Service use in children aged 6-8 years with attention deficit hyperactivity disorder

Medical disorders in a Danish cohort of children with attention-deficit hyperactivity disorder

Studies have identified a higher prevalence of co-existing psychiatric and medical disorders in children with ADHD. There is a shortage of longitudinal studies providing an overview of potential medical disorders in children with ADHD. The objective of this study was to provide a broad overview of lifetime prevalence and relative risk of medical disorders in a nationwide Danish cohort of children with and without ADHD during the first 12 years of life. A population-based prospective follow-back cohort study used data from Danish national health registries to identify a cohort of all children born in Denmark between 1995 and 2002. The children were followed from birth until 12 years of age in two national registries. Children with ADHD had a significantly higher prevalence of recorded diagnoses across all included chapters of medical disorders in the ICD-10, except for neoplasms, where the association with ADHD was non-significant. The highest relative risk was observed for the chapter concerning diseases of the nervous system, with episodic and paroxysmal disorders being the most frequently registered underlying category. The findings indicate that children with ADHD have an increased risk of a broad range of medical disorders compared to the general population during the first 12 years of life, except for neoplasms.

The Complexities of Everyday Life and Healthcare Utilization in Danish Children With ADHD: A Mixed Methods Study

PURPOSE

To explore and describe everyday life and hospital-based healthcare experiences and utilization in families of children with ADHD in Denmark.

DESIGN AND METHODS

The present work is a multistage, mixed methods study. The design consists of three individual studies: a meta-synthesis, a focused ethnographic study, and a historical cohort study.

RESULTS

The integrated findings show that: 1) parental stressors affect everyday life and hospital-based service use; 2) parents have concerns for their child from early childhood and fight to have their concerns recognized; and 3) healthcare professionals are important for parents to navigate the persistent challenges of everyday life.

CONCLUSIONS

Having a child with ADHD pervades everyday life and children with ADHD use more medical and psychiatric services in hospitals during the first 12 years of life than children without ADHD. The findings demonstrate a vulnerable everyday life experience and highlight the importance of the families being recognized, accepted, and respected in hospital-based healthcare services from early childhood.

PRACTICE IMPLICATIONS

Healthcare professionals need to recognize the challenges the family of a child with ADHD faces and to acknowledge that ADHD pervades all aspects of everyday life and all other healthcare issues. It is important for healthcare professionals, regardless of specialty, to engage with individual families and to positively contribute to the medical and psychiatric healthcare experience.

Waiting times for diagnosis of attention-deficit hyperactivity disorder in children and adolescents referred to Italian ADHD centers must be reduced

BACKGROUND

To investigate timely access to and the time needed to complete the diagnostic path of children and adolescents with suspected attention deficit hyperactivity disorder (ADHD) in the 18 Italian Lombardy Region ADHD reference centers.

METHODS

Data of children and adolescents enrolled in the Regional ADHD disease-oriented Registry for suspected ADHD who requested their first visit in 2013-2017 were analyzed.

RESULTS

The sample comprised 2262 children and adolescents aged 5-17 years who accessed the ADHD centers for diagnostic classification and management. The median waiting time was of 177 days (range 66-375) from the request for the initial appointment to the completion of the diagnostic path, with a three - fold difference between centers. In addition to the center, the strongest significant predictors of long waiting times were age comorbidities, the severity of the disorder, and having already completed some diagnostic procedures provided by the common standard path.

CONCLUSIONS

To guarantee an equal standard of care in ADHD centers for all children and adolescents there is a pressing need to reduce the times to complete the diagnostic path. It is the task of both policymakers and each center to optimize the quality of the service and of the care delivered.

Prevalence and Predictors of Medication Use in Children with Attention-Deficit/Hyperactivity Disorder: Evidence from a Community-Based Longitudinal Study

OBJECTIVES

To determine, in a community-based sample of primary school-aged children meeting diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD), (1) the proportion of children with ADHD treated with medication; (2) predictors of medication use; and (3) the association between medication use and psychological service utilization.

METHODS

Grade 1 children with ADHD were recruited through 43 schools in Melbourne, Australia, using a two-stage screening and case confirmation procedure. Parent report of medication treatment, clinician diagnosis, and psychological service use were collected at ages 7 and 10 years. Medication use was analyzed by ADHD subtype. Predictors of medication treatment examined included ADHD symptom severity and persistence, externalizing comorbidities, poor academic performance, and social disadvantage. Unadjusted and adjusted logistic regression were used to identify the predictors of medication status.

RESULTS

One hundred seventy-nine children with ADHD were recruited. At baseline, 17.3% had been clinically diagnosed with ADHD, increasing to 37.7% at age 10 years. At baseline, 13.6% were taking ADHD medications, increasing to 25.6% at age 10. Children with the combined and hyperactive-impulsive subtypes were more likely to be taking medication than those with inattentive subtype (age 7: p = 0.002; age 10: p = 0.03). ADHD symptom severity (Conners 3 ADHD Index) at baseline was concurrently and prospectively associated with medication use at both ages (both p = 0.01), and ADHD symptom severity at age 10 was also associated with medication use at age 10 (p = 0.01). Baseline area-level disadvantage was associated with medication use at age 7 (p = 0.04). At 10 years, children receiving medication were more likely, compared with those who were not, to be receiving psychological services (p = 0.001).

CONCLUSIONS

In this study, only a minority of children meeting diagnostic criteria for ADHD were diagnosed clinically or treated with ADHD medication by age 10. The strongest predictors of medication treatment were ADHD symptom severity and area disadvantage.

