Analysis reveals ADHD associations with externalizing and internalizing symptoms differ by sex in youth, suggesting limited differentiation implications.
ADHD is often characterized as having clinically relevant sex-differentiated manifestations. We revisited this popular conjecture and examined whether ADHD symptoms’ associations with 88 theoretically-relevant external validators (e.g., psychopathology, neurocognitive tasks) varied by sex. To do so, we used four waves of data from a large community sample of youth (N = 11,878, ages 9 through 13). Only 4.1% of tests (157 / 3,760) supported significant sex-differentiated manifestations of ADHD or its individual symptoms. ADHD and some of its symptoms (e.g., inattentive, impulsive, hyperactive) were more strongly associated with externalizing in boys than girls, but ADHD and other symptoms (i.e., inattentive, acted young) were also more associated with internalizing and thought problems in boys than girls. Most observed sex-differentiated manifestations were very small to small in magnitude, with only a handful emerging as large, suggesting sex-differentiated manifestations of ADHD may be the exception rather than the rule.
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Peng et al. (2025) studied this question.
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