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Antecedents and outcomes of a later attention deficit hyperactivity disorder (ADHD) diagnosis in females

Joanna Martin Orcid Logo, Olivier Rouquette, Kate Langley, Miriam Cooper, Kapil Sayal, Tamsin Ford, Ann John Orcid Logo, Anita Thapar

medRxiv

Swansea University Authors: Olivier Rouquette, Ann John Orcid Logo

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,...

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URI: https://cronfa.swan.ac.uk/Record/cronfa71334
first_indexed 2026-01-29T09:29:39Z
last_indexed 2026-02-21T05:25:40Z
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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=2,680 (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&#x2013;25) to those with earlier, timely diagnoses (ages 5&#x2013;11) and no diagnosis, in terms of childhood (ages 5&#x2013;11) antecedents and adolescent/adult (ages 12&#x2013;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 (ORs ranged from 0.18&#x2013;0.92), there was clear evidence of these difficulties in females with later diagnosed ADHD, compared to females without ADHD (ORs: 1.07&#x2013;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 (ORs: 1.39&#x2013;4.96) and those without ADHD (ORs: 1.54&#x2013;23.98). Many of these outcomes were exacerbated in females compared to 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 to females without ADHD. Therefore, timely childhood ADHD diagnosis may help to mitigate later risks, especially for females.</abstract><type>Journal Article</type><journal>medRxiv</journal><volume/><journalNumber/><paginationStart/><paginationEnd/><publisher/><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic/><keywords/><publishedDay>0</publishedDay><publishedMonth>0</publishedMonth><publishedYear>0</publishedYear><publishedDate>0001-01-01</publishedDate><doi/><url/><notes>Preprint article before certification by peer review.</notes><college>COLLEGE NANME</college><CollegeCode>COLLEGE CODE</CollegeCode><institution>Swansea University</institution><apcterm>Another institution paid the OA fee</apcterm><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 (Ref: NIHR-FS(A)-2022) and was also supported by a NARSAD Young Investigator Grant from the Brain &amp; Behavior Research Foundation (grant no. 27879). This work was supported by the Adolescent Mental Health Data Platform (ADP). The ADP is funded by 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 MQ Mental Health Research Charity. This work was supported by the Wolfson Centre for Young People&#x2019;s Mental Health, established with support from the Wolfson Foundation.</funders><projectreference/><lastEdited>2026-02-20T10:50:55.4898872</lastEdited><Created>2026-01-29T09:18:32.6519159</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Medicine</level></path><authors><author><firstname>Joanna</firstname><surname>Martin</surname><orcid>0000-0002-8911-3479</orcid><order>1</order></author><author><firstname>Olivier</firstname><surname>Rouquette</surname><order>2</order></author><author><firstname>Kate</firstname><surname>Langley</surname><order>3</order></author><author><firstname>Miriam</firstname><surname>Cooper</surname><order>4</order></author><author><firstname>Kapil</firstname><surname>Sayal</surname><order>5</order></author><author><firstname>Tamsin</firstname><surname>Ford</surname><order>6</order></author><author><firstname>Ann</firstname><surname>John</surname><orcid>0000-0002-5657-6995</orcid><order>7</order></author><author><firstname>Anita</firstname><surname>Thapar</surname><order>8</order></author></authors><documents/><OutputDurs/></rfc1807>
spelling 2026-02-20T10:50:55.4898872 v2 71334 2026-01-29 Antecedents and outcomes of a later attention deficit hyperactivity disorder (ADHD) diagnosis in females 0e502db88ea48ce6b053ed0eef9a54ce Olivier Rouquette Olivier Rouquette true false ed8a9c37bd7b7235b762d941ef18ee55 0000-0002-5657-6995 Ann John Ann John true false 2026-01-29 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=2,680 (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 (ORs ranged from 0.18–0.92), there was clear evidence of these difficulties in females with later diagnosed ADHD, compared to females without ADHD (ORs: 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 (ORs: 1.39–4.96) and those without ADHD (ORs: 1.54–23.98). Many of these outcomes were exacerbated in females compared to 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 to females without ADHD. Therefore, timely childhood ADHD diagnosis may help to mitigate later risks, especially for females. Journal Article medRxiv 0 0 0 0001-01-01 Preprint article before certification by peer review. COLLEGE NANME COLLEGE CODE Swansea University Another institution paid the OA fee 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 (Ref: NIHR-FS(A)-2022) and was also supported by a NARSAD 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 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 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. 2026-02-20T10:50:55.4898872 2026-01-29T09:18:32.6519159 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Joanna Martin 0000-0002-8911-3479 1 Olivier Rouquette 2 Kate Langley 3 Miriam Cooper 4 Kapil Sayal 5 Tamsin Ford 6 Ann John 0000-0002-5657-6995 7 Anita Thapar 8
title Antecedents and outcomes of a later attention deficit hyperactivity disorder (ADHD) diagnosis in females
spellingShingle Antecedents and outcomes of a later attention deficit hyperactivity disorder (ADHD) diagnosis in females
Olivier Rouquette
Ann John
title_short Antecedents and outcomes of a later attention deficit hyperactivity disorder (ADHD) diagnosis in females
title_full Antecedents and outcomes of a later attention deficit hyperactivity disorder (ADHD) diagnosis in females
title_fullStr Antecedents and outcomes of a later attention deficit hyperactivity disorder (ADHD) diagnosis in females
title_full_unstemmed Antecedents and outcomes of a later attention deficit hyperactivity disorder (ADHD) diagnosis in females
title_sort Antecedents and outcomes of a later attention deficit hyperactivity disorder (ADHD) diagnosis in females
author_id_str_mv 0e502db88ea48ce6b053ed0eef9a54ce
ed8a9c37bd7b7235b762d941ef18ee55
author_id_fullname_str_mv 0e502db88ea48ce6b053ed0eef9a54ce_***_Olivier Rouquette
ed8a9c37bd7b7235b762d941ef18ee55_***_Ann John
author Olivier Rouquette
Ann John
author2 Joanna Martin
Olivier Rouquette
Kate Langley
Miriam Cooper
Kapil Sayal
Tamsin Ford
Ann John
Anita Thapar
format Journal article
container_title medRxiv
institution Swansea University
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 - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 0
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description 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=2,680 (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 (ORs ranged from 0.18–0.92), there was clear evidence of these difficulties in females with later diagnosed ADHD, compared to females without ADHD (ORs: 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 (ORs: 1.39–4.96) and those without ADHD (ORs: 1.54–23.98). Many of these outcomes were exacerbated in females compared to 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 to females without ADHD. Therefore, timely childhood ADHD diagnosis may help to mitigate later risks, especially for females.
published_date 0001-01-01T07:32:21Z
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