Almost two thirds (63%) of the study group met criteria for ADHD or ASD. Most of the patients with NDD (particularly the “NDD females”) had not been diagnosed in childhood. Twelve percent of the females included had been given an ADHD diagnosis in childhood. In the current study we found that 48% of the females had ADHD. The high male:female NDD ratio reported among children, was not obvious in our NDD group. The results underscore the importance of screening for NDD in adult psychiatric services regardless of referral reason.Neurodevelopmental disorders and comorbidity in young adults attending a psychiatric outpatient clinic – ScienceDirect
This paper on diagnosis of neurodivergence offers shocking confirmation of what neurodiversity communities have been saying: we’re missing a whole lot of people. Particularly women.
Content note: Medicalized language
NDD = Neurodevelopmental Disorders
AOP = Adult Outpatient Psychiatric
More than two thirds of this young AOP clientele were diagnosed with a type of NDD. Almost two thirds of this young AOP clientele met criteria for ADHD or ASD (more than half meeting criteria for ADHD). The majority of these “NDD patients” (and particularly the women) had not been diagnosed in childhood. In addition, one third of the study group scored above cut off in the self-rating scale AUDIT, indicating risk use of alcohol, and although not significant, a high rate of those also fulfilled ADHD diagnosis. The NDD group (the vast majority of whom had ADHD, ASD or both) also usually met criteria for either affective, anxiety, OCD spectrum, or personality disorder.
When studying the prevalence of NDD within the more traditional psychiatric diagnoses we found that more than half of those with af- fective disorders, anxiety disorder, OCD spectrum, or personality disorders had an additional NDD. NDD was not as prevalent in the subgroup of those with eating disorder, however almost 30% in this group met criteria for an “additional” NDD. The results from our study accord well with the results from a recent study by Pehlivanidis et al. (2020) showing that adult patients with ADHD had a substantial co- morbidity with traditional psychiatric disorders (most commonly depression). For ADHD, the comorbidity rate with a traditional psychi- atric disorder was 73% and for ASD it was 50%. These traditional psy- chiatric diagnoses (affective disorders, anxiety disorders and/or personality disorders), are the ones most likely to be made in young AOP clientele, unless NDD is specifically considered and assessed for. What happens to all the young patients with these early onset developmental disorders in the transition from child and adolescent psychiatry and adult psychiatry? Is it possible that this group of patients have a certain kind of problems in childhood, but then change symptomatology when they grow up and end up with depression and anxiety instead? Or that adult psychiatrists when untrained or inexperienced in the field of NDD faced with young adult patients try to “fit them in” into diagnostic adult psychiatric diagnostic categories that they are familiar with? Our results support that there is a major comorbidity between NDD diagnosis and traditional adult psychiatric diagnosis. This may make it difficult to discover the underlying condition and might explain why NDD is underdiagnosed among adult patients (Fayyad et al., 2017).
Our results indicate that there may be a substantial group of patients with ASD and other NDDs that are missed in childhood. This is supported by the retrospective study of clinical charts of adults in two university services specialized in the assessment and treatment of adolescents and adults with ASD. They found that the mean age for the first formal ASD diagnosis was 22 years for men and 26 years for women (Fusar-Poli et al., 2020).
We found no gender difference regarding the rate of ASD after full assessment, suggesting that many female patients with ASD are missed in childhood, since studies from childhood show a male:female ratio of 3:1. (Loomes et al., 2017). Our results suggest also that female patients may be missed regarding ADHD in childhood, which have been reported in the study of Quinn et al. (2014). Only six percent of the females in our study had a previous ADHD diagnosis compared to 48% after full assessment in the study. The traditional gender ratio reported from childhood studies (Polanczyk et al., 2010) was not obvious in our NDD group. We found a trend for ADHD to be slightly more common in males but the difference was not significant.
We did not either find gender difference in the rate of previous NDD diagnosis established by external clinician when grouping all NDDs. However, more men than females had a previous ADHD diagnosis.
The results suggest the importance of screening for NDD, regardless of referral reason, in both adult psychiatric care and child and adolescent psychiatric care. The high rate found of women with NDD and additional psychiatric problems might suggest the notion that an early identification of NDD might have altered the outcome for this group.Neurodevelopmental disorders and comorbidity in young adults attending a psychiatric outpatient clinic – ScienceDirect
Such staggering omission.