Sex-specific trajectories of ADHD symptoms from adolescence to young adulthood

Abstract

Reports of current ADHD symptoms in adults with a childhood diagnosis of ADHD are often discrepant: While one subgroup reports a particularly high level of current ADHD symptoms, another reports-in contrast-a very low level. The reasons for this difference remain unclear. Although sex might play a moderating role, it has not yet been examined in this regard. In an epidemiological cohort study from birth to young adulthood, childhood ADHD diagnoses were assessed at the ages of 4.5, 8, and 11 years based on parent ratings. Sex-specific development of ADHD symptoms was analyzed from the age of 15 to 25 years via self-reported ADHD symptoms in participants with (n = 47) and without childhood ADHD (n = 289) using a random coefficient regression model. The congruence between parent reports and adolescents' self-ratings was examined, and the role of childhood ADHD diagnosis, childhood OCC/CD, and childhood internalizing disorder as possible sex-specific predictors of self-reported ADHD symptoms at age 25 years was investigated. With regard to self-reported ADHD symptoms, females with a childhood ADHD diagnosis reported significantly more ADHD symptoms compared to females without childhood ADHD and males with and without ADHD throughout adolescence and young adulthood. In contrast, males with childhood ADHD did not differ from control males either at age 15 or at age 25 years. Only in females did a childhood diagnosis of an externalizing disorder (ADHD and CD/ODD) predict self-reported ADHD symptoms by age 25 years. Our findings suggest that self-reports of young adults with a childhood diagnosis of ADHD are influenced by sex. Specifically, females with childhood ADHD report increased levels of ADHD symptoms upon reaching adulthood. To correctly evaluate symptoms and impairment in this subgroup, other, more objective, sources of information may be advisable, such as neurophysiological measures.

Let’s call the whole thing off: evaluating gender and sex differences in executive function

“…Moreover, the presentation of ADHD may differ between the sexes, with impulsivity more often diagnosed in boys [3]; however, other studies have reported similar presentation of ADHD symptoms between the sexes [4][5][6]. Further, adult women with ADHD have more severe symptoms if they were diagnosed with ADHD as a child, while this relationship is not present in boys [7]. The incidence of schizophrenia is higher in males [8], and may be slightly more prevalent in men [9], and the initial presentation is different by sex, with onset typically seen later in females [10,11].…”

Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women

“…By contrast, clinical studies typically report a greater prevalence of combined-type ADHD [ 5 , 12 , 22 ]. Early meta-analyses of gender effects have found lower severity of hyperactivity-impulsivity [ 40 ], or all ADHD symptoms (inattention, hyperactivity, impulsivity) [ 24 ] in girls than boys, although individual studies show more mixed results [ 8 , 35 , 41 , 42 ].…”

“…People may experience and respond to the same behaviour of males and females in different ways due to gender-related behavioural expectations [ 42 ]. For example in two studies where teachers were presented with ADHD-like vignettes, when simply varying the child’s name and pronouns used from male to female, boys names were more likely to be referred for additional support [ 45 ] and considered more suitable for treatment [ 46 ].…”

Kohortenstudien in der Kinder- und Jugendpsychiatrie

“…Hinsichtlich der Entwicklung externalisierender Störungen über die Lebensspanne sprechen die Befunde geschlechtsbedingt für einen homotypischen Verlauf: So prädizieren externalisierende Diagnosen in der Kindheit nur bei weiblichen Teilnehmern auch ADHS im jungen Erwachsenenalter [ 27 ].…”