attention difficulties and hyperactivity at different times, potentially affecting the accuracy of ADHD diagnosis and assessment[23,24]. Current research highlights significant gender influences on ADHD presentations, with females commonly illustrating more attentional deficits rather than hyperactivity-impulsivity, and symptom onset may be slowed[24]. Besides, diagnostic biases and inadequate standards in clinical practice may cause misdiagnosis or under recognition of ADHD in gender nonconforming individuals[24]. To enhance the sensitivity and specificity of diagnostic tools, further researches and clinical evidence centering on gender nonconforming individuals are needed. Such studies can ensure that ADHD assessment tools effectively capture and evaluate symptom expressions across different gender identities, ultimately facilitating diagnostic and treatment outcomes[12,24]. Overall future research should center on validating and strengthening existing ADHD diagnostic tools across various gender identities to better meet the diagnostic needs of diverse groups, and trigger precision medicine.

Challenges faced by gender nonconforming individuals in ADHD diagnosis: Gender nonconforming individuals may encounter various dilemmas and challenges under the ADHD diagnostic process, stemming from the specificity of their gender identity and the complexity of social contexts[16]. They may face challenges related to the applicability of diagnostic tools and assessment strategies, as traditional ADHD assessment tools might not account for the gender identity exploration and transition processes, causing potential biases or misjudgments in symptom identification and evaluation[9]. Societal prejudice and discrimination against gender nonconforming individuals may also impact their willingness and ability to seek and receive ADHD diagnoses[25]. They might choose to conceal symptoms due to societal pressures or misunderstanding, or undergo delays or neglect in diagnosis due to psychological stress during gender identity transition[26]. Besides, the lack of professionals or insufficient training may pose another challenge for gender nonconforming individuals[27]. Health and mental health professionals might lack sensitivity and understanding of the unique needs of gender nonconforming individuals, causing communication difficulties and inappropriate handling during the diagnostic process[28-30]. The challenges faced by gender nonconforming individuals in ADHD diagnosis, overall, include not only issues with the adaptability of diagnostic tools, but also insufficient support from social and professional environments, necessitating comprehensive understanding and targeted enhancements to enhance diagnostic accuracy and fairness.

Limitations of assessment tools

To fully identify the limitations of current ADHD assessment tools, it is crucial to delve into how these tools apply to gender nonconforming individuals. While traditional strategies have served general populations, they commonly fail to consider the complexities linked to gender identity. The following section explores the specific challenges these individuals face when undergoing ADHD assessments, stressing the need for a more inclusive and sensitive diagnostic approach. Table 2 displays detailed ADHD assessment tool limitations and recommendations.

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.

Analysis of the applicability and limitations of common ADHD assessment tools for gender nonconforming individuals: Common ADHD assessment tools face certain applicability and limitations, notably, when assessing gender nonconforming individuals. These tools are commonly based on traditional symptom manifestations and research designs centered on the general population, which may not fully account for the diversity of gender identities and the unique circumstances of individuals.

Traditional ADHD assessment tools, such as the ADHD Rating Scale, primarily count on self-reported symptoms and objective observations. This approach may be subject to interpretative biases when applied to gender nonconforming individuals[8,31]. Gender nonconforming individuals may undergo varying psychological states and social role transitions during their gender identity exploration, which can cause differing symptom presentations at various stages. This variability may cause inaccuracies or incomplete identification of symptoms by assessment tools[32]. Meanwhile, gender nonconforming individuals might conceal or suppress their symptoms, due to concerns about societal discrimination or medical bias. This concealment complicates the accurate reflection of their true symptom status by traditional assessment tools[33,34]. Besides, assessment tools, apparently, may not consider the unique needs of gender nonconforming individuals, such as the psychological stress and identity uncertainty linked to gender transition, further limiting their applicability[35].

Hence, to enhance the applicability of common ADHD assessment tools for gender nonconforming individuals, it is essential to conduct more thorough researches to explore and validate specialized assessment tools for this population or revise existing tools. This would ensure that the assessment tools can more accurately identify and assess ADHD symptoms in gender nonconforming individuals, providing a more effective basis for personalized treatment and support strategies.

Recommendations for facilitating existing assessment tools to address the needs of gender nonconforming individuals: (1) Consideration of gender identity diversity and individual differences. It is crucial to account for the diversity of gender identity and the different stages individuals may undergo during their gender identity exploration in the design and application of assessment tools. Gender identity diversity encompasses not only traditional male and female categories but also non-binary genders, transgender individuals, and other gender identities. This diversity implies that different gender identities may exhibit significant variations in symptom manifestations, emotional experiences, and coping mechanisms[36,37]. Individuals delving into their gender identity, in detail, may undergo various stages, which can affect their symptom presentation in neurodevelopmental disorders such as ADHD. For example, transgender or non-binary individuals may undergo additional psychological stress or social challenges under the exploration and affirmation of their gender identity, which may impact their attention, impulse control, and behavioral patterns[38]. Evidences, apparently, have confirmed that the exploration and affirmation of gender identity can vitally impact individuals’ mental health and behavioral expressions[32,39]. Therefore, when designing and utilizing assessment tools, it is essential to obtain an in-depth understanding and classification of symptom presentation patterns among different gender identities. This classification should center on surface symptoms, as well as consider the psychological and social factors individuals experience during the gender identity process. Through such detailed analysis, the sensitivity and specificity of diagnostic tools can be promoted, better meeting the needs of different gender identities and providing more accurate diagnoses and personalized treatment plans; and (2) Increasing education and training on gender identity. Healthcare and mental health professionals should receive specialized education and training on gender identity to enhance their understanding and sensitivity to the unique needs of gender nonconforming individuals. Gender identity involves an individual’s deep-seated sense of their gender, which may not align with their assigned sex at birth. Misunderstandings or neglect of gender identity issues, notably, can cause biases and misconceptions in medical and psychological evaluations, hence affecting diagnostic accuracy and treatment outcomes[29,39]. Professional training should include foundational knowledge on gender identity, relevant psychological and physiological aspects, and strategies for providing sensitive and informed care.

