Females with ADHD diagnosed 4 years later than males, study reveals

A recent study published in the Journal of Child Psychology and Psychiatry reveals that females with ADHD are diagnosed approximately four years later than males, potentially leading to a higher burden of concurrent psychiatric conditions and increased utilization of healthcare services.

Attention Deficit Hyperactivity Disorder (ADHD) is a lifelong condition characterized by symptoms of impulsivity, hyperactivity, and inattention. The disorder is associated with increased behaviors and consequences such as sexual risk-taking, substance use disorders, criminality, and academic underachievement.

Previous research has shown that ADHD is often underdiagnosed in females, with estimates of roughly 3 to 16 males being diagnosed for every female.

Concerned with the potential of significant challenges during the formative years and beyond, the research team embarked on this study to explore the diagnostic delay in females with ADHD and to assess the impact of this delay on their health outcomes.

Led by Charlotte Skoglund from Uppsala University in Sweden, the group conducted a population-based, cross-sectional cohort study involving 85,330 individuals with ADHD living in Stockholm County, using data from the Regional Healthcare Data Warehouse of Region Stockholm.

These individuals were required to possess at least one record of ADHD diagnosis and/or stimulant or non-stimulant medication for ADHD, and were matched to 426,626 healthy controls from the population.

The main measurement outcome was age at ADHD-index (i.e. ADHD diagnosis). Psychiatric comorbidity, pharmacological treatment, and health care utilization, prior to and after ADHD-index, were also measured.

Following statistical analysis, the researchers found that females with ADHD were diagnosed at an average age of 23.5 years, compared to 19.6 years for males.

Moreover, the results demonstrated that psychiatric comorbidity was more common: “females with ADHD were approximately twice as likely compared to males with ADHD to be diagnosed with both anxiety disorders (50.4% vs. 25.9%) and mood disorders (37.5% vs. 19.5%).”

Skoglund and colleagues also reported higher pharmacological treatment, “five years prior to ADHD-index females showed a higher use of anticonvulsants, neuroleptics, sedatives, and hypnotics, as well as psychoanaleptics, compared to males… Two years after index, females with ADHD still showed a significantly higher use of anticonvulsants, neuroleptics, sedatives, hypnotics, and psychoanaleptics, compared to males with ADHD.”

Finally, an increased healthcare utilization was evident, “females with ADHD were more likely than males with ADHD to have both an in- and outpatient psychiatric health care event across the entire study period.”

The researchers emphasized that “early detection, diagnosis, and treatment are important to reduce the risk of serious distress, morbidity, mortality, and impairments in life.”

However, it is important to note that the study only included data captured from publicly-funded registry, which may not capture individuals who are not in contact with health care services. The researchers also noted that the severity of different disorders were not measured.

The study, “Time after time: failure to identify and support females with ADHD – a Swedish population register study”, was authored by Charlotte Skoglund, Inger Sundstrom Poromaa, Daniel Leksell, Katarina Ekholm Selling, Thomas Cars, Maibritt Giacobini, Susan Young, and Helena Kopp Kallner.