ADHD Comorbidities Split Along Gender Lines: New Study
Learning disabilities and conduct disorders are more common among men with ADHD, while women with ADHD are more likely to experience emotional and sleep disorders, according to a new study that notably did not consider eating disorders or migraines.
January 22, 2025
Men with ADHD experience higher rates of learning disabilities, tics, oppositional defiant disorder (ODD), and conduct disorder, while women with ADHD face an elevated relative risk for emotional and sleep disorders, according to a new cross-sectional study published in PLOS One1. The research, which found a higher incidence of comorbid psychiatric conditions among adult men than any other demographic, notably did not examine eating disorders or migraines, two comorbid conditions known to be more common in women and girls with ADHD.
According to 3,152 ADDitude readers surveyed in 2022, 16% of women with ADHD reported having an eating disorder, compared to 7% of men. Similarly, a 2023 ADDitude survey of 7,095 adults found that 22% of women reported a migraine diagnosis, compared to only 8% of men. The same gender disparity is true for anxiety (74% in women vs. 63% in men) and depression (62% in women vs. 51% in men), according to ADDitude survey results.
These gender differences mirror those of prior scientific research that found higher rates of anxiety and depression in women compared with men before and after their ADHD diagnosis2.
“Comorbidity is the rule rather than the exception,” said Lotta Skoglund, M.D., Ph.D., in her 2024 ADDitude webinar, “The Emotional Lives of Girls with ADHD.” “When you have a girl or woman with ADHD, you should be prepared for anxiety, depression, eating disorders, self-harm, even more serious than actually for the boys.”
The new cross-sectional study analyzed the age, sex, and psychiatric diagnoses of 112,225 individuals with ADHD, using data collected between January 2000 and December 2011 from the Taiwan National Health Insurance Research Database. (The researchers noted their use of a Taiwanese database may affect the results’ applicability across cultures.)
Among children ages 12 and younger, the prevalence of learning disabilities, ODD, and sleep disorders were evenly split between the genders. Boys of any age were twice as likely as girls to experience a tic disorder. In adolescence, depressive disorders became markedly more common among girls (29.41%) compared to boys (17.74%) in the Taiwanese study. The same is true for anxiety disorder (35.22% in girls vs. 30.8% in boys) and sleep disorder (24.89% in girls vs. 17.36% in boys).
Surprisingly, the Taiwanese study shows a reversal in adulthood, with depression, anxiety, and bipolar disorder becoming more common in men than women. These findings contradict other similar studies and the ADDitude survey data cited above.
Perhaps less surprisingly, the researchers found that adult male participants had higher rates of alcohol use disorder when compared with women. This discrepancy also reflects the 2023 ADDitude survey, in which 10.75% of men reported substance use disorder, compared to 6.83% of women.
“Alcohol use can mask genuine ADHD manifestations,” the researchers wrote. “The convergence of ADHD and substance use disorder complicates diagnosis, with affected individuals facing greater challenges, including elevated suicide risk and treatment complexities.”
Notably, two-thirds of the cross-sectional study participants were boys ages 12 and under; less than 3% of participants were women over the age of 18. This relative scarcity of data on adults may have skewed results. Despite these and other limitations, examining the relationship between comorbidity, age, and sex is important given the impact of overlapping conditions on treatment.
“From the perspective of me as a clinician and a researcher, I know that just by fulfilling the criteria for ADHD, you will live about 10 fewer years than a person of the same age, sex, and socioeconomic status,” Skoglund said. “Many of these years are lost due to the comorbidity in undetected and untreated ADHD.”
ADHD diagnoses are more common in males during childhood and adolescence, according to the study. However, this pattern appears to reverse in adulthood.
“Our data show a reversal in the male-to-female ADHD ratio from childhood to adulthood, possibly due to under-recognition of ADHD in young females and reduced help-seeking behavior among adult males,” the researchers wrote.
This lower rate of ADHD in young and adolescent girls reflects research demonstrating that ADHD often goes undiagnosed or misdiagnosed in women2. At the same time, the impact of toxic masculinity and stigma on men and boys with ADHD has not been thoroughly examined.
“In my many years of ADHD coaching, I’ve encountered countless women who struggle with their husband’s or young adult son’s resistance to seek or accept an ADHD diagnosis because they fear the ‘stigma’ of the disorder,” wrote ADHD coach Alan P. Brown in the ADDitude article, “ADHD Symptoms in Men Manifest Differently.” “In their male minds, it’s admitting to ‘weakness.’”
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1 Kao PH, Ho CH, Huang CLC (2025) Sex differences in psychiatric comorbidities of attention-deficit/hyperactivity disorder among children, adolescents, and adults: A nationwide population-based cohort study. PLOS One, 20(1): e0315587. https://doi.org/10.1371/journal.pone.0315587
2 Siddiqui, U., Conover, M. M., Voss, E. A., Kern, D. M., Litvak, M., & Antunes, J. (2024). Sex Differences in Diagnosis and Treatment Timing of Comorbid Depression/Anxiety and Disease Subtypes in Patients With ADHD: A Database Study. Journal of Attention Disorders, 0(0). https://doi.org/10.1177/10870547241251738
