女性注意力缺陷多动障碍的研究进展与未来方向：激素波动与情绪、认知及疾病的终身相互作用
Research advances and future directions in female ADHD: the lifelong interplay of hormonal fluctuations with mood, cognition, and disease.
作者信息
Kooij J J Sandra, de Jong Maxime, Agnew-Blais Jessica, Amoretti Silvia, Bang Madsen Kathrine, Barclay Isabella, Bölte Sven, Borg Skoglund Charlotte, Broughton Thomas, Carucci Sara, van Dijken Dorenda K E, Ernst Julia, French Blandine, Frick Matilda A, Galera Cédric, Groenman Annabeth P, Kopp Kallner Helena, Kerner Auch Koerner Julia, Kittel-Schneider Sarah, Manor Iris, Martin Joanna, Matera Emilia, Parlatini Valeria, Philipsen Alexandra, Ramos-Quiroga Josep Anthoni, Rapoport Iris L, Remnélius Karl Lundin, Sénéquier Amandine, Thorell Lisa, Wittekoek Janneke M E, Wynchank Dora
机构信息
Department of Psychiatry, Amsterdam University Medical Center/VUmc, Amsterdam, Netherlands.
Expertise Center Adult ADHD, PsyQ, Psycho-medical Programs, The Hague, Netherlands.
出版信息
Front Glob Womens Health. 2025 Jul 7;6:1613628. doi: 10.3389/fgwh.2025.1613628. eCollection 2025.
INTRODUCTION
Attention-Deficit/Hyperactivity Disorder (ADHD) in girls and women is under-recognised and under-researched, despite increasing awareness of clinical challenges and unmet needs. This review by the Eunethydis Special Interest Group on Female ADHD, addresses current knowledge and identifies research gaps for future work. Issues in women with ADHD across the lifespan such as late diagnosis, pubertal development, sexual health, hormonal birth control, executive function difficulties, and gynaecological disorders associated with ADHD are highlighted.
METHODS
The review synthesises existing literature and self-reported experiences of women with ADHD to explore the impact of hormonal fluctuations [puberty, menstrual cycle, pregnancy, (peri)menopause] on ADHD symptoms and mood disturbances. It examines the interplay of oestrogen and progesterone with dopaminergic pathways, when periods of lower oestrogen may affect cognition, as well as the manifestation of executive function deficits, and the intersection of ADHD with reproductive health.
RESULTS
Hormonal transitions exacerbate ADHD symptoms and mood disturbances, yet pharmacological research and tailored treatments are lacking. Executive function deficits manifest differently in girls and women with ADHD and are influenced by neuropsychological and neurobiological profiles. Diagnostic practices and sociocultural factors contribute to delayed diagnoses, increasing the risk of comorbidities, impaired functioning, and diminished quality of life. Undiagnosed women have increased vulnerability to premenstrual dysphoric disorder, postpartum depression, and cardiovascular disease during perimenopause.
DISCUSSION
Longitudinal, sex-specific studies incorporating hormonal status and lived experience are needed. Individualised interventions should be developed to address the unique needs of girls and women with ADHD. Addressing these gaps will advance more equitable diagnosis, management, and support for girls and women with ADHD, improving outcomes across the female lifespan.
引言
尽管对临床挑战和未满足需求的认识不断提高，但女孩和女性的注意力缺陷/多动障碍（ADHD）仍未得到充分认识和研究。Eunethydis女性ADHD特别兴趣小组的这篇综述阐述了当前的认知，并确定了未来研究的空白。文中强调了ADHD女性在整个生命周期中面临的问题，如诊断延迟、青春期发育、性健康、激素避孕、执行功能困难以及与ADHD相关的妇科疾病。
方法
该综述综合了现有文献以及ADHD女性的自我报告经历，以探讨激素波动[青春期、月经周期、怀孕、（围）绝经期]对ADHD症状和情绪障碍的影响。研究了雌激素和孕激素与多巴胺能通路的相互作用，低雌激素时期可能影响认知的情况，以及执行功能缺陷的表现，还有ADHD与生殖健康的交叉问题。
结果
激素变化会加剧ADHD症状和情绪障碍，但缺乏药理学研究和针对性治疗。ADHD女孩和女性的执行功能缺陷表现不同，并受神经心理学和神经生物学特征影响。诊断实践和社会文化因素导致诊断延迟，增加了共病风险、功能受损和生活质量下降。未被诊断的女性在围绝经期更容易患经前烦躁障碍、产后抑郁症和心血管疾病。
讨论
需要开展纳入激素状态和生活经历的纵向、针对性别的研究。应制定个性化干预措施，以满足ADHD女孩和女性的独特需求。填补这些空白将推动对ADHD女孩和女性进行更公平的诊断、管理和支持，改善女性整个生命周期的结局。
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