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Antecedents and outcomes of a later attention–deficit hyperactivity disorder (ADHD) diagnosis in females
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Olivier Rouquette,
Kate Langley,
Miriam Cooper,
Kapil Sayal ,
Tamsin J. Ford ,
Ann John ,
Anita Thapar
The British Journal of Psychiatry, Pages: 1 - 8
Swansea University Authors:
Olivier Rouquette, Ann John
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PDF | Version of Record
© The Author(s), 2026. Published by Cambridge University Press on behalf of Royal College of Psychiatrists. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence.
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DOI (Published version): 10.1192/bjp.2026.10556
Abstract
Background: Females are less likely than males to be diagnosed with attention–deficit hyperactivity disorder (ADHD). When diagnosed, females are older than males. Aims: In this study, we examined the childhood antecedents of later ADHD diagnosis and its impact on adolescent/emerging adult outcomes,...
| Published in: | The British Journal of Psychiatry |
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| ISSN: | 0007-1250 1472-1465 |
| Published: |
Cambridge University Press (CUP)
2026
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| Online Access: |
Check full text
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| URI: | https://cronfa.swan.ac.uk/Record/cronfa71334 |
| Abstract: |
Background: Females are less likely than males to be diagnosed with attention–deficit hyperactivity disorder (ADHD). When diagnosed, females are older than males. Aims: In this study, we examined the childhood antecedents of later ADHD diagnosis and its impact on adolescent/emerging adult outcomes, with a focus on females. Method: In this cohort study, we used data from a Welsh nation-wide electronic cohort of 13 593 individuals (n = 2680 (19.7%) females) diagnosed with ADHD and 578 793 individuals (n = 286 734 (49.5%) females) without ADHD. We compared females with later diagnoses (ages 12–25) to those with earlier, timely diagnoses (ages 5–11) and no diagnosis, in terms of childhood (ages 5–11) antecedents and adolescent/adult (ages 12–25) outcomes. We also tested for sex differences. Results: Although females with earlier ADHD diagnosis showed more health and educational difficulties in childhood than those with later diagnosed ADHD (odds ratios ranged from 0.18 to 0.92), there was clear evidence of these difficulties in females with later diagnosed ADHD, compared with females without ADHD (odds ratios: 1.07–9.02). In adolescence/early adulthood, females with later diagnosed ADHD used more healthcare services and had worse mental health, educational and socioeconomic outcomes than females diagnosed earlier (odds ratios: 1.39–4.96) and those without ADHD (odds ratios: 1.54–23.98). Many of these outcomes were exacerbated in females compared with males. Conclusions: The results demonstrate that later ADHD diagnosis is associated with significant negative outcomes by adolescence and disproportionately disadvantages females. Despite later diagnosis, there was clear evidence of childhood mental health and educational difficulties when compared with females without ADHD. Therefore, timely childhood ADHD diagnosis may help to mitigate later risks, especially for females. |
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| Keywords: |
Attention–deficit hyperactivity disorder; neurodevelopmental disorders; mental health services; electronic health records; child and adolescent psychiatry |
| College: |
Faculty of Medicine, Health and Life Sciences |
| Funders: |
This study was funded by the Welsh Government through Health and Care Research Wales via a National Institute for Health and Care Research (NIHR) Advanced Fellowship (reference NIHR-FS(A)-2022) and was also supported by a National Alliance for Research on Schizophrenia and Depression Young Investigator Grant from the Brain & Behavior Research Foundation (grant no. 27879). This work was supported by the Adolescent Mental Health Data Platform (ADP). The ADP is funded by the MQ Mental Health Research Charity (grant reference MQBF/3 ADP). The views expressed are entirely those of the authors and should not be assumed to be the same as those of ADP or the MQ Mental Health Research Charity. This work was supported by the Wolfson Centre for Young People’s Mental Health, established with support from the Wolfson Foundation. |
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1 |
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8 |