Although ADHD has been linked to impulsive behavior and risk-prone decision-making, particularly in financial contexts, there is a critical lack of synthesis addressing how these behaviors manifest differently between men and women. Most existing studies are male-dominated or fail to disaggregate findings by sex, obscuring the role of gender as a moderator of risk behavior. Moreover, occupational implications—such as the potential overrepresentation of ADHD traits in high-frequency trading— remain underexplored in clinical and behavioral research.

This review addresses these gaps by systematically analyzing existing studies on financial decision- making in adults with ADHD, with a focus on gender differences in behavioral, neurobiological, and occupational outcomes. By integrating findings across disciplines, this study aims to advance our understanding of how ADHD-related impulsivity may differentially affect men and women in high- stakes financial environments. Such knowledge is vital for designing tailored interventions, improving workplace screening practices, and informing ethical investment guidelines in cognitively demanding sectors.

The present review is grounded in neuroeconomic and clinical theories that describe how impulsivity, reward sensitivity, and executive dysfunction influence decision-making in individuals with ADHD. Central to this framework is the concept of delay discounting the tendency to devalue delayed rewards in favor of immediate gratification—which has been consistently associated with ADHD and impulsive financial choices 112.

From a neurobiological perspective, dysfunction in frontostriatal circuits and altered regulation of dopaminergic and glutamatergic neurotransmission are key mechanisms implicated in impulsive behavior and impaired reward evaluation 19. These neural deviations may lead to heightened reactivity to short-term gains and impaired risk regulation— particularly under time pressure or uncertainty, as often seen in financial markets.

Gender differences in cognitive control and emotion regulation further enrich this framework. Research suggests that males with ADHD more frequently exhibit externalizing symptoms, behavioral disinhibition, and greater reward-seeking behavior, while females with ADHD may show relatively preserved executive function and enhanced capacity for risk aversion in complex decision tasks 1617.

Sociocultural influences may also moderate these patterns: societal norms often encourage financial risk-taking in men and caution in women, possibly reinforcing biological predispositions. Thus, gender may act as both a biological and social moderator in the expression of impulsivity and its financial consequences among adults with ADHD.

Taken together, these models suggest that impulsive decision-making in ADHD is not uniform, but rather shaped by the interaction of neurocognitive traits, sex-based differences, and contextual demands. The present study seeks to synthesize empirical findings within this framework to better understand how these dimensions influence financial behavior in real-world or simulated trading environments.

Based on existing literature and the outlined theoretical framework, we propose the following hypotheses:

Adults with ADHD will exhibit significantly more impulsive financial decision-making, including higher delay discounting and increased risk-taking, compared to adults without ADHD.

Males with ADHD will demonstrate greater sensitivity to immediate rewards, reduced cognitive control, and more volatile investment behavior compared to females with ADHD, despite similar levels of overall symptom severity.

Females with ADHD will show relatively higher levels of risk aversion, longer-term planning, and more conservative financial strategies than their male counterparts—potentially mediated by differences in frontostriatal functioning and socialized behavioral norms.

Neurobiological measures (e.g., glutamate levels, fMRI markers) will support the presence of gender-specific patterns in reward processing and cognitive control during financial decision- making tasks.

ADHD traits may be overrepresented in fast-paced trading professions, with gender differences in role adaptation, stress coping, and financial performance.

These hypotheses aim to guide the interpretation of behavioral, neurobiological, and occupational data in the current systematic review and meta-analysis.

A comprehensive literature search was performed in the databases PubMed, PsycINFO, Web of Science, and Scopus to identify peer-reviewed studies published between January 2008 and May 2025. Search terms included combinations of the following keywords: ADHD, impulsivity, financial decision-making, trading, risk-taking, investment behavior, delay discounting, gender, sex differences, neuroimaging, and glutamate. Boolean operators (AND/OR) and MeSH terms were applied as appropriate.

Studies were included if they:

Involved adult participants (≥18 years), with or without a formal ADHD diagnosis;

Assessed financial decision-making, risk-taking, or reward evaluation;

Reported gender-stratified results or included gender as a moderator;

Used validated behavioral tasks, neuroimaging (fMRI), neurochemical (e.g., MRS), or ecological financial outcomes (e.g., trading simulations);

Were published in English in peer-reviewed journals between 2008 and 2025.

