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Investigating the reasons behind a later or missed diagnosis of attention‐deficit/hyperactivity disorder in young people: A population cohort study

Isabella Barclay Orcid Logo, Kapil Sayal Orcid Logo, Tamsin Ford Orcid Logo, Ann John Orcid Logo, Mark J. Taylor Orcid Logo, Anita Thapar, Kate Langley, Joanna Martin Orcid Logo

JCPP Advances, Start page: e12301

Swansea University Author: Ann John Orcid Logo

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DOI (Published version): 10.1002/jcv2.12301

Abstract

Background: Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition, more often diagnosed in males. In many individuals, particularly females, ADHD is diagnosed later or missed, the reasons for this are not fully understood. Timely diagnosis is needed to provide supp...

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Published in: JCPP Advances
ISSN: 2692-9384
Published: Wiley 2024
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URI: https://cronfa.swan.ac.uk/Record/cronfa68614
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This study aimed to understand why some young people with ADHD experience later or missed diagnosis and to consider sex differences. Methods: This study included 9991 (females = 43.69%) individuals from the Millenium Cohort Study, a UK based population study which defined recognised ADHD by a parent&#x2010;reported clinician diagnosis, and unrecognised ADHD by parent&#x2010;reported questionnaires. Behavioural and emotional difficulties, engagement in leisure activities, and parental characteristics, were compared between those recognised earlier (by ages 5/7, n = 264, f = 19.3%) versus later (by ages 11/14, n = 260, f = 21.2%), and those recognised (n = 524, f = 20.2%) versus unrecognised (n = 1,138, f = 38.7%) using logistic regression, with odds ratios (OR) and 95% confidence intervals (CI) analysed. Sex differences were investigated with an interaction analysis. Results: Those recognised with ADHD earlier had more peer, conduct, and emotional problems, emotional dysregulation, lower cognitive ability, and poorer prosocial skills compared with those recognised later, ORs ranged from 0.27 (95% CI = 018, 0.41) to 1.20 (95% CI = 1.20, 1.32). Similar findings were seen when comparing those with recognised and unrecognised ADHD; ORs ranged from 0.11 (95% CI = 0.09, 0.15) to 1.31 (95% CI = 1.19, 1.43). Additionally, those recognised were more likely to have diagnosed autism and have less reported physical activity. Sex stratification showed that recognised males had higher emotional dysregulation than unrecognised males, but this was not seen in females. Conclusions: Our findings highlight the need to consider ADHD referral, regardless of cognitive and prosocial ability or comorbidities, if children are displaying ADHD symptoms. 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spelling 2024-12-20T12:58:23.1865888 v2 68614 2024-12-20 Investigating the reasons behind a later or missed diagnosis of attention‐deficit/hyperactivity disorder in young people: A population cohort study ed8a9c37bd7b7235b762d941ef18ee55 0000-0002-5657-6995 Ann John Ann John true false 2024-12-20 MEDS Background: Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition, more often diagnosed in males. In many individuals, particularly females, ADHD is diagnosed later or missed, the reasons for this are not fully understood. Timely diagnosis is needed to provide support, management, and treatment to improve outcomes. This study aimed to understand why some young people with ADHD experience later or missed diagnosis and to consider sex differences. Methods: This study included 9991 (females = 43.69%) individuals from the Millenium Cohort Study, a UK based population study which defined recognised ADHD by a parent‐reported clinician diagnosis, and unrecognised ADHD by parent‐reported questionnaires. Behavioural and emotional difficulties, engagement in leisure activities, and parental characteristics, were compared between those recognised earlier (by ages 5/7, n = 264, f = 19.3%) versus later (by ages 11/14, n = 260, f = 21.2%), and those recognised (n = 524, f = 20.2%) versus unrecognised (n = 1,138, f = 38.7%) using logistic regression, with odds ratios (OR) and 95% confidence intervals (CI) analysed. Sex differences were investigated with an interaction analysis. Results: Those recognised with ADHD earlier had more peer, conduct, and emotional problems, emotional dysregulation, lower cognitive ability, and poorer prosocial skills compared with those recognised later, ORs ranged from 0.27 (95% CI = 018, 0.41) to 1.20 (95% CI = 1.20, 1.32). Similar findings were seen when comparing those with recognised and unrecognised ADHD; ORs ranged from 0.11 (95% CI = 0.09, 0.15) to 1.31 (95% CI = 1.19, 1.43). Additionally, those recognised were more likely to have diagnosed autism and have less reported physical activity. Sex stratification showed that recognised males had higher emotional dysregulation than unrecognised males, but this was not seen in females. Conclusions: Our