Issues Which Marginalize Females with ADHD - A Mixed Methods Systematic Review

Background Marked disadvantages of females with ADHD were identified by previous narrative reviews. Factors side-lining females with ADHD appear to be both biological and sociological in nature. Some published systematic reviews have focused on circumscribed aspects of female ADHD. An all-inclusive systematic review of the inequities which confer a status of marginalization to females with ADHD is required, to comprehensively understand all implications of female ADHD. Objectives The aim of this review was to identify and synthesize quantitative and qualitative evidence of issues which marginalize females with ADHD. Methods A mixed methods systematic review following a convergent integrated approach, as outlined by the Joanna Briggs Institute’s manual for evidence synthesis was undertaken. Databases were accessed through the Hydro Data Initiative platform of the University of Malta. All types of studies were considered for inclusion. Extracted quantitative findings were transformed into qualitative findings prior to synthesis. The review protocol was registered with PROSPERO CRD42022384055. Results 34 papers were included in the review. Synthesis led to the emergence of five themes, namely ‘The gender gap in ADHD recognition, diagnosis and treatment’, ‘ADHD-related problems in females’, ‘Female ADHD and negative mental health sequelae’, ‘ADHD and female sexual and reproductive health issues’ and ‘The influence of ADHD on motherhood’. Conclusions Critically appraised, synthesized findings conclude that females with ADHD are disadvantaged in a number of ways. Clinicians and policy makers have access to latest evidence on all issues marginalizing females with ADHD in this mixed methods systematic review. Recommendations for policy and practice are advanced, together with directions future research ought to follow.