BACKGROUND Population-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. METHODS The 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. RESULTS There 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. CONCLUSIONS This 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.

中文翻译：

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注意力缺陷多动障碍诊断和临床护理的性别差异：威尔士人口健康记录的全国研究。


背景 基于人群的研究观察到注意力缺陷多动障碍 （ADHD） 的诊断和治疗中存在性别偏见。女性不太可能被诊断出或开具 ADHD 药物。本研究使用国家医疗保健记录来调查年轻 ADHD 患者在诊断和临床护理方面的性别差异，特别是在识别和治疗其他心理健康状况方面。方法 该队列包括被诊断患有 ADHD 的个体，出生于 1989 年至 2013 年之间，生活在 2000 年至 2019 年之间，居住在威尔士。常规的初级和次级医疗保健记录数据用于得出 ADHD 和其他神经发育和心理健康状况以及 ADHD 和抗抑郁药物的诊断。人口统计变量包括种族、社会经济剥夺和与社会服务的接触。结果有 16,458 名被诊断患有 ADHD 的人 （20.3% 为女性，年龄 3-30 岁），男女比例为 3.9：1。在诊断较年轻的个体 （<12 岁） 中，比率较高 （4.8：1），在被诊断为成年人的个体 （>18） 中，比率最低 （1.9：1）。男性在最初记录到 ADHD 诊断时更年轻（平均值 = 10.9 岁对 12.6 岁），更有可能被开具 ADHD 药物，并且在诊断同时发生的神经发育状况时更年轻。相比之下，女性更有可能在 ADHD 诊断之前被诊断出患有焦虑、抑郁或其他心理健康状况，并被开具抗抑郁药物。这些性别差异在人口群体中基本稳定。结论 这项研究增加了证据基础，即患有 ADHD 的女性正在经历较晚的 ADHD 识别和治疗。 结果表明，这可能部分是由于其他心理健康状况（如焦虑和抑郁）的诊断掩盖了诊断，或最初的误诊。需要进一步的研究和向公众传播研究结果，以提高女性对 ADHD 的认识、及时诊断和治疗。