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

Charlotte Skoglund; Inger Sundström Poromaa; Daniel Leksell; Katarina Ekholm Selling; Thomas Cars; Maibritt Giacobini; Susan Young; Helena Kopp Kallner

doi:10.1111/jcpp.13920

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

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

Authors

Charlotte Skoglund¹, Inger Sundström Poromaa², Daniel Leksell³, Katarina Ekholm Selling^{2

4}, Thomas Cars⁴, Maibritt Giacobini^{5

6}, Susan Young^{7

8}, Helena Kopp Kallner^{9

10}

Affiliations

¹ Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
² Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
³ Smart Psykiatri AB, Stockholm, Sweden.
⁴ Sence Research AB, Uppsala, Sweden.
⁵ Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
⁶ PRIMA Child and Adult Psychiatry, Stockholm, Sweden.
⁷ Psychology Services Limited, London, UK.
⁸ Department of Psychology, University of Reykjavik, Reykjavik, Iceland.
⁹ Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
¹⁰ Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden.

PMID: 38016697
DOI: 10.1111/jcpp.13920

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.

MeSH terms

Adolescent
Adult
Attention Deficit Disorder with Hyperactivity* / epidemiology
Child
Comorbidity
Cross-Sectional Studies
Delayed Diagnosis / statistics & numerical data
Female
Humans
Male
Patient Acceptance of Health Care / statistics & numerical data
Registries* / statistics & numerical data
Sex Factors
Sweden / epidemiology
Young Adult

Grants and funding

Takeda AB financially supported the analytical work for this study via Sence Research (an independent company in biostatistics and epidemiology). Authors received no compensation for manuscript writing.