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Ranjan JK, Kumari R, Choudhary A. Prevalence of attention deficit and hyperactive disorders in South Asian countries: A systematic review and meta-analysis of cross-sectional surveys from 1980 to 2023. Asian J Psychiatr 2024; 94:103970. [PMID: 38401384 DOI: 10.1016/j.ajp.2024.103970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 02/26/2024]
Affiliation(s)
- Jay Kumar Ranjan
- Department of Psychology, Banaras Hindu University, Varanasi, India
| | - Rajbala Kumari
- Ranchi Women's College, Ranchi University, Ranchi, India
| | - Amrita Choudhary
- Department of Psychology, St. Xavier's University, Kolkata, India.
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Ramos-Quiroga JA, Richarte V, Soto I, Targhetta M, Ward J, Perulero N. The Prevalence and Treatment of ADHD in Spain: A Retrospective Cohort Analysis. J Atten Disord 2023; 27:273-282. [PMID: 36373564 DOI: 10.1177/10870547221136226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Estimate the prevalence and incidence of Attention Deficit Hyperactivity Disorder (ADHD) and analyze variations in its treatment across Spain. METHOD Analyses were performed using IQVIA's clinical practice RealWorld Database, the electronic medical records of some 1 million patients from 2013 to 2018. MPH treatment was assessed using the Defined Daily Dose (DDD), MPH sales were extracted from IQVIA's Sell-Out database and the number of active psychiatrists from IQVIA's OneKey Database. RESULTS Significantly higher ADHD prevalence and incidence (1) in children than in adults and (2) in males compared to females. 91% of patients take MPH. Regional variations in MPH consumption range from 247 Daily Dose per Inhabitant (DDI) per 100,000 inhabitants to 414. CONCLUSION ADHD continues to be underdiagnosed and undertreated, particularly in adults, and more so in females. The lack of diagnostic tools for adults and the variations in treatment across the country need to be addressed.
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Affiliation(s)
- Jose Antonio Ramos-Quiroga
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain.,Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain.,Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain.,Universitat Autònoma de Barcelona, Catalonia, Spain
| | - Vanesa Richarte
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain.,Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain.,Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain.,Universitat Autònoma de Barcelona, Catalonia, Spain
| | - Isabel Soto
- IQVIA Information S.A., Madrid, Comunidad de Madrid, Spain
| | | | - John Ward
- IQVIA RDS S.L, Madrid, Comunidad de Madrid, Spain
| | - Núria Perulero
- IQVIA Information S.A., Madrid, Comunidad de Madrid, Spain
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Kusters MSW, Pérez-Crespo L, Canals J, Guxens M. Lifetime prevalence and temporal trends of incidence of child's mental disorder diagnoses in Catalonia, Spain. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023; 16:24-31. [PMID: 33706020 DOI: 10.1016/j.rpsm.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/17/2020] [Accepted: 02/28/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Most mental disorders have its onset during childhood, but less than one third of affected children seek professional help. The aim of this study is to (1) estimate the lifetime prevalence of mood, anxiety, conduct, and eating disorder diagnoses in 18-year-olds in 2017 and (2) the temporal trends of incidence diagnosis rates in 2009-2017 in children aged 2-18 in Catalonia, Spain. MATERIAL AND METHODS We used a registry-based cohort including all children aged 2-18 living in Catalonia in 2009-2017, from the Catalan Health Service. Cases were identified with ICD-9 codes. Lifetime prevalence was calculated for 2017, and annual incidence for 2009-2017. Temporal trends were analyzed with multivariate negative binomial regression models. RESULTS Lifetime prevalence of diagnoses was highest for conduct disorders (5.05%), followed by anxiety (4.37%), mood (3.07%), and eating disorders (2.11%). Median age of diagnosis was 16 years for mood, anxiety and eating disorders, and 15 years for conduct disorders. Comorbidity was present in 20.74% of those diagnosed with a mental disorder. Annual incidence rates for all disorders increased in 2011-2013/2014, and then stabilized. However, incidence rate of anxiety diagnoses in 13-18-year-old children doubled between 2016 and 2017. CONCLUSIONS Lifetime prevalence of diagnoses are lower than the expected rates of mental disorders based on interview/survey European studies. Further research is needed into the factors underlying (1) the underdiagnoses of mental disorders in children and (2) the increasing trend of anxiety disorder diagnoses in older children.
