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First Treatment Contact for ADHD: Predictors of and Gender Differences in Treatment Seeking
Elias Dakwar, M.D.; Frances R. Levin, M.D.; Mark Olfson, M.D., M.P.H.; Shuai Wang, Ph.D.; Bradley Kerridge; Carlos Blanco, M.D., Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300298
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With the exception of Mr. Kerridge, the authors are with the New York State Psychiatric Institute and the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City (e-mail: dakware@nyspi.columbia.edu). Mr. Kerridge is with the School of Public Health, University of Maryland, College Park, Maryland.

Copyright © 2014 by the American Psychiatric Association

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Abstract

Objective  For attention-deficit hyperactivity disorder (ADHD), treatment seeking is a critical first step in treatment initiation and remains insufficiently understood. The aims of this study were to estimate ADHD treatment-seeking probabilities over the lifetime and to identify predictors of treatment seeking for ADHD separately for males and females.

Methods  Data were drawn from 2001 to 2005 as part of the National Epidemiologic Survey on Alcohol and Related Conditions, a two-wave face-to-face survey conducted by the National Institute on Alcohol Abuse and Alcoholism (N=34,653).

Results  The lifetime cumulative probability of ADHD treatment seeking was estimated at 55%. Males identifying as African American, with less than 12 years of education, or paranoid personality disorder or in an older cohort (>30 years old) at the time of interview were more likely to experience delays, whereas males with comorbid alcohol dependence, dysthymic disorder, borderline personality disorder, or histrionic personality disorder were less likely. Among females, older age (>44 years) was the only predictor of a delay to first treatment seeking, whereas bipolar disorder was associated with more rapid treatment seeking. Age of onset had opposite effects on treatment-seeking delays by gender; males but not females with early-onset ADHD were more likely to experience treatment-seeking delays.

Conclusions  A large proportion of persons with ADHD do not seek treatment. Furthermore, treatment seeking by males was affected by a greater number of identifiable characteristics, suggesting that males might be more responsive to efforts directed toward expediting treatment entry. Future research should explore how to facilitate early access to treatment for individuals with ADHD.

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