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Antecedents and outcomes of a later attention–deficit hyperactivity disorder (ADHD) diagnosis in females

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

The British Journal of Psychiatry, Pages: 1 - 8

Swansea University Author: Ann John Orcid Logo

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DOI (Published version): 10.1192/bjp.2026.10556

Abstract

Background: Females are less likely than males to be diagnosed with attention–deficit hyperactivity disorder (ADHD). When diagnosed, females are older than males. AimsIn this study, we examined the childhood antecedents of later ADHD diagnosis and its impact on adolescent/emerging adult outcomes, wi...

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Published in: The British Journal of Psychiatry
ISSN: 0007-1250 1472-1465
Published: Royal College of Psychiatrists 2026
Online Access: Check full text

URI: https://cronfa.swan.ac.uk/Record/cronfa71276
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AimsIn this study, we examined the childhood antecedents of later ADHD diagnosis and its impact on adolescent/emerging adult outcomes, with a focus on females.Method: In this cohort study, we used data from a Welsh nation-wide electronic cohort of 13 593 individuals (n = 2680 (19.7%) females) diagnosed with ADHD and 578 793 individuals (n = 286 734 (49.5%) females) without ADHD. We compared females with later diagnoses (ages 12&#x2013;25) to those with earlier, timely diagnoses (ages 5&#x2013;11) and no diagnosis, in terms of childhood (ages 5&#x2013;11) antecedents and adolescent/adult (ages 12&#x2013;25) outcomes. We also tested for sex differences. Results: Although females with earlier ADHD diagnosis showed more health and educational difficulties in childhood than those with later diagnosed ADHD (odds ratios ranged from 0.18 to 0.92), there was clear evidence of these difficulties in females with later diagnosed ADHD, compared with females without ADHD (odds ratios: 1.07&#x2013;9.02). In adolescence/early adulthood, females with later diagnosed ADHD used more healthcare services and had worse mental health, educational and socioeconomic outcomes than females diagnosed earlier (odds ratios: 1.39&#x2013;4.96) and those without ADHD (odds ratios: 1.54&#x2013;23.98). Many of these outcomes were exacerbated in females compared with males. Conclusions: The results demonstrate that later ADHD diagnosis is associated with significant negative outcomes by adolescence and disproportionately disadvantages females. Despite later diagnosis, there was clear evidence of childhood mental health and educational difficulties when compared with females without ADHD. 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spelling 2026-04-13T15:29:11.2053364 v2 71276 2026-01-19 Antecedents and outcomes of a later attention–deficit hyperactivity disorder (ADHD) diagnosis in females ed8a9c37bd7b7235b762d941ef18ee55 0000-0002-5657-6995 Ann John Ann John true false 2026-01-19 MEDS Background: Females are less likely than males to be diagnosed with attention–deficit hyperactivity disorder (ADHD). When diagnosed, females are older than males. AimsIn this study, we examined the childhood antecedents of later ADHD diagnosis and its impact on adolescent/emerging adult outcomes, with a focus on females.Method: In this cohort study, we used data from a Welsh nation-wide electronic cohort of 13 593 individuals (n = 2680 (19.7%) females) diagnosed with ADHD and 578 793 individuals (n = 286 734 (49.5%) females) without ADHD. We compared females with later diagnoses (ages 12–25) to those with earlier, timely diagnoses (ages 5–11) and no diagnosis, in terms of childhood (ages 5–11) antecedents and adolescent/adult (ages 12–25) outcomes. We also tested for sex differences. Results: Although females with earlier ADHD diagnosis showed more health and educational difficulties in childhood than those with later diagnosed ADHD (odds ratios ranged from 0.18 to 0.92), there was clear evidence of these difficulties in females with later diagnosed ADHD, compared with females without ADHD (odds ratios: 1.07–9.02). In adolescence/early adulthood, females with later diagnosed ADHD used more healthcare services and had worse mental health, educational and socioeconomic outcomes than females diagnosed earlier (odds ratios: 1.39–4.96) and those without ADHD (odds ratios: 1.54–23.98). Many of these outcomes were exacerbated in females compared with males. Conclusions: The results demonstrate that later ADHD diagnosis is associated with significant negative outcomes by adolescence and disproportionately disadvantages females. Despite later diagnosis, there was clear evidence of childhood mental health and educational difficulties when compared