title: Sex and age differences in attention-deficit/hyperactivity disorder symptoms and diagnoses: implications for DSM-V and ICD-11.
abstract: OBJECTIVE
  To examine gender and age differences in attention-deficit/hyperactivity disorder (ADHD) symptom endorsement in a large community-based sample.
  
  
  METHODS
  Families with four or more full siblings ascertained from Missouri birth records completed telephone interviews regarding lifetime DSM-IV ADHD symptoms and the Strengths and Weaknesses of ADHD-Symptoms and Normal-behavior (SWAN) questionnaire for current ADHD symptoms. Complete data were available for 9,380 subjects aged 7 through 29 years. Lifetime and current DSM-IV-like ADHD diagnoses were assigned by the DSM-IV symptom criteria. Linear regression was used to examine sex and age effects on SWAN ADHD symptom scores. Logistic regression was used to examine sex and age effects on specific ADHD diagnoses. Fractional polynomial graphs were used to examine ADHD symptom count variations across age.
  
  
  RESULTS
  Overall prevalence of current DSM-IV-like ADHD was 9.2% with a male:female ratio of 2.28:1. The prevalence of DSM-IV-like ADHD was highest in children. Gender differences in DSM-IV-like ADHD subtype prevalences were highest in adolescents. On average, individuals with lifetime DSM-IV-like ADHD diagnoses had elevated current ADHD symptoms even as adolescents or adults.
  
  
  CONCLUSIONS
  Lower male:female ratios than reported in some clinic-based studies suggest that females are underdiagnosed in the community. Although they may no longer meet the full symptom criteria, young adults with a history of lifetime DSM-IV-like ADHD maintain higher levels of ADHD symptoms compared with the general population. The use of age-specific diagnostic criteria should be considered for DSM-V and ICD-11.
authors.affiliation: Washington University in St Louis School of Medicine, Saint Louis, MO 63110, USA.
authors.forename: Ujjwal P
authors.initials: UP
authors.lastname: Ramtekkar
authors.forename: Angela M
authors.initials: AM
authors.lastname: Reiersen
authors.forename: Alexandre A
authors.initials: AA
authors.lastname: Todorov
authors.forename: Richard D
authors.initials: RD
authors.lastname: Todd
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D002648:Child; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006306:Health Surveys; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008923:Missouri; D010552:Personality Assessment / Q000706:statistics & numerical data; D011594:Psychometrics; D012737:Sex Factors; D055815:Young Adult
references.citation: Behav Genet. 2007 Jul;37(4):559-66
references.pmid: 17443404
references.citation: J Clin Psychol. 2005 May;61(5):529-33
references.pmid: 15723420
references.citation: Biol Psychiatry. 2007 Mar 1;61(5):700-5
references.pmid: 16962074
references.citation: J Am Acad Child Adolesc Psychiatry. 1997 Aug;36(8):1036-45
references.pmid: 9256583
references.citation: Arch Pediatr Adolesc Med. 2007 Sep;161(9):857-64
references.pmid: 17768285
references.citation: J Am Acad Child Adolesc Psychiatry. 2008 Jan;47(1):76-85
references.pmid: 18174828
references.citation: Child Adolesc Psychiatr Clin N Am. 2006 Oct;15(4):919-37, ix
references.pmid: 16952768
references.citation: J Am Acad Child Adolesc Psychiatry. 2003 Dec;42(12):1460-8
references.pmid: 14627881
references.citation: J Am Acad Child Adolesc Psychiatry. 2005 Feb;44(2):159-68
references.pmid: 15689729
references.citation: J Atten Disord. 2002 Jan;5(3):143-54
references.pmid: 11911007
references.citation: Am J Psychiatry. 2006 Apr;163(4):716-23
references.pmid: 16585449
references.citation: J Child Psychol Psychiatry. 2007 Nov;48(11):1080-7
references.pmid: 17995483
references.citation: JAMA. 1998 Apr 8;279(14):1100-7
references.pmid: 9546570
references.citation: Int J Educ Psychol Assess. 2012 Apr;10(1):51-70
references.pmid: 26504617
references.citation: Eur Child Adolesc Psychiatry. 2000 Sep;9(3):212-8
references.pmid: 11095044
references.citation: J Am Acad Child Adolesc Psychiatry. 1996 Aug;35(8):978-87
references.pmid: 8755794
references.citation: Am J Psychiatry. 1994 Nov;151(11):1673-85
references.pmid: 7943460
references.citation: J Am Acad Child Adolesc Psychiatry. 1995 Aug;34(8):1001-8
references.pmid: 7665438
references.citation: N Engl J Med. 1999 Mar 11;340(10):780-8
references.pmid: 10072414
references.citation: J Am Acad Child Adolesc Psychiatry. 2009 May;48(5):484-500
references.pmid: 19318991
references.citation: MMWR Morb Mortal Wkly Rep. 2005 Sep 2;54(34):842-7
references.pmid: 16138075
references.citation: Psychol Med. 2006 Feb;36(2):159-65
references.pmid: 16420712
references.citation: Arch Gen Psychiatry. 2005 Aug;62(8):896-902
references.pmid: 16061767
references.citation: Am J Psychiatry. 2005 Jun;162(6):1083-9
references.pmid: 15930056
references.citation: Child Psychiatry Hum Dev. 2009 Dec;40(4):543-59
references.pmid: 19455417
references.citation: J Am Acad Child Adolesc Psychiatry. 1997 Dec;36(12):1706-14
references.pmid: 9401332
references.citation: J Am Acad Child Adolesc Psychiatry. 1996 Mar;35(3):319-24
references.pmid: 8714320
references.citation: J Atten Disord. 2005 Nov;9(2):392-401
references.pmid: 16371662
references.citation: J Child Psychol Psychiatry. 2008 Sep;49(9):942-9
references.pmid: 18564071
references.citation: Biol Psychiatry. 2000 Jul 1;48(1):9-20
references.pmid: 10913503
references.citation: Pediatrics. 2001 Mar;107(3):E43
references.pmid: 11230624
references.citation: Am J Psychiatry. 1997 Sep;154(9):1323-5
references.pmid: 9286210
references.citation: Am J Public Health. 1997 May;87(5):827-32
references.pmid: 9184514
references.citation: Ment Retard Dev Disabil Res Rev. 2002;8(3):162-70
references.pmid: 12216060
references.citation: Am J Med Genet B Neuropsychiatr Genet. 2004 May 15;127B(1):60-4
references.pmid: 15108181