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Sex differences in attention‐deficit hyperactivity disorder diagnosis and clinical care: a national study of population healthcare records in Wales

Joanna Martin Orcid Logo, Kate Langley Orcid Logo, Miriam Cooper Orcid Logo, Olivier Rouquette Orcid Logo, Ann John Orcid Logo, Kapil Sayal Orcid Logo, Tamsin Ford Orcid Logo, Anita Thapar Orcid Logo

Journal of Child Psychology and Psychiatry, Volume: 65, Issue: 12, Pages: 1648 - 1658

Swansea University Authors: Olivier Rouquette Orcid Logo, Ann John Orcid Logo

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DOI (Published version): 10.1111/jcpp.13987

Abstract

BackgroundPopulation-based studies have observed sex biases in the diagnosis and treatment of attention-deficit hyperactivity disorder (ADHD). Females are less likely to be diagnosed or prescribed ADHD medication. This study uses national healthcare records, to investigate sex differences in diagnos...

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Published in: Journal of Child Psychology and Psychiatry
ISSN: 0021-9630 1469-7610
Published: Wiley 2024
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URI: https://cronfa.swan.ac.uk/Record/cronfa66081
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Females are less likely to be diagnosed or prescribed ADHD medication. This study uses national healthcare records, to investigate sex differences in diagnosis and clinical care in young people with ADHD, particularly regarding recognition and treatment of other mental health conditions.MethodsThe cohort included individuals diagnosed with ADHD, born between 1989 and 2013 and living in Wales between 2000 and 2019. Routine primary and secondary healthcare record data were used to derive diagnoses of ADHD and other neurodevelopmental and mental health conditions, as well as ADHD and antidepressant medications. Demographic variables included ethnicity, socioeconomic deprivation and contact with social services.ResultsThere were 16,458 individuals diagnosed with ADHD (20.3% females, ages 3&#x2013;30&#x2009;years), with a male-to-female ratio of 3.9:1. Higher ratios (4.8:1) were seen in individuals diagnosed younger (&lt;12&#x2009;years), with the lowest ratio (1.9:1) in those diagnosed as adults (&gt;18). Males were younger at first recorded ADHD diagnosis (mean&#x2009;=&#x2009;10.9 vs. 12.6&#x2009;years), more likely to be prescribed ADHD medication and younger at diagnosis of co-occurring neurodevelopmental conditions. In contrast, females were more likely to receive a diagnosis of anxiety, depression or another mental health condition and to be prescribed antidepressant medications, prior to ADHD diagnosis. These sex differences were largely stable across demographic groups.ConclusionsThis study adds to the evidence base that females with ADHD are experiencing later recognition and treatment of ADHD. The results indicate that this may be partly because of diagnostic overshadowing from other mental health conditions, such as anxiety and depression, or initial misdiagnosis. 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spelling 2024-12-02T16:15:55.5933262 v2 66081 2024-04-18 Sex differences in attention‐deficit hyperactivity disorder diagnosis and clinical care: a national study of population healthcare records in Wales 0e502db88ea48ce6b053ed0eef9a54ce 0000-0001-8088-4800 Olivier Rouquette Olivier Rouquette true false ed8a9c37bd7b7235b762d941ef18ee55 0000-0002-5657-6995 Ann John Ann John true false 2024-04-18 MEDS BackgroundPopulation-based studies have observed sex biases in the diagnosis and treatment of attention-deficit hyperactivity disorder (ADHD). Females are less likely to be diagnosed or prescribed ADHD medication. This study uses national healthcare records, to investigate sex differences in diagnosis and clinical care in young people with ADHD, particularly regarding recognition and treatment of other mental health conditions.MethodsThe cohort included individuals diagnosed with ADHD, born between 1989 and 2013 and living in Wales between 2000 and 2019. Routine primary and secondary healthcare record data were used to derive diagnoses of ADHD and other neurodevelopmental and mental health conditions, as well as ADHD and antidepressant medications. Demographic variables included ethnicity, socioeconomic deprivation and contact with social services.ResultsThere were 16,458 individuals diagnosed with ADHD (20.3% females, ages 3–30 years), with a male-to-female ratio of 3.9:1. Higher ratios (4.8:1) were seen in individuals diagnosed younger (<12 years), with the lowest ratio (1.9:1) in those diagnosed as adults (>18). Males were younger at first recorded ADHD diagnosis (mean = 10.9 vs. 12.6 years), more likely to be prescribed ADHD medication and younger at diagnosis of co-occurring neurodevelopmental conditions. In contrast, females were more likely to receive a diagnosis of anxiety, depression or another mental health condition and to be prescribed antidepressant medications, prior to ADHD diagnosis. These sex differences were largely stable across demographic groups.ConclusionsThis study adds to the evidence base that females with ADHD are experiencing later recognition and treatment of ADHD. The results indicate that this may be partly because of diagnostic