with females without ADHD. Therefore, timely childhood ADHD diagnosis may help to mitigate later risks, especially for females. Journal Article The British Journal of Psychiatry 0 1 8 Royal College of Psychiatrists 0007-1250 1472-1465 Attention–deficit hyperactivity disorder; neurodevelopmental disorders; mental health services; electronic health records; child and adolescent psychiatry 10 3 2026 2026-03-10 10.1192/bjp.2026.10556 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee This study was funded by the Welsh Government through Health and Care Research Wales via a National Institute for Health and Care Research (NIHR) Advanced Fellowship (Ref: NIHR-FS(A)-2022) and was also supported by a NARSAD Young Investigator Grant from the Brain & Behavior Research Foundation (grant no. 27879). 2026-04-13T15:29:11.2053364 2026-01-19T14:52:13.7944873 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Joanna Martin 0000-0002-8911-3479 1 Olivier Y. Rouquette 2 Kate Langley 3 Miriam Cooper 4 Kapil Sayal 0000-0002-2050-4316 5 Tamsin J. Ford 0000-0001-5295-4904 6 Ann John 0000-0002-5657-6995 7 Anita Thapar 8 71276__36500__a67653aca54f4c31be14f6bc01c8d65d.pdf 71276.VoR.pdf 2026-04-13T15:26:36.5001053 Output 381761 application/pdf Version of Record true © The Author(s), 2026. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence. true eng https://creativecommons.org/licenses/by/4.0/
title Antecedents and outcomes of a later attention–deficit hyperactivity disorder (ADHD) diagnosis in females
spellingShingle Antecedents and outcomes of a later attention–deficit hyperactivity disorder (ADHD) diagnosis in females
Ann John
title_short Antecedents and outcomes of a later attention–deficit hyperactivity disorder (ADHD) diagnosis in females
title_full Antecedents and outcomes of a later attention–deficit hyperactivity disorder (ADHD) diagnosis in females
title_fullStr Antecedents and outcomes of a later attention–deficit hyperactivity disorder (ADHD) diagnosis in females
title_full_unstemmed Antecedents and outcomes of a later attention–deficit hyperactivity disorder (ADHD) diagnosis in females
title_sort Antecedents and outcomes of a later attention–deficit hyperactivity disorder (ADHD) diagnosis in females
author_id_str_mv ed8a9c37bd7b7235b762d941ef18ee55
author_id_fullname_str_mv ed8a9c37bd7b7235b762d941ef18ee55_***_Ann John
author Ann John
author2 Joanna Martin
Olivier Y. Rouquette
Kate Langley
Miriam Cooper
Kapil Sayal
Tamsin J. Ford
Ann John
Anita Thapar
format Journal article
container_title The British Journal of Psychiatry
container_volume 0
container_start_page 1
publishDate 2026
institution Swansea University
issn 0007-1250
1472-1465
doi_str_mv 10.1192/bjp.2026.10556
publisher Royal College of Psychiatrists
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 Background: Females are less likely than males to be diagnosed with attention–deficit hyperactivity disorder (ADHD). When diagnosed, females are older than males. AimsIn this study, we examined the childhood antecedents of later ADHD diagnosis and its impact on adolescent/emerging adult outcomes, with a focus on females.Method: In this cohort study, we used data from a Welsh nation-wide electronic cohort of 13 593 individuals (n = 2680 (19.7%) females) diagnosed with ADHD and 578 793 individuals (n = 286 734 (49.5%) females) without ADHD. We compared females with later diagnoses (ages 12–25) to those with earlier, timely diagnoses (ages 5–11) and no diagnosis, in terms of childhood (ages 5–11) antecedents and adolescent/adult (ages 12–25) outcomes. We also tested for sex differences. Results: Although females with earlier ADHD diagnosis showed more health and educational difficulties in childhood than those with later diagnosed ADHD (odds ratios ranged from 0.18 to 0.92), there was clear evidence of these difficulties in females with later diagnosed ADHD, compared with females without ADHD (odds ratios: 1.07–9.02). In adolescence/early adulthood, females with later diagnosed ADHD used more healthcare services and had worse mental health, educational and socioeconomic outcomes than females diagnosed earlier (odds ratios: 1.39–4.96) and those without ADHD (odds ratios: 1.54–23.98). Many of these outcomes were exacerbated in females compared with males. Conclusions: The results demonstrate that later ADHD diagnosis is associated with significant negative outcomes by adolescence and disproportionately disadvantages females. Despite later diagnosis, there was clear evidence of childhood mental health and educational difficulties when compared with females without ADHD. Therefore, timely childhood ADHD diagnosis may help to mitigate later risks, especially for females.
published_date 2026-03-10T07:38:52Z
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