Sex differences in ADHD Diagnosis and Care Patterns Among Children Enrolled in North Carolina Medicaid.

Authors

Julia C Schechter, Zhen Li, Jessica R Lunsford-Avery, Kelley A Jones, Naomi N Duke, Samantha Repka, Jennifer M Gierisch, Naomi O Davis

Published in

Academic pediatrics. Pages 103753. Nov 06, 2026. Epub Nov 06, 2026.

Abstract

Delayed diagnosis and treatment for ADHD is associated with significant impairment. Limited research has explored sex differences in diagnostic and treatment patterns before and after ADHD diagnosis and how patterns vary by sociodemographic characteristics. We hypothesized female children, compared to males, would be older at ADHD diagnosis with more prior behavioral health (BH) diagnoses, diagnosed more often by BH clinicians, and less likely to receive empirically-based treatment.
We conducted a retrospective cohort study of pediatric Medicaid enrollees ages 5-17 in North Carolina between 2019-2023 with a 2022 ADHD index date (N=12,398). Using claims data, we examined sex differences in characteristics before, during, and after ADHD diagnosis using t-tests, χ2 tests, relative risk, and odds ratios. Race/ethnicity and rurality were examined as moderators.
Females were older at ADHD diagnosis (9.0 vs. 8.0 years), had received over twice as many prior BH diagnoses-including 34% having previous internalizing diagnoses-and were more likely to be diagnosed by BH than primary care providers. Post-diagnosis, females were less likely to receive ADHD medication and more likely to receive psychotherapy. Hispanic females were most likely to be diagnosed > age 12.
Findings represent the first known study examining sex differences in ADHD care patterns via comprehensive look-back and follow-up periods in a diverse, U.S.-based sample. Results indicate internalizing concerns in females may signal the need for ADHD screening. Findings highlight importance of culturally-informed clinical resources, particularly for Hispanic families. Future research should clarify underlying reasons for sex differences in care patterns.

PMID:
42994682
Bibliographic data and abstract were imported from PubMed on 07 Nov 2026.

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