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Affiliation(s)
- Michelle S W Kusters
- ISGlobal, Barcelona, Spain; Maastricht University, The Netherlands; Pompeu Fabra University, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Department of Child and Adolescent Psychiatry, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Laura Pérez-Crespo
- ISGlobal, Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Josefa Canals
- CRAMC, Department of Psychology, Rovira i Virgili University, Tarragona, Spain
| | - Mònica Guxens
- ISGlobal, Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Department of Child and Adolescent Psychiatry, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands.
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Rojo-Marticella M, Arija V, Alda JÁ, Morales-Hidalgo P, Esteban-Figuerola P, Canals J. Do Children with Attention-Deficit/Hyperactivity Disorder Follow a Different Dietary Pattern than That of Their Control Peers? Nutrients 2022; 14:nu14061131. [PMID: 35334788 PMCID: PMC8949924 DOI: 10.3390/nu14061131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 12/15/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children and adolescents. A current area of interest is the association between ADHD and food consumption. The aim of this study was to determine the food consumption and dietary patterns of children with and without ADHD in relation to their age and ADHD presentation. The study involved 259 preschoolers aged 3 to 6 years old (57 with ADHD and 202 controls) and 475 elementary-school-age children, aged 10 to 12 years old (213 with ADHD and 262 controls) from Spain. ADHD was diagnosed in accordance with the Diagnostic and Statistical Manual of Mental Disorders (5th edition) from Schedule for Affective Disorders and Schizophrenia for School-Age Children interviews. Eating data were collected using a food consumption frequency questionnaire, and principal component analysis was carried out to analyze dietary patterns. Western-like, sweet, and healthy patterns were identified. The ADHD group was negatively associated with the healthy pattern (p < 0.001) and positively associated with the Western-like diet (p = 0.004). Children with inattentive presentation showed lower adherence (12.2%) to a healthy pattern than that of the control group (39.9%) (p < 0.001). There is an association between ADHD and dietary habits; children with inattentive presentation may particularly be at risk of unhealthy eating habits.
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Affiliation(s)
- Meritxell Rojo-Marticella
- Nutrition and Mental Health Research Group (NUTRISAM), Rovira i Virgili University (URV), 43201 Reus, Spain; (M.R.-M.); (V.A.); (P.M.-H.); (P.E.-F.)
- Research Centre for Behavioral Assessment (CRAMC), Department of Psychology, Rovira i Virgili University (URV), 43007 Tarragona, Spain
| | - Victoria Arija
- Nutrition and Mental Health Research Group (NUTRISAM), Rovira i Virgili University (URV), 43201 Reus, Spain; (M.R.-M.); (V.A.); (P.M.-H.); (P.E.-F.)
- Institut d’Investigació Sanitaria Pere Virgili (IISPV), Rovira i Virgili University (URV), 43204 Reus, Spain
| | - José Ángel Alda
- Attention Deficit Hyperactivity Disorder Unit, Sant Joan de Déu Hospital, 08950 Barcelona, Spain;
- Children and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, 08950 Barcelona, Spain
| | - Paula Morales-Hidalgo
- Nutrition and Mental Health Research Group (NUTRISAM), Rovira i Virgili University (URV), 43201 Reus, Spain; (M.R.-M.); (V.A.); (P.M.-H.); (P.E.-F.)
- Research Centre for Behavioral Assessment (CRAMC), Department of Psychology, Rovira i Virgili University (URV), 43007 Tarragona, Spain
- Institut d’Investigació Sanitaria Pere Virgili (IISPV), Rovira i Virgili University (URV), 43204 Reus, Spain
| | - Patricia Esteban-Figuerola
- Nutrition and Mental Health Research Group (NUTRISAM), Rovira i Virgili University (URV), 43201 Reus, Spain; (M.R.-M.); (V.A.); (P.M.-H.); (P.E.-F.)
- Research Centre for Behavioral Assessment (CRAMC), Department of Psychology, Rovira i Virgili University (URV), 43007 Tarragona, Spain
- Institut d’Investigació Sanitaria Pere Virgili (IISPV), Rovira i Virgili University (URV), 43204 Reus, Spain
| | - Josefa Canals
- Nutrition and Mental Health Research Group (NUTRISAM), Rovira i Virgili University (URV), 43201 Reus, Spain; (M.R.-M.); (V.A.); (P.M.-H.); (P.E.-F.)
