The road to diagnosis and treatment in girls and boys with ADHD - gender differences in the diagnostic process.

Introduction: The number of referrals for diagnostic assessments of Attention Deficit/Hyperactivity Disorder (ADHD) has increased in the last decade. There is a lack of studies examining the diagnostic process and the treatment provided, particularly from a gender perspective.

Methods: From a consecutive cohort of Child and Adolescent Psychiatric (CAP) outpatients, the medical records of 50 boys and 50 girls (under 18 years of age) with a diagnosis of ADHD were selected by an Excel random numbers generator. Data about referral reason, diagnostic process and treatment were analysed.

Results: Emotional symptoms were more common as a reason for referral to CAP among girls, whereas neurodevelopmental disorders were more common among boys. Compared to the boys, the girls were older at first visit to CAP and at the ADHD diagnosis. The girls had had more visits to the clinic prior to the ADHD diagnostic decision and had more often been prescribed non-ADHD medication both before and after the ADHD diagnosis. The rate of ADHD medication was similar in boys and girls. Girls had more often been admitted to a CAP inpatient care unit prior to the ADHD diagnosis due to acute psychiatric symptoms, and had received more individual psychotherapeutic counselling.

Conclusion: The results highlight the need for broader psychiatric investigations including neuropsychiatric symptoms in girls referred for 'emotional problems'.