Sex differences in psychiatric comorbidities of attention-deficit/hyperactivity disorder among children, adolescents, and adults: A nationwide population-based cohort study
Open accessAbstract
This cross-sectional, nationwide, population-based study aimed to elucidate sex differences in psychiatric comorbidities of Attention-deficit/hyperactivity disorder (ADHD) across children, adolescents, and adults. We analyzed data from Taiwan’s comprehensive healthcare database, including 112,225 individuals diagnosed with ADHD, categorized by age (0–12, 13–18, ≥18 years) and sex. Psychiatric comorbidities were assessed using ICD-9-CM codes, focusing on age and sex-specific prevalence. Among the cohort, 83.50% were children (0–12 years) presenting primarily with learning disabilities and tics, while adolescents (13–18 years; 11.88%) had higher instances of oppositional defiant and conduct disorders. In adults (≥18 years; 4.62%), the prevalence of anxiety, depression, bipolar disorder, and substance misuse was notably higher. Males under 18 predominantly had ADHD, whereas females exhibited increased vulnerability to emotional disorders. In adulthood, males showed greater susceptibility to most psychiatric comorbidities, except sleep disorders. The study highlights the evolving nature of ADHD-related psychiatric comorbidities across different life stages, with distinct sex-based patterns. The transition from childhood to adulthood sees an increased prevalence of various psychiatric conditions, particularly impacting adult males. These findings underscore the need for age- and sex-specific therapeutic approaches in ADHD management. The cultural context of the study necessitates further research in diverse populations for broader applicability of the findings.
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Men with ADHD more often present with impulsivity, risk-taking, and disruptive externalizing behaviors.
“Conversely, men more often present with impulsivity, risk-taking, and disruptive externalizing behaviors [126].”
From ADHD in Adulthood: Clinical Presentation, Comorbidities, and Treatment Perspectives (2025) · cites this paper as [126]
The Discussion (Comorbid with oppositional defiant disorder and conduct disorder; page unavailable) reports higher conduct-disorder rates among males with ADHD across age groups and higher oppositional-defiant-disorder rates among adult males, supporting the disruptive-behavior portion. The Introduction describes impulsivity as a feature of ADHD generally, but the paper does not establish that men with ADHD more often show impulsivity or risk-taking. (LLM, conf=0.86)
Experimental — accuracy not yet measuredWomen with ADHD frequently enter care through mood or anxiety pathways, whereas men are more often referred due to behavioral or substance-related difficulties.
“women frequently enter care through mood or anxiety pathways, whereas men are more often referred due to behavioral or substance-related difficulties [125,126]”
From ADHD in Adulthood: Clinical Presentation, Comorbidities, and Treatment Perspectives (2025) · cites this paper as [126]
The Discussion’s “Sex-based comorbidity patterns” section reports more emotional disorders among females with ADHD and more behavioral disorders among males; the substance-use discussion reports more alcohol use disorder among adult males. The paper discusses referral bias and healthcare-seeking in “Age and sex dynamics,” but does not establish that women enter care through mood or anxiety pathways or that men are referred because of behavioral or substance-related difficulties. The indexed passages provide no page numbers. (LLM, conf=0.84)
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- Authors
- Kao, P.-H., Ho, C.-H., & Huang, C. L.-C.
- Affiliations
- Chi Mei Medical Center (TW)
- Kaohsiung Medical University (TW)
- Corresponding author
- Huang, Charles Lung-Cheng
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2025-01-03
- Volume
- 20
- Issue
- 1
- Pages
- e0315587
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC11698318
- OpenAlex
- W4406048650
- Cited by
- 13
- References
- 52
- Citations by year
- 2026: 8 · 2025: 5
- FWCI
- 8.70
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Ministry of Health and Welfare
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Keywords
- attention deficit hyperactivity disorder, psychiatric comorbidity, sex differences, children, adolescents, adults, learning disabilities, tics, oppositional defiant disorder, conduct disorder, anxiety, depression, bipolar disorder, substance abuse, sleep disorders, age-specific prevalence, Taiwan
- MeSH terms
- Adolescent, Adult, Attention Deficit Disorder with Hyperactivity, Mental Disorders, Child, Child, Preschool, Cross-Sectional Studies, Female, Humans, Infant, Infant, Newborn, Male, Sex Factors, Taiwan, Cohort Studies, Comorbidity, Prevalence, Young Adult
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