CONCLUSION

Summary of the impact of gender identity on ADHD presentation

Our review examines the role of gender identity in ADHD, indicating a significant impact on the manifestation of ADHD symptoms. Individuals with various gender identities exhibit distinct patterns of ADHD presentation, in detail, in core symptoms, such as attention difficulties, hyperactivity, and impulsive behavior. Specifically: (1) Male-identifying individuals generally exhibit poorer performance in task-oriented activities and attention stability, which may cause greater challenges in academic and professional settings. ADHD symptoms in male-identifying individuals, commonly, are more pronounced and easily recognizable; and (2) Female-identifying individuals, apparently, may demonstrate more variability in attention control and executive function, with their ADHD symptoms commonly turning into more subtle and prone to being neglected or misdiagnosed. Besides, female-identifying individuals might face unique challenges related to emotional regulation and social difficulties.

Considerations of gender identity in clinical practice

Current clinical practices commonly overlook the impact of gender identity in managing ADHD. Differences in symptom presentation and treatment responses among gender identities, already, reveal that traditional treatment approaches may not meet all patients’ needs. To enhance treatment efficacy, the following considerations are recommended: (1) Personalized treatment: Treatment strategies should be tailored to the patient’s gender identity, for instance, male-identifying individuals with hyperactive symptoms may benefit from more behavioral interventions and medication, while female-identifying individuals with subtle symptoms, apparently, may require more detailed psychological counseling and emotional support; (2) Multidisciplinary collaboration: Clinicians should collaborate with psychologists, social workers, and other professionals to develop comprehensive treatment, notably, plans that address the multifaceted needs of individuals with various gender identities; and (3) Education and training: Healthcare providers, urgently, should receive training on the relationship between gender identity and ADHD to increase sensitivity to and capability in addressing the specific needs of gender-identifying individuals.

Directions for future research

Despite existing studies on the relationship between gender identity and ADHD, numerous questions remain unanswered, and research gaps persist. Future research should delineate short-term and long-term objectives to effectively address these gaps. In the short term, notably, efforts should center on the progression and validation of inclusive diagnostic tools that accommodate diverse gender identities, ensuring accurate and equitable diagnosis for non-binary, transgender, and other gender-diverse populations. Besides, it is essential to validate existing ADHD assessment instruments across different gender identity groups to identify and mitigate potential biases. In the long term, meanwhile, researches should prioritize the advancement of policies that support ADHD management for individuals with diverse gender identities, incorporating gender sensitivity into healthcare training and practices. Expanding cross-cultural studies is also crucial to identify how various cultural and social contexts affect the interplay between gender identity and ADHD, hence boosting the establishment of universal diagnostic and treatment standards. In the context of clearly distinguishing between short-term and long-term goals, future research, potentially, can mainly bridge knowledge gaps and deepen the understanding of the complex interactions between gender identity and ADHD, ultimately informing clinical practices and policy progression.

Policy recommendations

Based on the existing research findings, several policy recommendations, notably, have been put forward to effectively address the intersection of gender identity and ADHD. Ensure equitable access to gender-affirming care by establishing specialized clinics and providing mandatory training programs for healthcare providers. This includes advocating for legislation to protect individuals from gender-based discrimination in medical settings. Promoting comprehensive treatment is of vital significance. Medical institutions should adopt comprehensive and multidisciplinary treatment plans that combine behavioral therapy, psychological counseling, and medications tailored to the unique needs of individuals with different gender identities. Besides, supporting relevant research, potentially, is crucial for enhancing the understanding of this field. More funding should be allocated to research projects exploring the neurobiological and psychological mechanisms between gender identity and ADHD, as well as longitudinal and cross-cultural, in detail, comparative studies that strengthen the generalizability of research findings. Moreover, carrying out nationwide public education campaigns utilizing various media platforms, progressing informative educational materials, and establishing partnerships with community organizations can effectively disseminate knowledge about the role of gender identity in managing ADHD. Enhancing the adaptability of the healthcare system to gender diversity involves implementing inclusive policies and practices, such as using preferred pronouns, providing gender-neutral facilities, as well as ensuring the privacy and security of patients with gender diversity. Allocating resources to develop support services, comprising specialized counseling and peer support groups, and establishing mechanisms to monitor and assess the effectiveness of these policies will ensure continuous enhancement and meet the needs of gender-diverse individuals with ADHD. By implementing these comprehensive strategies, policymakers can create a more inclusive and effective medical environment that meets the diverse needs of individuals with various gender identities, ultimately causing better health outcomes and greater equity in ADHD management.

ACKNOWLEDGEMENTS

We would like to thank Dr. Jasmine Thompson for the language quality polishing.