Department of Economics and Business Economics

Sex Differences in Comorbidity Patterns of Attention-Deficit/Hyperactivity Disorder

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OBJECTIVE: To investigate sex differences in associations between attention-deficit/hyperactivity disorder (ADHD) and a spectrum of comorbid disorders.

METHOD: The study population included all children born in Denmark between 1981 and 2013 (N=1,665,729). We merged data from Danish registers and obtained information on birth characteristics, socioeconomic status, familial psychiatric history, and diagnoses of ADHD (n=32,308) and comorbid disorders. In order to estimate absolute and relative risks of comorbid disorders, incidence rates (IRs) and adjusted hazard ratios (HRs) with 95% CIs were calculated for females and males. We also examined interactions between ADHD and sex in association with comorbid disorders - estimated as ratios of the hazard ratios (HRRs) in females and males (95% CIs).

RESULTS: Individuals diagnosed with ADHD had significantly increased absolute and relative risks of all 12 comorbid psychiatric disorders investigated. For some comorbid disorders, we found ADHD-sex interactions. Compared to males, ADHD in females showed a stronger association with autism spectrum disorder (HRR=1.86; 95%CI 1.62-2.14), oppositional defiant/conduct disorder (HRR=1.97; 95%CI 1.68-2.30), intellectual disability (HRR=1.79; 95%CI 1.54-2.09), personality disorders (HRR=1.23; 95%CI 1.06-1.43), schizophrenia (HRR=1.21; 95%CI 1.02-1.43), substance use disorders (HRR=1.21; 95%CI 1.07-1.38), and suicidal behavior (1.28; 95%CI 1.12-1.47). The remaining disorders showed no significant sex differences in association with ADHD.

CONCLUSION: This study indicates that the association between ADHD and several comorbid disorders is stronger in females than in males. These important findings add to the literature on sex differences in ADHD and suggest that females diagnosed with ADHD are a more vulnerable group of patients.

Original languageEnglish
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Volume58
Issue4
Pages (from-to)412-422.e3
ISSN0890-8567
DOIs
Publication statusPublished - Apr 2019

    Research areas

  • ADHD, comorbid disorders, sex differences

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