Sex Differences and Lifestyle Changes in ADHD

In a discussion with Psychiatric Times, Justin Kei, MD, outpatient medical director at Hackensack Meridian Health, discussed evolving perspectives in the diagnosis and management of attention-deficit hyperactivity disorder (ADHD), emphasizing sex-based differences, diagnostic challenges, and holistic care. Kei noted that traditional diagnostic criteria for ADHD have historically emphasized externalizing, hyperactive behaviors, which are more characteristic of male presentations, while underrecognizing inattentive and internalizing symptoms more common in females. This discrepancy contributes to underdiagnosis of ADHD in women and underscores the importance of clinician awareness when eliciting histories and collateral information.

Dr Kei highlighted the forthcoming American Professional Society on ADHD and Related Disorders guidelines for adult ADHD as a significant step toward standardization, given the growing recognition of adult ADHD and the need for consistent diagnostic and management approaches. He stressed the importance of comprehensive evaluation to rule out mimicking conditions such as bipolar disorder, sleep disturbances, or substance use.

Lifestyle interventions, including optimizing sleep hygiene, diet, and exercise, are foundational components of ADHD management, Kei said. He advocated for practical, individualized behavioral strategies, citing evidence that even modest physical activity can improve attention and mood regulation.¹

Emerging research directions include neurobiological individualization of ADHD diagnosis, potential use of biomarkers, and exploration of related syndromes such as cognitive disengagement syndrome. Kei emphasized the need to account for hormonal fluctuations across the menstrual cycle, pregnancy, and menopause in the assessment and treatment of women with ADHD—an area of increasing clinical and research importance.²

Dr Kei is the outpatient medical director at Hackensack Meridian Health.

References

1. Mahindru A, Patil P, Agrawal V. Role of Physical Activity on Mental Health and Well-Being: A Review. Cureus. 2023;15(1):e33475.

2. Eng AG, Nirjar U, Elkins AR, et al. Attention-deficit/hyperactivity disorder and the menstrual cycle: theory and evidence. Horm Behav. 2024;158:105466.