Table 5 Treating ADHD in girls and women: key consensus recommendations

Pharmacological treatment

• Medication recommendations do not differ by sex and differ only modestly by age.

• Treatment monitoring may require deviation from conventional outcomes from rating scales and behaviour management. Individualised targets (e.g. emotional lability, academic attainment) may be more appropriate.

• Prescribing needs to consider interactions between ADHD and other medications for comorbid conditions, where applicable.

• Where mood problems are apparent but not pervasive it is advisable to treat ADHD symptoms and monitor for improvement first, prior to considering or initiating treatment for mood disorders.

• Appetite suppression as a side effect of stimulant medication should be considered if eating disorders are a concern.

• Risks of substance use whilst on ADHD medications should be considered and discussed with patients.

• Treatment with ADHD medications is generally not advised during pregnancy or breastfeeding.

• Review is advised during and after key periods of hormonal change (menopause, pregnancy).

• Psychoeducation on pharmacological treatment options and treatment targets for parents and affected girls may help to improve adherence and engagement.

• Regular review is required throughout development and may be especially important at times of key transitions.

Non-pharmacological treatment

• Whenever possible, provide psychoeducation taking a lifespan approach.

• Parents and carers of teenage girls need psychoeducation to support detection of deliberate self-harming or risky behaviour.

• Follow-up sessions are essential for support at key points of transition.

• Interventions should be tailored to needs and address difficulties and challenges faced at home, school/work and in social activities.

• Both group and individual assessments may be beneficial.

• Direct parental input into interventions is required for children. Adolescents and adults are more likely to receive direct interventions without parental/carer input.

• Programmes for all ages will benefit from focus on ADHD symptoms and associated problems, including executive functions, emotion regulation, conduct and social impairments, in an age-sensitive manner.

• Programmes should differ depending on age with issues relating to transition,

• As relevant, risk (sexual risk, substance misuse), and self-management should be addressed in adolescence, with adult interventions including employment problems, child-rearing and parenting.