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.

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.