- Research Centre for Behavioral Assessment (CRAMC), Department of Psychology, Rovira i Virgili University (URV), 43007 Tarragona, Spain
- Institut d’Investigació Sanitaria Pere Virgili (IISPV), Rovira i Virgili University (URV), 43204 Reus, Spain
- Correspondence:
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Yuchi W, Brauer M, Czekajlo A, Davies HW, Davis Z, Guhn M, Jarvis I, Jerrett M, Nesbitt L, Oberlander TF, Sbihi H, Su J, van den Bosch M. Neighborhood environmental exposures and incidence of attention deficit/hyperactivity disorder: A population-based cohort study. ENVIRONMENT INTERNATIONAL 2022; 161:107120. [PMID: 35144157 DOI: 10.1016/j.envint.2022.107120] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 01/23/2022] [Accepted: 01/26/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Emerging studies have associated low greenspace and high air pollution exposure with risk of child attention deficit/hyperactivity disorder (ADHD). Population-based studies are limited, however, and joint effects are rarely evaluated. We investigated associations of ADHD incidence with greenspace, air pollution, and noise in a population-based birth cohort. METHODS We assembled a cohort from administrative data of births from 2000 to 2001 (N ∼ 37,000) in Metro Vancouver, Canada. ADHD was identified by hospital records, physician visits, and prescriptions. Cox proportional hazards models were applied to assess associations between environmental exposures and ADHD incidence adjusting for available covariates. Greenspace was estimated using vegetation percentage derived from linear spectral unmixing of Landsat imagery. Fine particulate matter (PM2.5) and nitrogen dioxide (NO2) were estimated using land use regression models; noise was estimated using a deterministic model. Exposure period was from birth until the age of three. Joint effects of greenspace and PM2.5 were analysed in two-exposure models and by categorizing values into quintiles. RESULTS During seven-year follow-up, 1217 ADHD cases were diagnosed. Greenspace was associated with lower incidence of ADHD (hazard ratio, HR: 0.90 [0.81-0.99] per interquartile range increment), while PM2.5 was associated with increased incidence (HR: 1.11 [1.06-1.17] per interquartile range increment). NO2 (HR: 1.01 [0.96, 1.07]) and noise (HR: 1.00 [0.95, 1.05]) were not associated with ADHD. There was a 50% decrease in the HR for ADHD in locations with the lowest PM2.5 and highest greenspace exposure, compared to a 62% increase in HR in locations with the highest PM2.5 and lowest greenspace exposure. Effects of PM2.5 were attenuated by greenspace in two-exposure models. CONCLUSIONS We found evidence suggesting environmental inequalities where children living in greener neighborhoods with low air pollution had substantially lower risk of ADHD compared to those with higher air pollution and lower greenspace exposure.
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Affiliation(s)
- Weiran Yuchi
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, 2206 East Mall, Vancouver, British Columbia, Canada
| | - Michael Brauer
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, 2206 East Mall, Vancouver, British Columbia, Canada
| | - Agatha Czekajlo
- Department of Forest Resource Management, Faculty of Forestry, The University of British Columbia, 2424 Main Mall, Vancouver, Canada
| | - Hugh W Davies
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, 2206 East Mall, Vancouver, British Columbia, Canada
| | - Zoë Davis
- Department of Forest and Conservation Sciences, Faculty of Forestry, The University of British Columbia, 2424 Main Mall, Vancouver, Canada
| | - Martin Guhn
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, 2206 East Mall, Vancouver, British Columbia, Canada
| | - Ingrid Jarvis
- Department of Forest and Conservation Sciences, Faculty of Forestry, The University of British Columbia, 2424 Main Mall, Vancouver, Canada
| | - Michael Jerrett
- Fielding School of Public Health, University of California at Los Angeles, 650 Charles E. Young Drive South, Los Angeles, CA, the United States
| | - Lorien Nesbitt
- Department of Forest Resource Management, Faculty of Forestry, The University of British Columbia, 2424 Main Mall, Vancouver, Canada
| | - Tim F Oberlander
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, 2206 East Mall, Vancouver, British Columbia, Canada; Department of Pediatrics, The University of British Columbia, 4480 Oak St. Vancouver, Canada
| | - Hind Sbihi
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, 2206 East Mall, Vancouver, British Columbia, Canada; BC Centre for Disease Control, Vancouver, Canada
| | - Jason Su
- School of Public Health, University of California at Berkeley, 2121 Berkeley Way West, Berkeley, CA, the United States
| | - Matilda van den Bosch
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, 2206 East Mall, Vancouver, British Columbia, Canada; Department of Forest and Conservation Sciences, Faculty of Forestry, The University of British Columbia, 2424 Main Mall, Vancouver, Canada; ISGlobal, Parc de Recerca Biomèdica de Barcelona, Doctor Aiguader 88, 08003 Barcelona, Spain; Universitat Pompeu Fabra, Plaça de la Mercè, 10-12, 08002 Barcelona, Spain; Centro de Investigación Biomédica en Red Instituto de Salud Carlos III, Calle de Melchor Fernández Almagro, 3, 28029, Madrid, Spain.
