Sex Differences in Adult ADHD: A Multidimensional Multi-Informant Observational Study
Anna Magnesa1, Elena Costagli1, Francesco De Dominicis1,2
1Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56126 Pisa, Italy.
Journal of Clinical Medicine
|August 13, 2026
Summary
Adult women with ADHD exhibit distinct clinical profiles, including higher emotional dysregulation and internalizing comorbidities. Emotional dysregulation significantly influences self-reported ADHD severity in females, highlighting the importance of assessment methods.
Area of Science:
- Neurodevelopmental Disorders
- Clinical Psychology
- Psychiatry
Background:
- Sex differences in adult Attention-Deficit/Hyperactivity Disorder (ADHD) require further investigation, especially in referred populations using multi-method assessments.
- Understanding these differences is crucial for accurate diagnosis and tailored interventions.
Purpose of the Study:
- To investigate sex differences in clinical presentation, comorbidities, and ADHD severity in adults.
- To examine the specific roles of emotional dysregulation and rating-source effects in these sex differences.
Main Methods:
- A comprehensive assessment of 212 adults with ADHD (93 females, 119 males) at a tertiary referral service.
- Analysis of sociodemographic, clinical, comorbidity, functional, and psychometric data, including self- and observer-rated ADHD severity.
- Statistical modeling (regression, mediation, mixed-effects models) to explore the influence of emotional dysregulation.
Main Results:
- Females presented with more inattentive symptoms, higher rates of mood, anxiety, and eating disorders, and greater emotional dysregulation.
- While observer-rated ADHD severity did not differ by sex, females reported higher self-rated severity.
- Emotional dysregulation significantly mediated the relationship between female sex and higher self-reported ADHD severity.
Conclusions:
- Adult females with ADHD have a distinct clinical profile, marked by increased internalizing comorbidities and emotional dysregulation.
- Emotional dysregulation explains a significant portion of the elevated self-reported ADHD severity in females.
- Sex differences in adult ADHD assessment may be influenced by the rating source and the presence of emotional dysregulation.
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