The significance of attention deficit hyperactivity disorder (ADHD) in athlete populations has received much attention over the last decade. ADHD is the most commonly diagnosed neurodevelopmental disorder, with a global prevalence of 5.9%–7.1% in adolescents and a male predominance ranging from 1.8 to 3.5:1.1 The prevalence may be even higher in athlete populations, at 7%–8%,2 with a similar sex ratio (7%–8% males vs 4% females).3 Certain ADHD traits that are well suited to the sporting context, such as quick movements, reactive decision-making, a tendency towards hyperfocus on enjoyable activities and a positive effect of physical activity on ADHD symptoms,2 may explain the apparent preponderance of ADHD in athletes. However, no studies have evaluated ADHD and how it specifically or directly affects the female athlete. ADHD can impact recovery from concussion, be influenced by hormonal fluctuations and affect mental health and social relationships, particularly in females.3 4 The purpose of this editorial is to raise awareness of the often-overlooked topic of ADHD in female athletes and encourage more investigation in this field.

Historically, there has been a significant sex bias in the recognition, diagnosis and treatment of females of all ages with ADHD.5 6 A common misconception is that ADHD presents with less frequency and severity in females. On the contrary, the symptom burden in females is comparable to that in males.6 However, it is more likely to present with internalising features such as inattention, conduct and mood disorders, and feelings of poor self-esteem and low self-efficacy.6 Most of the research demonstrating lower recognition and referral rates in girls was conducted 10–15 years ago; thus, little data are available on how caregivers, teachers and healthcare providers (HCPs) currently perceive and manage ADHD in females. As women become increasingly active …