{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T10:06:26Z","timestamp":1785405986223,"version":"3.56.0"},"reference-count":45,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Sex differences in adult attention-deficit\/hyperactivity disorder (ADHD) remain insufficiently characterized, particularly in clinically referred samples assessed through multidimensional and multi-informant approaches. This study investigated sex differences in clinical presentation, psychiatric comorbidity, psychometric features, and ADHD severity in adults with ADHD, with a specific focus on emotional dysregulation and rating-source effects. Methods: A total of 212 consecutively recruited adults with ADHD, including 93 females and 119 males, underwent a comprehensive assessment at a tertiary referral service. Sex differences were examined across sociodemographic, clinical, comorbidity, functional, and psychometric domains. ADHD severity was assessed using both self-rated and observer-rated measures. Regression, mediation, and repeated-measures mixed-effects models were fitted to examine the role of emotional dysregulation in the association between sex and ADHD severity. Results: Females showed a higher frequency of predominantly inattentive presentation; higher rates of mood, anxiety, and eating disorders; and more pronounced emotional dysregulation, affective temperamental traits, personality-related impairment, and biological rhythm disturbances. Observer-rated ADHD severity did not differ by sex, while females reported higher self-rated ADHD severity. Emotional dysregulation was associated with both observer-rated and self-rated ADHD severity, with a stronger association for self-rated symptoms. Mediation analysis showed a significant indirect effect of female sex on self-reported ADHD severity through emotional dysregulation, accounting for 79.4% of the total association. Mixed-effects models further indicated that sex differences in ADHD severity varied according to rating source and persisted, although attenuated, after accounting for emotional dysregulation. Conclusions: Adult females with ADHD showed a different clinical profile, characterized by greater internalizing comorbidity, emotional dysregulation, personality-related impairment, and biological rhythm disturbances. Emotional dysregulation accounted for a substantial part of the higher self-reported ADHD severity observed among females, while rating-source effects suggested that sex differences in adult ADHD may partly depend on how symptom severity is assessed.<\/jats:p>","DOI":"10.3390\/jcm15155954","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:32:13Z","timestamp":1785403933000},"page":"5954","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sex Differences in Adult ADHD: A Multidimensional Multi-Informant Observational Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-1381-9733","authenticated-orcid":false,"given":"Anna","family":"Magnesa","sequence":"first","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Costagli","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco De","family":"Dominicis","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56126 Pisa, Italy"},{"name":"Mental Health Centre, Local Health Unit 2, Via San Carlo 2, 06049 Spoleto, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ugo","family":"De Rosa","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Iriti","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Petrucci","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56126 Pisa, Italy"},{"name":"Mental Health Centre, Local Health Unit 2, Viale Trieste 68, 05100 Terni, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berenice","family":"Rimoldi","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierpaolo","family":"Medda","sequence":"additional","affiliation":[{"name":"Psychiatry Unit 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6516-263X","authenticated-orcid":false,"given":"Elisa","family":"Schiavi","sequence":"additional","affiliation":[{"name":"Psychiatry Unit 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4460-0406","authenticated-orcid":false,"given":"Giulio Emilio","family":"Brancati","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5556-1858","authenticated-orcid":false,"given":"Giulio","family":"Perugi","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1016\/j.neubiorev.2021.01.022","article-title":"The World Federation of ADHD International Consensus Statement: 208 Evidence-Based Conclusions about the Disorder","volume":"128","author":"Faraone","year":"2021","journal-title":"Neurosci. 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