overshadowing from other mental health conditions, such as anxiety and depression, or initial misdiagnosis. Further research and dissemination of findings to the public are needed to improve awareness, timely diagnosis and treatment of ADHD in females. Journal Article Journal of Child Psychology and Psychiatry 65 12 1648 1658 Wiley 0021-9630 1469-7610 ADHD; sex differences; neurodevelopmental conditions; mental health 1 12 2024 2024-12-01 10.1111/jcpp.13987 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee Brain and Behavior Research Foundation. Grant Number: 27879 Health and Care Research Wales. Grant Number: NIHR-FS(A)-2022 2024-12-02T16:15:55.5933262 2024-04-18T12:41:33.4545599 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Joanna Martin 0000-0002-8911-3479 1 Kate Langley 0000-0002-2033-2657 2 Miriam Cooper 0000-0002-4695-5481 3 Olivier Rouquette 0000-0001-8088-4800 4 Ann John 0000-0002-5657-6995 5 Kapil Sayal 0000-0002-2050-4316 6 Tamsin Ford 0000-0001-5295-4904 7 Anita Thapar 0000-0002-3689-737x 8 66081__30763__6af210aa05f1406bbbe60f3785171b0e.pdf 66081.VoR.pdf 2024-06-26T17:00:11.4560836 Output 866299 application/pdf Version of Record true Copyright: 2024 The Author(s). This is an open access article under the terms of the Creative Commons Attribution License. true eng http://creativecommons.org/licenses/by/4.0/
title Sex differences in attention‐deficit hyperactivity disorder diagnosis and clinical care: a national study of population healthcare records in Wales
spellingShingle Sex differences in attention‐deficit hyperactivity disorder diagnosis and clinical care: a national study of population healthcare records in Wales
Olivier Rouquette
Ann John
title_short Sex differences in attention‐deficit hyperactivity disorder diagnosis and clinical care: a national study of population healthcare records in Wales
title_full Sex differences in attention‐deficit hyperactivity disorder diagnosis and clinical care: a national study of population healthcare records in Wales
title_fullStr Sex differences in attention‐deficit hyperactivity disorder diagnosis and clinical care: a national study of population healthcare records in Wales
title_full_unstemmed Sex differences in attention‐deficit hyperactivity disorder diagnosis and clinical care: a national study of population healthcare records in Wales
title_sort Sex differences in attention‐deficit hyperactivity disorder diagnosis and clinical care: a national study of population healthcare records in Wales
author_id_str_mv 0e502db88ea48ce6b053ed0eef9a54ce
ed8a9c37bd7b7235b762d941ef18ee55
author_id_fullname_str_mv 0e502db88ea48ce6b053ed0eef9a54ce_***_Olivier Rouquette
ed8a9c37bd7b7235b762d941ef18ee55_***_Ann John
author Olivier Rouquette
Ann John
author2 Joanna Martin
Kate Langley
Miriam Cooper
Olivier Rouquette
Ann John
Kapil Sayal
Tamsin Ford
Anita Thapar
format Journal article
container_title Journal of Child Psychology and Psychiatry
container_volume 65
container_issue 12
container_start_page 1648
publishDate 2024
institution Swansea University
issn 0021-9630
1469-7610
doi_str_mv 10.1111/jcpp.13987
publisher Wiley
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
active_str 0
description BackgroundPopulation-based studies have observed sex biases in the diagnosis and treatment of attention-deficit hyperactivity disorder (ADHD). Females are less likely to be diagnosed or prescribed ADHD medication. This study uses national healthcare records, to investigate sex differences in diagnosis and clinical care in young people with ADHD, particularly regarding recognition and treatment of other mental health conditions.MethodsThe cohort included individuals diagnosed with ADHD, born between 1989 and 2013 and living in Wales between 2000 and 2019. Routine primary and secondary healthcare record data were used to derive diagnoses of ADHD and other neurodevelopmental and mental health conditions, as well as ADHD and antidepressant medications. Demographic variables included ethnicity, socioeconomic deprivation and contact with social services.ResultsThere were 16,458 individuals diagnosed with ADHD (20.3% females, ages 3–30 years), with a male-to-female ratio of 3.9:1. Higher ratios (4.8:1) were seen in individuals diagnosed younger (<12 years), with the lowest ratio (1.9:1) in those diagnosed as adults (>18). Males were younger at first recorded ADHD diagnosis (mean = 10.9 vs. 12.6 years), more likely to be prescribed ADHD medication and younger at diagnosis of co-occurring neurodevelopmental conditions. In contrast, females were more likely to receive a diagnosis of anxiety, depression or another mental health condition and to be prescribed antidepressant medications, prior to ADHD diagnosis. These sex differences were largely stable across demographic groups.ConclusionsThis study adds to the evidence base that females with ADHD are experiencing later recognition and treatment of ADHD. The results indicate that this may be partly because of diagnostic overshadowing from other mental health conditions, such as anxiety and depression, or initial misdiagnosis. Further research and dissemination of findings to the public are needed to improve awareness, timely diagnosis and treatment of ADHD in females.
published_date 2024-12-01T02:47:36Z
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