Women's Football Hub

Authors Carolyn Kent Lecturer in Physiotherapy, University of Cumbria & Dr Kelly Collins Australasia College of Sport & Exercise Medicine.

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder and is frequently diagnosed in young adults (1). Historically, ADHD has been thought of as a disorder that affected males, with females presenting less. However, there is an increasing recognition that ADHD affects both sexes and athletes may be affected more than the general population (2).

How common is it in athletes?

Studies suggest that it may be as common as 7-8% of student and elite athletes (3). ADHD may in some athletes give them a performance edge because of hyper focus symptoms, allowing them to perform under pressure (4). Children with ADHD may be drawn to sport due to the positive attention activating effects (3).

Symptoms

Kelly Collins’s editorial in the BJSM described the symptoms below for males and females and also the female specific symptoms (2)

Males	Females
Hyperactivity Impulsivity Oppositional, defiance, rule breaking Physical aggression Conduct disorders	Inattention Anxiety Verbal aggression Disturbances in social interactions—peer rejection, bullying Poor self-esteem

How will you notice ADHD in a female athlete?

Hyperactivity	Hyperactivity is internalised Less aggressive & impulsive features Higher symptoms needed for diagnosis
Inattention	Predominance of inattentive features: forgetful, distractible, disorganised, ‘dreamy’ May experience cyclical fluctuations with menstrual cycle
Impact on social/behavioural function	Adolescent cigarette smoking and pregnancy Poor self-esteem, external locus of control Relationship challenges (eg, with family, peers) Emotional dysregulation Academic and career underachievement Misdiagnosis with an alternative psychiatric disorder Coping and masking behaviours (eg, people pleasing) Vulnerability to sexual exploitation, harassment and abuse
Co-morbidities	Anxiety and depression Substance misuse Compulsive disorder and perfectionism Eating disorders (2)

Barriers and challenges

Female athletes with ADHD are underdiagnosed and under represented (5). Neuro-divergent people can struggle with time management, planning, and behavioural issues. It has also been reported that female players who suffer a concussion and who have ADHD may take longer to recover, their ADHD may be worse at certain stages of their menstrual cycle and there is also a link with ADHD to eating disorders (2).

So, what now?

Players with ADHD may benefit from sports psychology input. Coaching sessions should consider the unique issues that an athlete with ADHD may face and more research is required for female athletes with ADHD.

References

1. Poysophon P, Rao AL. Neurocognitive Deficits Associated With ADHD in Athletes: A Systematic Review. Sports Health. 2018 Jul-Aug;10(4):317-326. doi: 10.1177/1941738117751387. Epub 2018 Jan 16. PMID: 29337649; PMCID: PMC6044120.
2. Collins K. Female athletes with ADHD: time to level the playing field. Br J Sports Med. 2024 Jul 1;58(13):695.
3. Han DH, McDuff D, Thompson D, Hitchcock ME, Reardon CL, Hainline B. Attention-deficit/hyperactivity disorder in elite athletes: a narrative review. Br J Sports Med. 2019 Jun 1;53(12):741.
4. Cummings S, Ayisire J, Pusch S, Pennington, C. How can attention deficit hyperactivity disorder affect sports performance? . 10.23977/curtm.2020.030206.
5. Kelly CA, Kelly C, Taylor R. Review of the Psychosocial Consequences of Attention Deficit Hyperactivity Disorder (ADHD) in Females. EJMED [Internet]. 2024 Feb. 23 [cited 2024 Aug. 1];6(1):10-2. Available from: https://www.ej-med.org/index.php/ejmed/article/view/2033