findings highlight the need to consider ADHD referral, regardless of cognitive and prosocial ability or comorbidities, if children are displaying ADHD symptoms. Additionally, symptoms of ADHD not traditionally included in screening criteria, such as emotional dysregulation, should be considered to improve gender‐inclusive recognition of ADHD. Journal Article JCPP Advances 0 e12301 Wiley 2692-9384 ADHD, emotional dysregulation, missed diagnosis, sex differences 18 12 2024 2024-12-18 10.1002/jcv2.12301 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee Health and Care Research Wales. Grant Number: NIHR-FSA-2022 2024-12-20T12:58:23.1865888 2024-12-20T12:51:09.6300051 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Isabella Barclay 0009-0004-7694-3467 1 Kapil Sayal 0000-0002-2050-4316 2 Tamsin Ford 0000-0001-5295-4904 3 Ann John 0000-0002-5657-6995 4 Mark J. Taylor 0000-0001-5161-4182 5 Anita Thapar 6 Kate Langley 7 Joanna Martin 0000-0002-8911-3479 8
title Investigating the reasons behind a later or missed diagnosis of attention‐deficit/hyperactivity disorder in young people: A population cohort study
spellingShingle Investigating the reasons behind a later or missed diagnosis of attention‐deficit/hyperactivity disorder in young people: A population cohort study
Ann John
title_short Investigating the reasons behind a later or missed diagnosis of attention‐deficit/hyperactivity disorder in young people: A population cohort study
title_full Investigating the reasons behind a later or missed diagnosis of attention‐deficit/hyperactivity disorder in young people: A population cohort study
title_fullStr Investigating the reasons behind a later or missed diagnosis of attention‐deficit/hyperactivity disorder in young people: A population cohort study
title_full_unstemmed Investigating the reasons behind a later or missed diagnosis of attention‐deficit/hyperactivity disorder in young people: A population cohort study
title_sort Investigating the reasons behind a later or missed diagnosis of attention‐deficit/hyperactivity disorder in young people: A population cohort study
author_id_str_mv ed8a9c37bd7b7235b762d941ef18ee55
author_id_fullname_str_mv ed8a9c37bd7b7235b762d941ef18ee55_***_Ann John
author Ann John
author2 Isabella Barclay
Kapil Sayal
Tamsin Ford
Ann John
Mark J. Taylor
Anita Thapar
Kate Langley
Joanna Martin
format Journal article
container_title JCPP Advances
container_volume 0
container_start_page e12301
publishDate 2024
institution Swansea University
issn 2692-9384
doi_str_mv 10.1002/jcv2.12301
publisher Wiley
college_str Faculty of Medicine, Health and Life Sciences
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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
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description Background: Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition, more often diagnosed in males. In many individuals, particularly females, ADHD is diagnosed later or missed, the reasons for this are not fully understood. Timely diagnosis is needed to provide support, management, and treatment to improve outcomes. This study aimed to understand why some young people with ADHD experience later or missed diagnosis and to consider sex differences. Methods: This study included 9991 (females = 43.69%) individuals from the Millenium Cohort Study, a UK based population study which defined recognised ADHD by a parent‐reported clinician diagnosis, and unrecognised ADHD by parent‐reported questionnaires. Behavioural and emotional difficulties, engagement in leisure activities, and parental characteristics, were compared between those recognised earlier (by ages 5/7, n = 264, f = 19.3%) versus later (by ages 11/14, n = 260, f = 21.2%), and those recognised (n = 524, f = 20.2%) versus unrecognised (n = 1,138, f = 38.7%) using logistic regression, with odds ratios (OR) and 95% confidence intervals (CI) analysed. Sex differences were investigated with an interaction analysis. Results: Those recognised with ADHD earlier had more peer, conduct, and emotional problems, emotional dysregulation, lower cognitive ability, and poorer prosocial skills compared with those recognised later, ORs ranged from 0.27 (95% CI = 018, 0.41) to 1.20 (95% CI = 1.20, 1.32). Similar findings were seen when comparing those with recognised and unrecognised ADHD; ORs ranged from 0.11 (95% CI = 0.09, 0.15) to 1.31 (95% CI = 1.19, 1.43). Additionally, those recognised were more likely to have diagnosed autism and have less reported physical activity. Sex stratification showed that recognised males had higher emotional dysregulation than unrecognised males, but this was not seen in females. Conclusions: Our findings highlight the need to consider ADHD referral, regardless of cognitive and prosocial ability or comorbidities, if children are displaying ADHD symptoms. Additionally, symptoms of ADHD not traditionally included in screening criteria, such as emotional dysregulation, should be considered to improve gender‐inclusive recognition of ADHD.
published_date 2024-12-18T02:57:46Z
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