Female-specific pharmacotherapy in ADHD: premenstrual adjustment of psychostimulant dosage

ADHD and Alcohol Use Disorder: Optimizing Screening and Treatment in Co-occurring Conditions

Attention deficit hyperactivity disorder (ADHD) is notably overrepresented in substance use treatment centers, with an estimated prevalence of 21-23% when screening practices are implemented. Many adults in these settings receive an ADHD diagnosis for the first time, highlighting the frequent underdiagnosis of ADHD among individuals seeking treatment for alcohol and substance use issues. Additionally, those entering treatment programs represent only a small fraction of the broader population with problematic alcohol use. This review explores the research on the prevalence and treatment of co-occurring ADHD and substance use disorders (SUD), with a particular emphasis on alcohol use disorders (AUD) as the most common SUD. It also provides clinical guidelines for the screening and diagnosis of ADHD in patients with active alcohol and substance use and offers recommendations to enhance screening practices and improve access to treatment for individuals with co-occurring ADHD and AUD.

Evaluating the evidence: a systematic review of reviews of the effectiveness and safety of digital interventions for ADHD

BACKGROUND

Attention-Deficit/Hyperactivity Disorder (ADHD) impacts academics, work and social relationships. Digital interventions, such as virtual reality, games, app and other, offer accessible therapeutic options, yet understanding their efficacy and potential adverse effects is crucial for safe use. The objective of this study is to identify and analyze the efficacy and adverse effects reported in systematic reviews of digital interventions for ADHD.

METHODS

We conducted a systematic review of systematic reviews to assess the reported efficacy and safety of digital interventions for ADHD. We searched for relevant publications in Scopus, PubMed, PsycINFO and Cochrane Library. Both study selection and data extraction were performed in duplicate to ensure accuracy and reduce bias. This review followed PRISMA 2020 guidelines, PRISMA-harms checklist, and we used AMSTAR-2 to assess the quality and risk of bias of the included reviews.

RESULTS

A total of 26 systematic reviews on digital interventions for ADHD were included. These reviews collectively involved 34,442 participants, with the majority focusing on children and adolescents. The digital interventions analyzed included video games, computerized cognitive training, virtual reality, apps, and others. The outcomes reported various positive effects, such as improvements in inattention and executive function, though evidence was generally low quality. Adverse effects were reported in 8 of the 26 included reviews (30,1%), and included physical discomfort, emotional reactions, and behavioral issues, such as video game addiction.

CONCLUSIONS

This systematic review of systematic reviews indicates that while digital interventions for ADHD show potential benefits, their effectiveness remains inconclusive due to low evidence quality. Adverse effects, particularly from video games, have been reported but are inconsistently documented. Future research should focus on rigorous safety assessments, standardized reporting, and long-term effectiveness.

TRIAL REGISTRATION

This systematic review is registered in Prospero: CRD42024521084.

ADHD and Sex Hormones in Females: A Systematic Review

OBJECTIVE

ADHD is a neurodevelopmental condition associated with elevated symptoms of inattention and hyperactivity/impulsivity. Symptoms of ADHD typically persist into adulthood and can impair functioning and overall quality of life. In females (including women and people assigned female at birth), ADHD is under-recognized, and knowledge about the relationship between ADHD symptoms and sex hormones is lacking. This systematic review aimed to synthesize the current evidence investigating the relationship between ADHD symptoms (including medication effects) and sex hormones in females.

METHOD

Searches were conducted within Ovid MEDLINE, Embase, and PsycINFO from 1980 to January 2025. Included studies investigated ADHD symptoms in the context of hormonal changes in females, including studies specifically exploring ADHD and sex hormones, as well as hormonal life stages (puberty, menstrual cycle, and pregnancy). Narrative synthesis was utilized for data extraction, grouping studies by hormonal phase.

RESULTS

A total of 11 studies were included in this review. Evidence was largely suggestive of a relationship between ADHD symptoms and sex hormones in females, specifically in puberty and across the menstrual cycle. Findings were limited by the small number of studies reviewed, often with small sample sizes and considerable diversity in participant populations and outcome measures.

CONCLUSION

Sex hormones and phases related to hormonal changes (such as puberty and the menstrual cycle) may be associated with ADHD symptom changes in females. Further research is needed to understand the relationship between sex hormones and ADHD symptoms and requires investigation of a wider range of hormonal milestones in females, including menopause.

Gender differences in ADHD and impulsivity among alcohol or alcohol- and cocaine-dependent patients

Background

Impulsivity plays a fundamental role in the realm of addiction as is considered a risk factor for addiction. Moreover, it influences the age of onset, severity, and therapeutic management of addictions. The aim of this study was to explore measures of impulsivity in a cohort of male and female diagnosed with Alcohol Use Disorder (AUD) and contrast these findings with those from a group with Alcohol and Cocaine Use Disorder (ACUD).