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Ning K, Wang T. Multimodal Interventions Are More Effective in Improving Core Symptoms in Children With ADHD. Front Psychiatry 2021; 12:759315. [PMID: 34975569 PMCID: PMC8716759 DOI: 10.3389/fpsyt.2021.759315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate the effect of sensory integration training combined with EEG biofeedback on core symptoms in children with ADHD. Methods: Fifty-two children with attention-deficit, hyperactive-impulsive and combined ADHD were selected. They were randomly divided into control group, sensory integration training group, EEG biofeedback group, and sensory integration training + EEG biofeedback group, and after 4 months of intervention, concentration time and impulsive- hyperactivity and hyperactivity index scores on the PSQ scale were assessed. Results: Compared with that before the intervention, the attention time was significantly increased (P < 0.01), and the impulsive-hyperactivity and hyperactivity index scores were significantly decreased (P < 0.05, P < 0.01). After the intervention, the attention time was significantly higher than that of the control group (P < 0.05, P < 0.01), the attention time of the multimodal intervention group was significantly higher than that of the single intervention group (P < 0.01), and the impulsive-hyperactivity and hyperactivity index scores were significantly lower than those of the single intervention group (P < 0.05). Conclusion: Multimodal intervention can significantly improve the concentration level of children with ADHD, and significantly improve the behavioral symptoms of impulsive-hyperactivity and hyperactivity. Multimodal interventions were more effective than single interventions in improving core symptoms in children with ADHD. The results of this study provide a reference for related research and practical application.
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Affiliation(s)
- Ke Ning
- Physical Education Institute of Shaanxi Normal University, Xi'an, China
| | - Tingzhao Wang
- School of Education Shaanxi Normal University, Xi'an, China
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Leache L, Arrizibita O, Gutiérrez-Valencia M, Saiz LC, Erviti J, Librero J. Incidence of Attention Deficit Hyperactivity Disorder (ADHD) Diagnoses in Navarre (Spain) from 2003 to 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179208. [PMID: 34501798 PMCID: PMC8431029 DOI: 10.3390/ijerph18179208] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/24/2021] [Accepted: 08/27/2021] [Indexed: 12/04/2022]
Abstract
(1) Background: Attention deficit hyperactivity disorder (ADHD) constitutes one of the leading mental health and behavioral disorders in childhood and adolescence. The main objective of this study was to analyze the time trend in the incidence of ADHD diagnoses in Navarre (Spain) from 2003 to 2019 in children and adolescents from 5 to 19 years old. Additionally, the seasonal trends of ADHD incidence and ADHD prevalence were determined. (2) Methods: A population-based observational retrospective study, which included people born between 1991 and 2011 and who attended compulsory education between 2007 and 2017 in Navarre (Spain), was carried out with data from both the Education and Health Department databases. (3) Results: The incidence rate increased from 4.18 cases per 1000 person-years in 2003 to 7.43 cases per 1000 person-years in 2009, before decreasing progressively to 2.1 cases per 1000 person-years in 2019. A peak incidence rate at 7–8 years of age was observed, which is consistent across the study period and for both genders. Males were more than twice as likely to be diagnosed with ADHD than females, with similar time trends in both. A seasonal pattern in ADHD diagnosis was found, with peaks in February–March and the lowest rates in the summer months. Inattentive cases were much more frequent than hyperactive cases, whereas combined cases remained low across the study period. (4) Conclusions: In this age-period-cohort analysis, a clear period and age effect was observed. We found a decreasing trend in the ADHD incidence rate since 2015. Further research is needed to confirm whether a change of trend is occurring globally.