Studies focusing solely on children or adolescents;

Qualitative studies without measurable outcomes;

Articles lacking gender-specific data;

Reviews, editorials, or opinion pieces without original data.

Two independent reviewers extracted data on sample characteristics, diagnostic criteria, measures of impulsivity and decision-making, neurobiological findings, and gender-stratified outcomes. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) for observational studies and the Cochrane Risk of Bias tool (RoB2) for RCTs.

Where sufficient data were available, random-effects meta-analyses were performed to calculate pooled effect sizes (Hedges’ g) for impulsive decision-making, delay discounting, and financial risk- taking, stratified by sex and ADHD status. Meta-regressions explored the moderating effects of gender, diagnostic status (clinical vs. subthreshold), and type of task (e.g., monetary vs. simulated trading). Publication bias was assessed via funnel plots and Egger’s test.

Study Selection and Characteristics A total of 17 studies met the inclusion criteria and were included in the final synthesis (see Figure 1, PRISMA flowchart). The studies comprised a total of N = 2,009 participants, of whom approximately 42.7% were female (n = 859) and 57.3% were male (n = 1,150). Age ranges spanned from 18 to 60 years.

Most studies employed behavioral economic paradigms, including delay discounting tasks, the Iowa Gambling Task, and simulated trading environments to assess impulsivity and financial decision-making in individuals with ADHD. Others utilized functional magnetic resonance imaging (fMRI) or magnetic resonance spectroscopy (MRS) to investigate neurobiological correlates of financial behavior in adults with ADHD.

Five studies included neuroimaging or neurochemical measures:

fMRI results showed hypoactivation in the dorsolateral prefrontal cortex (DLPFC) and hyperactivation in the ventral striatum during reward-related decision-making in ADHD males 13.

MRS studies reported elevated glutamate concentrations in the anterior cingulate cortex among participants with high impulsivity, with gender-specific differences in lateralization and activation magnitude 10.

Five studies included neuroimaging or neurochemical measures:

fMRI results showed hypoactivation in the dorsolateral prefrontal cortex (DLPFC) and hyperactivation in the ventral striatum during reward-related decision-making in ADHD males 13.

MRS studies reported elevated glutamate concentrations in the anterior cingulate cortex among participants with high impulsivity, with gender-specific differences in lateralization and activation magnitude 10.

Data Two studies 145 provided real-world trading performance data. Findings suggested a potential overrepresentation of ADHD traits in high- frequency trading roles, particularly among males. However, performance varied based on risk tolerance and impulse regulation. Female traders with ADHD traits tended to show greater adherence to predefined strategies and lower turnover ratios.

Visual inspection of funnel plots indicated moderate asymmetry, suggesting potential publication bias. While no formal meta-analytic test (e.g., Egger’s regression) was applied at this stage, variability in study design, sample composition, and measurement tools likely contributed to moderate-to-high heterogeneity across findings. Factors such as gender distribution, ADHD subtype, and type of behavioral or neurobiological assessment may explain some of this variance.

These findings underscore the occupational relevance of ADHD traits, particularly in environments requiring rapid decisions and risk evaluation. The emerging evidence suggests that gender-specific mechanisms influence financial decision-making in adults with ADHD, with females potentially exhibiting greater resilience to impulsivity-driven outcomes. Future research should:

Include larger, balanced samples with stratification by sex and ADHD subtype

Investigate hormonal and sociocultural influences on risk behavior

Evaluate the effectiveness of impulsivity regulation training in financial professionals

Develop and validate occupational screening tools aimed at identifying impulsivity- related vulnerabilities in financial sectors

Given the elevated impulsivity and risk-taking behaviors observed among adults with ADHD— particularly males—clinicians should consider screening for financial vulnerability and impulsive decision-making as part of ADHD assessment and treatment. Tailored psychoeducation, executive function training, and behavioral interventions may help mitigate financial harm, especially for individuals working in high-stakes economic environments.

Increased awareness in occupational and financial sectors is warranted.