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. 2024 Jun;65(6):832-844.
doi: 10.1111/jcpp.13920. Epub 2023 Nov 28.

Time after time: failure to identify and support females with ADHD - a Swedish population register study

Charlotte Skoglund  1 , Inger Sundström Poromaa  2 , Daniel Leksell  3 , Katarina Ekholm Selling  2   4 , Thomas Cars  4 , Maibritt Giacobini  5   6 , Susan Young  7   8 , Helena Kopp Kallner  9   10
Affiliations

Time after time: failure to identify and support females with ADHD - a Swedish population register study

Charlotte Skoglund et al. J Child Psychol Psychiatry. 2024 Jun.

Abstract

Background: Attention deficit hyperactivity disorder (ADHD) is associated with risk taking and negative health-related outcomes across the lifespan. Due to delay in referral and diagnostics, young females with ADHD may not be identified, nor appropriately supported by adequate interventions.

Methods: A total of 85,330 individuals with ADHD, all of whom were residents in Stockholm County between January 01, 2011, and December 31, 2021, were included as participants in this population-based, cross-sectional cohort study. Population controls (n = 426,626) were matched by age, sex, and socioeconomic status (SES). Data was obtained from Regional Healthcare Data Warehouse of Region Stockholm (VAL) in Stockholm County. Exposure was ADHD-index, defined as the first record of either ICD-10 F90 diagnosis and/or ATC-code for stimulant or non-stimulant ADHD-medication during the study period. Primary outcome was age at ADHD-index. Secondary outcome measures were psychiatric comorbidity, pharmacological treatment, and health care utilization, prior to and after ADHD-index.

Results: Females were 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). Overall, females with ADHD showed higher rates of psychiatric comorbidity, pharmacological treatment, and health care utilization, compared to males with ADHD and female controls.

Conclusions: Females with ADHD receive diagnosis and treatment for ADHD approximately 4 years later than males. They have a higher burden of comorbid psychiatric conditions and health care utilization, compared to males with ADHD and female controls, both prior to and after ADHD-index. To prevent long-term adverse consequences for females with ADHD, methods, and tools for early diagnosis and treatments that mitigate personal suffering and societal burden are warranted.

Keywords: Attention deficit hyperactivity disorder; comorbidity; diagnosis; girls; sex; women.

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