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Affiliation(s)
- Leire Leache
- Unit of Innovation and Organization, Navarre Health Service, 31003 Pamplona, Navarre, Spain; (L.L.); (M.G.-V.); (L.C.S.)
| | | | - Marta Gutiérrez-Valencia
- Unit of Innovation and Organization, Navarre Health Service, 31003 Pamplona, Navarre, Spain; (L.L.); (M.G.-V.); (L.C.S.)
- Navarre Institute for Health Research (IdiSNA), 31008 Pamplona, Navarre, Spain
| | - Luis Carlos Saiz
- Unit of Innovation and Organization, Navarre Health Service, 31003 Pamplona, Navarre, Spain; (L.L.); (M.G.-V.); (L.C.S.)
| | - Juan Erviti
- Therapeutics Initiative, Department of Anesthesiology, Pharmaceuticals and Therapeutics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| | - Julián Librero
- Navarrabiomed Biomedical Research Centre, Navarre Institute for Health Research (IdiSNA), Complejo Hospitalario de Navarra, Public University of Navarre (UPNA), 31008 Pamplona, Navarre, Spain
- Correspondence: ; Tel.: +34-848-428-392
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Burgard JP, Krause J, Münnich R, Morales D. l2-Penalized temporal logit-mixed models for the estimation of regional obesity prevalence over time. Stat Methods Med Res 2021; 30:1744-1768. [PMID: 34077289 DOI: 10.1177/09622802211017583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Obesity is considered to be one of the primary health risks in modern industrialized societies. Estimating the evolution of its prevalence over time is an essential element of public health reporting. This requires the application of suitable statistical methods on epidemiologic data with substantial local detail. Generalized linear-mixed models with medical treatment records as covariates mark a powerful combination for this purpose. However, the task is methodologically challenging. Disease frequencies are subject to both regional and temporal heterogeneity. Medical treatment records often show strong internal correlation due to diagnosis-related grouping. This frequently causes excessive variance in model parameter estimation due to rank-deficiency problems. Further, generalized linear-mixed models are often estimated via approximate inference methods as their likelihood functions do not have closed forms. These problems combined lead to unacceptable uncertainty in prevalence estimates over time. We propose an l2-penalized temporal logit-mixed model to solve these issues. We derive empirical best predictors and present a parametric bootstrap to estimate their mean-squared errors. A novel penalized maximum approximate likelihood algorithm for model parameter estimation is stated. With this new methodology, the regional obesity prevalence in Germany from 2009 to 2012 is estimated. We find that the national prevalence ranges between 15 and 16%, with significant regional clustering in eastern Germany.
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Affiliation(s)
- Jan P Burgard
- Department of Economic and Social Statistics, Trier University, Trier, Germany
| | - Joscha Krause
- Department of Economic and Social Statistics, Trier University, Trier, Germany
| | - Ralf Münnich
- Department of Economic and Social Statistics, Trier University, Trier, Germany
| | - Domingo Morales
- Operations Research Center, University Miguel Hernández de Elche, Elche, Spain
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Kazda L, Bell K, Thomas R, McGeechan K, Sims R, Barratt A. Overdiagnosis of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: A Systematic Scoping Review. JAMA Netw Open 2021; 4:e215335. [PMID: 33843998 PMCID: PMC8042533 DOI: 10.1001/jamanetworkopen.2021.5335] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE Reported increases in attention-deficit/hyperactivity disorder (ADHD) diagnoses are accompanied by growing debate about the underlying factors. Although overdiagnosis is often suggested, no comprehensive evaluation of evidence for or against overdiagnosis has ever been undertaken and is urgently needed to enable evidence-based, patient-centered diagnosis and treatment of ADHD in contemporary health services. OBJECTIVE To systematically identify, appraise, and synthesize the evidence on overdiagnosis of ADHD in children and adolescents using a published 5-question framework for detecting overdiagnosis in noncancer conditions. EVIDENCE REVIEW This systematic scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Extension for Scoping Reviews and Joanna Briggs Methodology, including the PRISMA-ScR Checklist. MEDLINE, Embase, PsychINFO, and the Cochrane Library databases were searched for studies published in English between January 1, 1979, and August 21, 2020. Studies of children and adolescents (aged ≤18 years) with ADHD that focused on overdiagnosis plus studies that could be mapped to 1 or more framework question were included. Two researchers independently reviewed all abstracts and full-text articles, and all included studies were assessed for quality. FINDINGS Of the 12 267 potentially relevant studies retrieved, 334 (2.7%) were included. Of the 334 studies, 61 (18.3%) were secondary and 273 (81.7%) were primary research articles. Substantial evidence of a reservoir of ADHD was found in 104 studies, providing a potential for diagnoses to increase (question 1). Evidence that actual ADHD diagnosis had increased was found in 45 studies (question 2). Twenty-five studies showed that these additional cases may be on the milder end of the ADHD spectrum (question 3), and 83 studies showed that pharmacological treatment of ADHD was increasing (question 4). A total of 151 studies reported on outcomes of diagnosis and pharmacological treatment (question 5). However, only 5 studies evaluated the critical issue of benefits and harms among the additional, milder cases. These studies supported a hypothesis of diminishing returns in which the harms may outweigh the benefits for youths with milder symptoms. CONCLUSIONS AND RELEVANCE This review found evidence of ADHD overdiagnosis and overtreatment in children and adolescents. Evidence gaps remain and future research is needed, in particular research on the long-term benefits and harms of diagnosing and treating ADHD in youths with milder symptoms; therefore, practitioners should be mindful of these knowledge gaps, especially when identifying these individuals and to ensure safe and equitable practice and policy.
