Prediction of MGMT promoter methylation in glioblastoma and grade 4 astrocytoma using fluid-suppressed chemical exchange saturation transfer MRI and machine learning-based segmentation.

It is now well recognized that attention deficit hyperactivity disorder (ADHD) in females has been historically underrecognized, underdiagnosed and undertreated. Long viewed as a predominantly male childhood disorder, until the last two decades, female presentations of ADHD—which are often more inattentive and internalized—frequently went undiagnosed. As a result, the long-term consequences of ADHD in girls and women have been largely overlooked in both clinical practice and research. However, growing evidence suggests that relative to males, females with a childhood ADHD diagnosis face a substantially elevated risk of adverse outcomes across the life course, including poorer physical and mental health in adulthood. One area of increasing research interest is the risk of multimorbidity, commonly defined as two or more long-term conditions (LTCs) in the same individual. Emerging evidence suggests that this may be particularly prevalent and complex among neurodivergent individuals, yet it remains critically understudied in this population generally and among females in particular. The mechanisms underlying these increased risks are also poorly understood. However, it is clear that ADHD is likely to contribute to poorer health trajectories via multiple interrelated pathways. For example, biological pathways, such as dysregulated stress responses and inflammation, are likely to interact with behavioral pathways, such as impulsivity-related risk behaviors, to influence an individual’s overall risk. Crucially, ADHD rarely occurs in isolation from structural influences and inequalities. Among these, socioeconomic disadvantage is the factor most consistently and strongly associated with both childhood ADHD diagnoses and adverse adult health outcomes. While many studies therefore aim to disentangle the effects of ADHD and socioeconomic status (SES) to determine their relative influence, in clinical reality, they frequently co-occur. As such, there is a pressing need to examine not only their individual contributions but also their combined and potentially interacting effects. Nevertheless, current literature rarely examines these factors in combination, and the additive or synergistic effects of socioeconomic disadvantage and ADHD on long-term health outcomes have so far not been systematically explored in females. Moreover, while most studies treat multimorbidity as a homogeneous end point, it is now well recognized that LTCs tend to cluster into distinct, nonrandom groupings with considerable variation in the severity of outcomes they confer. For example, musculoskeletal conditions commonly co-occur with depression, while renal conditions co-occur with cardiovascular disease—each cluster potentially reflecting different etiological pathways and impacting on different functional outcomes. These clusters are also associated with differing patterns of healthcare utilization. For instance, individuals with co-occurring mental and physical health conditions have been associated with increased secondary care use and potentially preventable hospital admissions, while the clustering of autoimmune conditions—more commonly observed in women—is often linked to higher primary care attendance. Understanding multimorbidity clustering and the associated patterns of healthcare use is thus crucial for helping healthcare services to better meet the needs of those with multiple conditions, through designing tailored management strategies and developing more precise public health responses. In females with ADHD—a population that often faces unique challenges such as later or missed diagnosis, internalizing symptom profiles and heightened exposure to social and educational disadvantage—the identification of specific multimorbidity clusters may be particularly valuable. Through revealing distinct health trajectories, and thus the potential underlying mechanisms of risk, this could inform more targeted, sex-sensitive interventions. However, so far, no study has investigated such patterns in this group.