A recent study published in the Journal of Child Psychology and Psychiatry shows that ADHD is diagnosed approximately four years later in women than in men, potentially leading to a higher burden of co-occurring psychiatric disorders and greater demands on health care.
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 abuse, delinquency, and academic underachievement.
Previous research has shown that ADHD is often undiagnosed in women. It is estimated that approximately 3 to 16 men are diagnosed for every woman.
Concerned about the potential significant challenges during the formative years and beyond, the research team initiated this study to investigate diagnostic delay in women with ADHD and assess the impact of this delay on their health.
Led by Charlotte Skoglund from Uppsala University in Sweden, the group conducted a population-based, cross-sectional cohort study of 85,330 individuals with ADHD living in Stockholm County, using data from the Stockholm County Regional Healthcare Data Warehouse.
These individuals had to have at least one record of an ADHD diagnosis and/or stimulant or non-stimulant medication for ADHD. They were matched with 426,626 healthy controls from the population.
The main outcome was age at the time of the ADHD index (i.e., ADHD diagnosis). Psychiatric comorbidity, pharmacological treatment, and health care utilization, before and after the ADHD index, were also measured.
After statistical analysis, the researchers found that ADHD was diagnosed at an average age of 23.5 years in females, compared to 19.6 years in males.
In addition, the results showed that psychiatric comorbidity was more common: “women with ADHD were approximately twice as likely compared to men 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 before the ADHD index, women showed higher use of anticonvulsants, neuroleptics, sedatives, and hypnotics, as well as psychoanaleptics, compared with men… Two years after the index, women with ADHD still showed significantly higher use of anticonvulsants, neuroleptics, sedatives, hypnotics, and psychoanaleptics, compared with men with ADHD.”
Finally, there was increased health care utilization: “Women with ADHD were more likely than men with ADHD to have both a psychiatric hospitalization and an outpatient hospitalization during the entire study period.”
The researchers stressed that “early detection, diagnosis and treatment are important to reduce the risk of serious distress, morbidity, mortality and disability.”
It is important to note, however, that the study only included data from a government-funded registry, which may not include individuals who do not have contact with health care services. The researchers also noted that the severity of several conditions was 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.