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Affiliation(s)
- Luise Kazda
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Katy Bell
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rae Thomas
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Kevin McGeechan
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca Sims
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Alexandra Barratt
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Blanco-Martínez N, Delgado-Lobete L, Montes-Montes R, Ruiz-Pérez N, Ruiz-Pérez M, Santos-del-Riego S. Participation in Everyday Activities of Children with and without Neurodevelopmental Disorders: A Cross-Sectional Study in Spain. CHILDREN-BASEL 2020; 7:children7100157. [PMID: 33019630 PMCID: PMC7600717 DOI: 10.3390/children7100157] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/15/2020] [Accepted: 09/27/2020] [Indexed: 12/27/2022]
Abstract
Children with neurodevelopmental disorders (NDDs) often report significant difficulties performing activities of daily living (ADLs), which may restrict their daily participation. The aim of this study was to investigate the differences in ADLs participation between children with NDDs and typically developing (TD) children, and to explore the associations between different daily participation contexts. A cross-sectional study was conducted that included twenty children with a medical diagnosis of an NDD and 26 sex- and age-matched TD controls. The daily participation across home, community, school, and instrumental living activities was measured using the Child and Adolescent Scale of Participation (CASP). The results show that children with NDDs engaged in lower participation in all CASP contexts (Δ = 1.7-5.5, p < 0.001) and had a significantly higher prevalence of moderate or severe restricted participation than their TD peers (OR = 23.4, 95% CI = 3.6-154.2, p < 0.001). Additionally, a strong association was found between the different contexts of participation (r = 0.642-0.856). Overall, the children with NDDs experienced significant participation restrictions on their daily activities. This study adds to the growing evidence showing that intervention strategies in this population should adopt a participation-oriented approach.
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Affiliation(s)
- Nerea Blanco-Martínez
- Faculty of Health Sciences, Health Integration and Promotion Research Unit (INTEGRA SAÚDE), University of A Coruña, 15011 A Coruña, Spain; (N.B.-M.); (S.S.-d.-R.)
- Faculty of Educational Sciences & Sports, University of Vigo, 36005 Pontevedra, Spain
| | - Laura Delgado-Lobete
- Faculty of Health Sciences, Health Integration and Promotion Research Unit (INTEGRA SAÚDE), University of A Coruña, 15011 A Coruña, Spain; (N.B.-M.); (S.S.-d.-R.)
- Correspondence: ; Tel.: +34-881-014-339
| | - Rebeca Montes-Montes
- TALIONIS Research Group, Centre for Information and Communications Technology Research (CITIC), University of A Coruña, 15008 A Coruña, Spain;
| | - Nuria Ruiz-Pérez
- Faculty of Pharmacy, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain;
- Faculty of Health Sciences, Catholic University of Ávila, 05005 Ávila, Spain
| | - Marcos Ruiz-Pérez
- University College of Teacher Training, University of Vigo, 36214 Vigo, Spain;
| | - Sergio Santos-del-Riego
- Faculty of Health Sciences, Health Integration and Promotion Research Unit (INTEGRA SAÚDE), University of A Coruña, 15011 A Coruña, Spain; (N.B.-M.); (S.S.-d.-R.)
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