People with ADHD may experience higher rates of gender variance and gender dysphoria. Here’s why, and how to offer support to loved ones.

People of all ages, races, and genders question their gender identity. But are folks with certain neurodevelopmental disorders, like attention deficit hyperactivity disorder (ADHD), more likely to experience gender identity issues?

Understanding how living with ADHD may impact gender identity can lead to increased compassion, support, and access to gender-affirming care for those who are neurodivergent and gender nonconforming.

What is gender identity?

The American Psychological Associationdefines gender identity as:

“A person’s deeply felt, inherent sense of being a boy, a man, or male; a girl, a woman, or female; or an alternative gender (e.g., genderqueer, gender nonconforming, gender neutral) that may or may not correspond to a person’s sex assigned at birth or to a person’s primary or secondary sex characteristics.”

“Since gender identity is internal, a person’s gender identity is not necessarily visible to others.”

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More studies are needed on ADHD and gender. But some research suggests that people with ADHD may be more likely to question their gender.

According to a 2014 study on gender variance in people living with autism spectrum disorder (ASD) and ADHD, participants with ADHD were 6.64 times more likely to express gender variance.

However, ADHD advocate and certified sex educator Cate Osborn who lives with ADHD herself notes studies like these point out that ADHD doesn’t “cause” someone to question their gender identity or experience gender dysphoria.

“Rather, individuals with neurodivergence are predisposed to reject the rigidity of gendered expectations placed on them by society,” they say.

A potentially helpful reframe

Instead of saying that ADHD causes someone to question their gender or experience gender dysphoria, Osborn says it would be more correct to explain it this way:

People who have ADHD often experience social rejection, bullying, and criticism from both their peers and the authority figures in their lives.

Because of this, many people with ADHD begin to perceive the world differently and come to realize that many of the expectations placed on them are arbitrary.

They can tend to reject these rules in service of their own systems and behaviors that better support them and cater to their needs.

For some people with ADHD, this includes the way they navigate and present their gender.

A 2017 study that explores 20 cases of gender dysphoria points out that 90% of cases had at least one psychiatric diagnosis. ADHD was the leading comorbidity at 75%.

What is gender dysphoria?

“Gender dysphoria is essentially a negative reaction to gender identity — discomfort or distress related to incongruence between a person’s gender identity, sex assigned at birth, gender identity, and/or primary and secondary sex characteristics,” says Osborn.

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There are many possible explanations for this:

ADHD and executive dysfunction

Osborn explains that symptoms of executive dysfunction may play a large role, especially in connection with societal pressures to “perform” as a certain gender.

For example, Osborn says that a person assigned female at birth (AFAB) may feel pressure to wear makeup or jewelry. But they might lack the executive function necessary to do a full face of makeup every day or deal with sensory issues that make wearing jewelry or certain types of clothes difficult.

“Similarly, care tasks, like caring for long hair, can be difficult, whereas a short, cropped hairstyle might make for easier care and maintenance, but impact a person’s gender identity in that they don’t look how they want to or need to to feel fulfilled,” adds Osborn.

These executive dysfunction challenges could ultimately lead to higher rates of gender dysphoria for nonbinary, transgender, and gender nonconforming people with ADHD.

How we’re socialized

Many researchers now believe that how a person is socialized has much to do with how ADHD presents, says Osborn.

Whereas a young girl is much more likely to be socialized to sit still and be quiet and respectful, young boys may be more likely to be allowed to run around and roughhouse.

“As a result, there can be a lot of confusion when a woman presents as extremely hyperactive or a man presents primarily inattentive,” she adds.

“In extreme cases, this can result in a missed or misdiagnosis. I’ve heard from a lot of followers who say that their doctor basically told them that girls ‘can’t’ be hyperactive or young boys ‘never’ present as inattentive — and that’s just fundamentally not the case.”

If your child or loved one is experiencing gender identity issues, there are plenty of ways to support them through their process.

Educate yourself

There are many toxic ideas out there about what gender is, what gender isn’t, and what it “should be,” reminds Osborn.

Instead of expecting your loved one to teach you, she suggests learning about gender on your own, at your own pace.

Osborn recommends:

  • engaging with content surrounding gender identity and gender diversity
  • watching content created by gender nonconforming folks and experts in the space
  • taking time to learn about your loved one’s specific identity and what that means to them

Process on your own

Your emotions are valid. But Osborn points out that many parents often make the mistake of putting the burden of reassurance and need for support onto their gender-questioning kid.

“That isn’t their job,” she reminds. “They’re in the midst of a big moment of self-discovery. Let them have that without having to hold your hand through it.”

Know the importance of acceptance

Osborn explains that the majority of LGBTQIA+ kids who attempt suicide do so because they’ve been ostracized from their families and lack a safe support structure.

A 2021 study conducted by The Trevor Project found that 52% of transgender and nonbinary youth seriously considered suicide in the past year, with 1 in 5 reported attempting suicide.

The organization also found that having at least one accepting adult can drastically reduce the risk of suicide attempts in young LGBTQ+ people by 40%.

So try your best to offer support and practice acceptance.

“In trusting you with their concerns or questions about their gender, your kids are also offering you the opportunity to provide them support, acceptance, and kindness,” says Osborn.

“Remember that your acceptance can literally save their life.”

If you’re experiencing suicidal thoughts, help is available

You can access free support right away with these resources:

  • 988 Suicide and Crisis Lifeline.Call the Lifeline at 988 for English or Spanish, 24 hours a day, 7 days a week.
  • The Crisis Text Line.Text HOME to the Crisis Text Line at 741741.
  • The Trevor Project. LGBTQIA+ and under 25 years old? Call 866-488-7386, text “START” to 678678, or chat online 24/7.
  • Veterans Crisis Line.Call 988 and press 1, text 838255, or chat online 24/7.
  • Deaf Crisis Line.Call 321-800-3323, text “HAND” to 839863, or visit their website.
  • Befrienders Worldwide.This international crisis helpline network can help you find a local helpline.
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Encourage them to seek support

Receiving support from a therapist, accepting yourself, and being accepted by others can be incredibly healing and validating while on this journey of self-discovery.

Osborn explains that many folks find support in groups of neurodivergent people who share similar symptoms and experiences. “These groups tend to be more accepting and understanding than neurotypical peers who don’t understand the particular challenges of living with a neurodiversity.”

And when a person finds acceptance in a peer group, they note that there can be less pressure to “perform” or “mask” to avoid expressing these inclinations.

For some adults, teens, and children with ADHD, this can mean being more open and honest about their gender identity.

If you’re looking for a therapist, but you’re not sure where to start, Psych Central’s How to Find Mental Health Support resource can help.

If your kid comes to you and shares that they’d like to use a new name or different pronouns, Osborn recommends taking this seriously.

“Do not refuse because it’s ‘hard to remember’ or ‘not what you named them,’” she adds. “This is a tiny adaptation that can mean the world to your child and can literally be lifesaving.”

People living with ADHD may question their gender identity or experience gender dysphoria more often than people without ADHD. But there’s no evidence to support a direct cause-and-effect relationship between ADHD and gender nonconformity.

If you’re having a hard time navigating the process of questioning your gender identity or you’d like help supporting a loved one who is, you can consider speaking with a therapist.

And remember: There’s no one “right way” to be any gender, whether you live with ADHD or not. Your gender expression is deeply personal and deeply yours, says Osborn.

“Accepting yourself fully and completely is a deeply vulnerable process and can come with many, many mixed emotions,” she says.

“It’s OK to be unsure. It’s OK to question. It’s OK to change your mind, and it’s also OK to know with certainty that you are who you know you are. No one can take that away from you.”