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Peer-reviewedCC BY-NC-ND 4.0European Child & Adolescent Psychiatry

Disparities in treatment initiation following diagnosis of attention-deficit/hyperactivity disorder: a systematic review

  • Philip Wickham1
  • Saima Orangzeb2,3,4
  • Jacqueline M. Cohen4
  • Patricia Li5
  • Thuy Mai Luu6
  • Gabriel Côté-Corriveau6
  • Farzana Uddin7
  • Ugochinyere Vivian Ukah1,8
8 affiliations
  1. 1Department of Medicine, McGill University Health Centre, Montreal, Canada
  2. 2Innlandet Hospital Trust, Hamar, Norway
  3. 3Faculty of Medicine, University of Oslo, Oslo, Norway
  4. 4Department of Chronic Diseases and Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
  5. 5Department of Pediatrics, McGill University, Montreal, QC Canada
  6. 6Department of Pediatrics, Sainte-Justine Hospital Research Centre, University of Montreal, Montreal, QC Canada
  7. 7Department of Psychology, Concordia University, Montreal, QC Canada
  8. 8Child Health and Human Development Program, Research Institute, McGill University Health Centre, Montreal, QC Canada
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Abstract

Early intervention improves long-term outcomes in children with Attention-Deficit/Hyperactivity Disorder (ADHD). However, disparities may exist in the timing of treatment initiation following diagnosis. The objective of this systematic review was to examine associations between sociodemographic factors and time to treatment initiation after ADHD diagnosis in children and adolescents. We searched MEDLINE, EMBASE, PsycINFO, and CINAHL from inception to October 8, 2025. We included quantitative studies comparing time to ADHD treatment initiation after a diagnosis across sociodemographic groups, including sex, race and ethnicity, socioeconomic status, insurance type, and geographic factors. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Newcastle-Ottawa Scale. Heterogeneity between studies prevented meta-analysis. We narratively synthesized findings. Twelve out of 6,223 studies initially identified were included in the review. Seven studies reported on pharmacological treatment alone while four studies examined both pharmacological and non-pharmacological treatments; one study reported on psychosocial treatment alone. Sex was the most frequently assessed factor (N = 10 studies), with most studies reporting earlier treatment initiation among males compared with females (effect estimates ranged from 1.02 (95% CI 0.82–1.26) to 1.36 (95% CI 1.21–1.54)). Children from racial and ethnic minority groups, lower-income families, and rural areas generally experienced longer delays in treatment initiation. Findings varied by geographic region, and no consistent differences were observed by insurance type. Sociodemographic disparities persist in the timing of ADHD treatment initiation. These findings may inform strategies to promote equitable and timely ADHD care following diagnosis.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00787-026-03159-4.

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Cite

BibTeXRIS
BibTeX
@article{wickham2026disparities,
  title = {{Disparities in treatment initiation following diagnosis of attention-deficit/hyperactivity disorder: a systematic review}},
  author = {Philip Wickham and Saima Orangzeb and Jacqueline M. Cohen and Patricia Li and Thuy Mai Luu and Gabriel Côté-Corriveau and Farzana Uddin and Ugochinyere Vivian Ukah},
  journal = {European Child \& Adolescent Psychiatry},
  year = {2026},
  month = sep,
  doi = {10.1007/s00787-026-03159-4},
  url = {https://doi.org/10.1007/s00787-026-03159-4},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Disparities in treatment initiation following diagnosis of attention-deficit/hyperactivity disorder: a systematic review
AU  - Philip Wickham
AU  - Saima Orangzeb
AU  - Jacqueline M. Cohen
AU  - Patricia Li
AU  - Thuy Mai Luu
AU  - Gabriel Côté-Corriveau
AU  - Farzana Uddin
AU  - Ugochinyere Vivian Ukah
PY  - 2026
DA  - 2026/09/11
JO  - European Child & Adolescent Psychiatry
DO  - 10.1007/s00787-026-03159-4
UR  - https://doi.org/10.1007/s00787-026-03159-4
AB  - Early intervention improves long-term outcomes in children with Attention-Deficit/Hyperactivity Disorder (ADHD). However, disparities may exist in the timing of treatment initiation following diagnosis. The objective of this systematic review was to examine associations between sociodemographic factors and time to treatment initiation after ADHD diagnosis in children and adolescents. We searched MEDLINE, EMBASE, PsycINFO, and CINAHL from inception to October 8, 2025. We included quantitative studies comparing time to ADHD treatment initiation after a diagnosis across sociodemographic groups, including sex, race and ethnicity, socioeconomic status, insurance type, and geographic factors. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Newcastle-Ottawa Scale. Heterogeneity between studies prevented meta-analysis. We narratively synthesized findings. Twelve out of 6,223 studies initially identified were included in the review. Seven studies reported on pharmacological treatment alone while four studies examined both pharmacological and non-pharmacological treatments; one study reported on psychosocial treatment alone. Sex was the most frequently assessed factor (N = 10 studies), with most studies reporting earlier treatment initiation among males compared with females (effect estimates ranged from 1.02 (95% CI 0.82–1.26) to 1.36 (95% CI 1.21–1.54)). Children from racial and ethnic minority groups, lower-income families, and rural areas generally experienced longer delays in treatment initiation. Findings varied by geographic region, and no consistent differences were observed by insurance type. Sociodemographic disparities persist in the timing of ADHD treatment initiation. These findings may inform strategies to promote equitable and timely ADHD care following diagnosis.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00787-026-03159-4.
SN  - 1018-8827
SN  - 1435-165X
ER  -