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Women With ADHD Diagnosed, On Average, 4 Years Later Than Men
Women with attention-deficit/hyperactivity disorder (ADHD) are diagnosed, on average, 4 years later than their male counterparts and have a higher burden of comorbid psychiatric conditions than males with ADHD and healthy female controls, according to a cross-sectional cohort study published in The Journal of Child Psychology and Psychiatry.
“Our results indicate a need for increased knowledge about early symptom display, comorbidity, and health care utilization prior to ADHD diagnosis,” authors noted, “as well as a better understanding of neurobiological underpinnings and, specifically, the influence of biological sex through sex hormones on ADHD symptoms and treatment outcomes in females.”
Related: ADHD Medication Use Sharply Increased During COVID-19 Pandemic
A total of 85,330 participants with ADHD were included in the study, all of whom were residents of Stockholm County, Sweden, between January 01, 2011, and December 31, 2021. Population controls (n = 426,626) were matched by age, sex, and socioeconomic status (SES). Researchers gathered data from the Regional Healthcare Data Warehouse of Region Stockholm, using age at ADHD-index as the primary outcome.
Women were found to be older at ADHD-index (23.5 years, SD 13.8) compared to males (19.6 years, SD 13.9, 95% CI of difference 3.74–4.11). Women also showed higher rates of psychiatric comorbidity, pharmacological treatment, and health care utilization, compared to males with ADHD and female controls. For both sexes and population controls, the most common comorbidities were anxiety disorders and mood disorders, respectively, though women with ADHD were twice as likely compared to their male counterparts to be diagnosed with both anxiety disorders (50.4% vs. 25.9%) and mood disorders (37.5% vs. 19.5%). Males with ADHD were found to have higher rates of autism spectrum disorders (ASD), conduct disorder, tics, and Tourette's disorder than women with ADHD. Women with ADHD, more often than males with ADHD, had a diagnosis of self-harm events prior to, and after ADHD-index.
Authors hypothesized that this gap in treatment exists because of the difference in how ADHD typically manifests in boys versus girls. Researchers noted that females “exhibit less disruptive or externalizing symptoms than males” and “exhibit hyperactivity and impulsivity traits, but that these are displayed as externalizing emotional or verbal hyperactivity and impulsivity symptoms that are misinterpreted (eg, anxiety, borderline personality disorder, or bipolar disorder).”
Researchers mentioned that, as with all observational studies, risk of selection bias cannot be completely ruled out, especially since researchers focused particularly on individuals who were actively in contact with health care services.
“These factors may inform future research and decrease diagnostic delay, polypharmacy, and multimorbidity and aid in improving the efficacy of the multimodal treatment for females with ADHD,” authors concluded.
