Understanding Stimulant Treatment in Attention-Deficit/Hyperactivity Disorder: A Sex and Gender Perspective

Although stimulant medications are the primary pharmacological intervention for attention-deficit/hyperactivity disorder (ADHD), our understanding of sex and gender influences on stimulant treatment remains limited. Clinical guidelines do not differ for female and male individuals despite possible sex and gender-related differences in pharmacokinetics, effectiveness, and adverse events. This theoretical framework identifies six knowledge gaps in sex and gender effects in stimulant treatment by investigating every step of the stimulant treatment trajectory pathway including diagnosis, prescription, daily use and outcomes. We explore potential mechanisms, summarize existing literature, propose testable predictions, and suggest directions for future research. Key areas of interest include the impact of hormonal fluctuations during the menstrual cycle and female reproductive life transitions, the influence of gender socialization and gendered expectations on stimulant effectiveness, diagnosis and prescription rates, stigma, and treatment adherence. While the scarce data available cannot support sex/gender-specific treatment guidelines, there is a pressing need for studies to systematically investigate these factors. Understanding these influences could enhance treatment outcomes for girls and women with ADHD throughout their lives and provide support in times of biological and gender role transitions.