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J Am Acad Child Adolesc Psychiatry. 2019 Jan 8. pii: S0890-8567(19)30005-X. doi: 10.1016/j.jaac.2018.07.910. [Epub ahead of print]

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

Author information

1
National Centre for Register- based Research, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark; Centre for Integrated Register-based Research at Aarhus University (CIRRAU), Aarhus, Denmark. Electronic address: c.g.ottosen@gmail.com.
2
National Centre for Register- based Research, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark; Centre for Integrated Register-based Research at Aarhus University (CIRRAU), Aarhus, Denmark.
3
Dr. Faraone is with SUNY Upstate Medical University, Syracuse, NY, and the K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of Bergen, Norway.
4
Dr. Chen and Dr. Larsson are with Karolinska Institutet, Stockholm, Sweden.
5
Dr. Hartmann is with the University of Groningen, The Netherlands.
6
Dr. Chen and Dr. Larsson are with Karolinska Institutet, Stockholm, Sweden; Dr. Larsson is also with the School of Medical Sciences, Örebro University, Sweden.
7
National Centre for Register- based Research, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark; Hospital of Telemark, Kragerø, Norway.

Abstract

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.

KEYWORDS:

ADHD; comorbid disorders; sex differences

PMID:
30768399
DOI:
10.1016/j.jaac.2018.07.910

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