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Sex differences in predicting ADHD clinical diagnosis and pharmacological treatment
Social, Genetic, and Developmental Psychiatry Centre (SGDP), Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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2019 (English)In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 28, no 4, p. 481-489Article in journal (Refereed) Published
Abstract [en]

In youth, ADHD is more commonly diagnosed in males than females, but higher male-to-female ratios are found in clinical versus population-based samples, suggesting a sex bias in the process of receiving a clinical diagnosis of ADHD. This study investigated sex differences in the severity and presentation of ADHD symptoms, conduct problems, and learning problems in males and females with and without clinically diagnosed ADHD. We then investigated whether the predictive associations of these symptom domains on being diagnosed and treated for ADHD differed in males and females. Parents of 19,804 twins (50.64% male) from the Swedish population completed dimensional assessments of ADHD symptoms and co-occurring traits (conduct and learning problems) when children were aged 9 years. Children from this population sample were linked to Patient Register data on clinical ADHD diagnosis and medication prescriptions. At the population level, males had higher scores for all symptom domains (inattention, hyperactivity/impulsivity, conduct, and learning problems) compared to females, but similar severity was seen in clinically diagnosed males and females. Symptom severity for all domains increased the likelihood of receiving an ADHD diagnosis in both males and females. Prediction analyses revealed significant sex-by-symptom interactions on diagnostic and treatment status for hyperactivity/impulsivity and conduct problems. In females, these behaviours were stronger predictors of clinical diagnosis (hyperactivity/impulsivity: OR 1.08, 95% CI 1.01, 1.15; conduct: OR 1.43, 95% CI 1.09, 1.87), and prescription of pharmacological treatment (hyperactivity/impulsivity: OR 1.24, 95% CI 1.02, 1.50; conduct: OR 2.20, 95% CI 1.05, 4.63). Females with ADHD may be more easily missed in the ADHD diagnostic process and less likely to be prescribed medication unless they have prominent externalising problems.

Place, publisher, year, edition, pages
Springer, 2019. Vol. 28, no 4, p. 481-489
Keywords [en]
Attention-deficit/hyperactivity disorder/ADHD, Clinical diagnosis, Population-based study, Sex differences
National Category
Psychiatry Pediatrics Psychology
Identifiers
URN: urn:nbn:se:oru:diva-71737DOI: 10.1007/s00787-018-1211-3ISI: 000463206100006PubMedID: 30097723OAI: oai:DiVA.org:oru-71737DiVA, id: diva2:1281858
Funder
Forte, Swedish Research Council for Health, Working Life and WelfareStiftelsen Söderström - Königska sjukhemmetSwedish Research CouncilThe Swedish Foundation for International Cooperation in Research and Higher Education (STINT), IG2012-5056Wellcome trust
Note

Funding Agencies:

ALF agreement

Medical Research Council  

Institute of Psychiatry Excellence Fund 

National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London

Available from: 2019-01-23 Created: 2019-01-23 Last updated: 2019-06-18Bibliographically approved

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Larsson, Henrik

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