Methodology

A total of 204 patients (153 men and 51 women) underwent evaluation using Adult ADHD Self-Report Scale (ASRS), Barrat Impulsiveness Scale (BIS-11), Zuckerman-Kuhlman Personality Questionnaire (ZKPQ), Visual Analogue Scale (VAS), Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI).

Results

A total of 24.6% of the sample (21.9% AUD group and 32.2% ACUD group) screened positive for ADHD. Differences were observed in Total Impulsivity (T(199) =-2.587, p=.010), with the mean score being higher in the ACUD group. Gender differences were noted with ADHD exhibiting a significant explanatory power for impulsivity (greater than 37%) in women compared to men, where its relevance is minimal. Among women, an inverse relationship was found between impulsivity and activity and sociability, in contrast to men, where the inverse relationship was with intolerance to isolation. Both men and women showed associations between ADHD and elevated levels of anxiety and depression. Study limitations and practical implications are discussed.

Conclusions

Although this is an observational study and should be develop a longitudinal study, we detected that the presence of ADHD in addicted women significantly influences impulsivity and should be systematically assessed due to the differences in the clinical approach.

A Review of Sex and Gender Factors in Stimulant Treatment for ADHD: Knowledge Gaps and Future Directions

OBJECTIVE

Stimulant medications are the primary pharmacological intervention for ADHD, yet our understanding of how sex and gender impact stimulant treatment outcomes remains limited. Clinical guidelines do not differ for female and male individuals despite possible sex and gender-related differences in effectiveness, adverse events, and pharmacokinetics. This theoretical framework identifies five key knowledge gaps relating to sex and gender effects in stimulant treatment.

METHOD

We investigate the stimulant treatment trajectories of girls and women with ADHD from diagnosis and prescription to daily use and outcomes. We examine the impact of reproductive life transitions and hormonal fluctuations and their interactions with gender socialization and gendered expectations on treatment effectiveness, stigma, and adherence.

RESULTS

By synthesizing existing literature, proposing testable predictions, and suggesting future research directions, we highlight the urgent need for studies that systematically investigate these factors.

CONCLUSION

Addressing these gaps could significantly improve treatment outcomes for girls and women with ADHD, particularly during biological and gender role transitions.

The effects of psychostimulants in menstruating women with ADHD - A gender health gap in ADHD treatment?

INTRODUCTION

Attention-deficit/hyperactivity disorder is a chronic disorder that begins in childhood and often persists into adulthood. There are clinical observations of a cycle-dependent efficacy of psychostimulants in the treatment of ADHD. This relationship appears to be poorly researched.

METHODS

A narrative literature review is used to provide an overview of the current state of research and to draw implications for necessary future research.

RESULTS

Two studies examined the influence of psychostimulants on female sex hormones in women with ADHD. Another four studies suggested that ADHD symptoms worsen during the luteal phase of the menstrual cycle. Two studies provided a specific intervention tailored to the menstrual cycle.

DISCUSSION

Women with ADHD remain understudied and are likely to be mistreated. Investigation of the efficacy of psychostimulants in menstruating women with ADHD seems necessary and long overdue.

CONCLUSION

This highlights the gender health gap in our society and the need for further research to develop an understanding of behavioural and neuroscientific processes in order to adapt treatment strategies for women with ADHD.

A Female-Specific Treatment Group for ADHD-Description of the Programme and Qualitative Analysis of First Experiences

Background: The diagnostics and treatment of attention-deficit/hyperactivity disorder (ADHD) in women remain insufficient. Fluctuations of reproductive hormones during the premenstrual period, postpartum period, and (peri)menopause are neglected, even though they impact ADHD symptoms and associated mood disorders. Therefore, we created a female-specific treatment group for women with ADHD and premenstrual worsening of ADHD and/or mood symptoms. Methods: We describe the group programme and underlying rationale, offering a qualitative analysis of the participants' evaluation. Results: The seven bi-weekly sessions foreground the menstrual cycle and address several ADHD-specific topics in relation to this cyclical pattern. Concurrently, women track their menstrual cycle and (fluctuating) ADHD and mood symptoms with an adjusted premenstrual calendar. In total, 18 women (25-47 years) participated in three consecutive groups. We analysed the evaluation of the last group. Participants experienced the group as a safe and welcoming space. Recognition was valued by all. The topics discussed were deemed valuable, and the structure suited them well. Completing the premenstrual calendar augmented the awareness and recognition of individual cyclical symptoms. A lifespan approach increased self-understanding. Participants took their menstrual cycle more seriously, prioritising self-acceptance and self-care. Conclusions: Exploring a cyclical approach in a group setting seems to be a positive addition to treatment for female ADHD.