Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women.

BACKGROUND: There is evidence to suggest that the broad discrepancy in the ratio of males to females with diagnosed ADHD is due, at least in part, to lack of recognition and/or referral bias in females. Studies suggest that females with ADHD present with differences in their profile of symptoms, comorbidity and associated functioning compared with males. This consensus aims to provide a better understanding of females with ADHD in order to improve recognition and referral. Comprehensive assessment and appropriate treatment is hoped to enhance longer-term clinical outcomes and patient wellbeing for females with ADHD. METHODS: The United Kingdom ADHD Partnership hosted a meeting of experts to discuss symptom presentation, triggers for referral, assessment, treatment and multi-agency liaison for females with ADHD across the lifespan. RESULTS: A consensus was reached offering practical guidance to support medical and mental health practitioners working with females with ADHD. The potential challenges of working with this patient group were identified, as well as specific barriers that may hinder recognition. These included symptomatic differences, gender biases, comorbidities and the compensatory strategies that may mask or overshadow underlying symptoms of ADHD. Furthermore, we determined the broader needs of these patients and considered how multi-agency liaison may provide the support to meet them. CONCLUSIONS: This practical approach based upon expert consensus will inform effective identification, treatment and support of girls and women with ADHD. It is important to move away from the prevalent perspective that ADHD is a behavioural disorder and attend to the more subtle and/or internalised presentation that is common in females. It is essential to adopt a lifespan model of care to support the complex transitions experienced by females that occur in parallel to change in clinical presentation and social circumstances. Treatment with pharmacological and psychological interventions is expected to have a positive impact leading to increased productivity, decreased resource utilization and most importantly, improved long-term outcomes for girls and women.

Staff Perceptions of Responsible Gambling Training Programs: Qualitative Findings.

Staff training in responsible gambling forms an integral component of industry measures designed to respond to and minimize gambling-related harms. Research suggests that venue staff members have the capacity to identify behavioral indicators of problem gambling among patrons, but often are reluctant or fail to respond to patrons unless directly approached for assistance. Understanding the barriers preventing staff from proactively intervening with identified patrons is necessary if a positive shift toward greater levels of assistance for at-risk individuals is to be achieved. A series of focus groups were conducted with management and floor staff (N = 20) from a large New South Wales registered club venue to better understand their experiences and attitudes towards existing responsible gambling training programs. Qualitative phenomenological data were analyzed using inductive thematic analyses and resulted in the identification of three primary domains: ability to identify harmful gambling behaviors; perceived challenges and barriers to intervention; and potential improvements to current programs. Responses were consistent with the literature in demonstrating staff abilities to identify behavioral indicators, but importantly revealed a lack of certainty and understanding in relation to their specific roles, potential legal consequences and implications for employment by taking the initiative to proactively intervene. Recommended improvements to strengthen the effectiveness of programs included the implementation of well-defined protocols setting out role expectations and procedures for floor staff to follow, and importantly, a fundamental shift in middle and senior management culture to one that actively supports and positively acknowledges staff-customer interactions designed to assist problem gamblers.