ADHD and transgender identity

Q: Is ADHD more common among transgender young people?

Yes. Various studies, including Warrier and colleagues' 2020 study, find that transgender people are more likely to have an ADHD diagnosis than cisgender controls. The Cass Review also found that neurodivergence, including ADHD and autism, was much more common among English patients than among their peers. The exact prevalence varies between studies.

Q: Why do ADHD and gender dysphoria often occur together?

This is not known. Researchers cite shared genetic vulnerability, environmental stress and diagnostic overlap as possible factors. ADHD also often co-occurs with anxiety, low mood and difficulties relating to peers, each of which can intensify the feeling of not belonging.

Q: Why is ADHD relevant when making a decision about transition?

Because ADHD is associated with impulsivity, difficulty planning and a strong focus on the here and now. Young people with ADHD are more likely to struggle to see the long-term consequences. This is significant when treatment has lasting effects on fertility and the body; a thorough diagnostic evaluation is therefore recommended.

Q: Should ADHD treatment wait until the gender pathway has been completed?

No. Existing ADHD treatment does not need to wait for the outcome of the gender pathway. Parents should mention at the intake that their child has a diagnosis or takes medication, and explicitly ask whether ADHD and other developmental difficulties will be assessed.

Warning label on a box of methylphenidate — Photo: Ravenperch, CC BY-SA 4.0, via Wikimedia Commons

Various studies, including Warrier and colleagues (2020), report a higher prevalence of ADHD diagnoses among transgender people compared with cisgender controls.

What is known

Various studies, including Warrier and colleagues (2020), report a higher prevalence of ADHD diagnoses among transgender people compared with cisgender controls. The precise mechanisms are unknown; possible factors include shared genetic vulnerability, environmental stressors and diagnostic overlap.

Clinical considerations

Among young people with gender dysphoria, international attention has been drawn to co-occurring ADHD, because impulsivity and a short-term focus can influence decision-making about far-reaching treatments. A thorough diagnostic evaluation is therefore recommended.

Figures from clinics

The association has also been observed in clinics for young people. In 2015, Finnish researchers described the first group of adolescents presenting to the gender clinic in Tampere: three-quarters had previously received psychiatric treatment for problems other than gender dysphoria. The Cass Review found that neurodivergence, including ADHD and autism, was much more common among English patients than among their peers. The exact prevalence of ADHD varies between studies because clinics do not assess it in the same way. Research on the relationship between ADHD and gender dysphoria is discussed in detail on genderautisme.nl.

Why it matters

ADHD is associated with impulsivity, difficulty planning and a strong focus on the here and now. Young people with ADHD may focus intensely and for long periods on a single subject, and are more likely to struggle to see the long-term consequences. This is significant when treatment has lasting effects on fertility and the body. ADHD also often co-occurs with anxiety, low mood and difficulties relating to peers, each of which can intensify the feeling of not belonging.

What parents can do

At an intake, explicitly ask whether ADHD and other developmental difficulties will be assessed, and mention if your child already has a diagnosis or takes medication. A proper assessment establishes when the distress began and how it relates to other difficulties. Existing ADHD treatment does not need to wait for the outcome of the gender pathway. See also autism and transgender identity and the guide for concerned parents.

Is ADHD more common among transgender young people?

Why do ADHD and gender dysphoria often occur together?

Why is ADHD relevant when making a decision about transition?

Should ADHD treatment wait until the gender pathway has been completed?

Sources

Warrier, V., Greenberg, D.M., Weir, E., et al. (2020). Elevated rates of autism, other neurodevelopmental and psychiatric diagnoses, and autistic traits in transgender and gender-diverse individuals. Nature Communications, 11, 3959. doi:10.1038/s41467-020-17794-1

Cass, H. (2024). Independent Review of Gender Identity Services for Children and Young People: Final Report. cass.independent-review.uk