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

From: Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women

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.