Psychiatric Disorders After Attention-Deficit/Hyperactivity Disorder: A Nationwide Population-Based Study in Taiwan

PURPOSE

To investigate the risk for psychiatric disorders in patients newly diagnosed with attention deficit hyperactive disorder (ADHD) from two longitudinal groups of children with and without ADHD.

STUDY DESIGN

In total, 1,745 children newly diagnosed with ADHD and 6,980 participants without ADHD were identified from Taiwan's National Health Insurance Research Database in 2005 and followed until 2010. Risks for psychiatric disorders in the ADHD and non-ADHD groups were compared.

RESULTS

The ADHD group was 3.82 times more likely to develop psychiatric disorders than their counterparts. The ADHD group showed the highest risk for oppositional defiant disorder, followed by adult ADHD and autism spectrum disorder. Moreover, the time effects of psychiatric disorders in the ADHD group were significant. Patients with ADHD subtypes had a significant risk for psychiatric disorders compared to their counterparts.

CONCLUSIONS

A high risk for psychiatric disorders was revealed in this study among children with ADHD. Childhood ADHD, the duration after the ADHD diagnosis, and the ADHD subtype were associated with psychiatric disorders.

CLINICAL RELEVANCE

Various psychiatric disorders were observed in children after they had been newly diagnosed with ADHD, indicating a need for integrated care that includes medical practitioners, family members, social workers, and early intervention workers for patients newly diagnosed with ADHD to decrease the risk for comprehensive psychiatric disorders.

Attention Deficit Hyperactivity Disorder in Childhood: Healthcare Use in a Danish Birth Cohort during the First 12 Years of Life

OBJECTIVES

To compare the mean number of medical and psychiatric hospital-based services in children with and without attention deficit hyperactivity disorder (ADHD) and to assess the effect of ADHD on hospital-based service use, including child-, parental-, and socioeconomic-related risk factors.

STUDY DESIGN

A Danish birth cohort was followed through 12 years, and children with ADHD were identified using Danish nationwide registries. Poisson regression analyses were used to assess the association of ADHD with service use and to adjust for a comprehensive set of explanatory variables.

RESULTS

Children diagnosed with ADHD used more medical and psychiatric hospital-based healthcare than those without ADHD. In children with ADHD, intellectual disability and parental psychiatric disorder were associated with increased medical and psychiatric service use. Low birth weight and low gestational age were associated with increased medical service use. Psychiatric comorbidity and having a divorced or single parent were associated with increased psychiatric service use.

CONCLUSIONS

ADHD independently affected medical and psychiatric hospital-based service use even when adjusting for a comprehensive set of explanatory variables. However, the pattern of medical and psychiatric hospital-based service use is complex and cannot exclusively be explained by the child-, parental-, and socioeconomic-related variables examined in this study.

Correlates of Anxiety in 6- to 8-Year-Old Children With ADHD: A Community-Based Study

OBJECTIVE

The aim of this study was to identify the child and parent/family correlates of anxiety in a community-based sample of children with ADHD.

METHOD

Children (6-8 years) with ADHD ( n = 179) and controls ( n = 212) were assessed for ADHD and anxiety using the Diagnostic Interview Schedule for Children IV. Potential child and parent/family correlates were measured through direct assessments, and parent- and teacher-reported questionnaires. Associations were examined using univariate and multivariate logistic regression analyses.

RESULTS

One in four children with ADHD ( n = 44) met criteria for an anxiety disorder, compared with one in 20 controls ( n = 10). Anxiety was common in both boys and girls with ADHD. The strongest correlates of anxiety in multivariate analyses were ADHD subtype, primary caregiver psychosocial distress, and neighborhood socioeconomic disadvantage.

CONCLUSION

Anxiety is common in children with ADHD. This study provides insight into the potential parent/family stressors that may increase risk for anxiety in children with ADHD.

ADHD Treatment in Primary Care: Demographic Factors, Medication Trends, and Treatment Predictors

BACKGROUND

The aim of this study is to determine the prevalence and characteristics of youth with attention-deficit hyperactivity disorder (ADHD) in Ontario, Canada, and to determine the predictors of psychotropic medication prescriptions in youth with ADHD.

METHOD

This is a cross-sectional retrospective chart abstraction of more than 250 000 medical records from youth aged 1 to 24 years in a large geographical region in Ontario, Canada, linked to population-based health administrative data. A total of 10 000 charts were randomly selected and manually reviewed using predetermined criteria for ADHD and comorbidities. Prevalence, comorbidities, demographic indicators, and health service utilization characteristics were calculated. Predictors of treatment characteristics were determined using logistic regression modelling.

RESULTS

The prevalence of ADHD was 5.4% (7.9% males, 2.7% females). Youth with ADHD had significant psychiatric comorbidities. The majority (70.0%) of ADHD patients received prescriptions for stimulant or nonstimulant ADHD medication. Antipsychotic prescriptions were provided to 11.9% of ADHD patients versus 0.9% of patients without ADHD. Antidepressant prescriptions were provided to 19.8% versus 5.4% of patients with and without ADHD, respectively. Predictors of antidepressant prescriptions were increasing age (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.07 to 1.21), psychiatric consultation (OR, 2.04; 95% CI, 1.16 to 3.58), and diagnoses of both anxiety and depression (OR, 18.4; 95% CI, 8.03 to 42.1), whereas the only predictor of antipsychotic prescriptions was psychiatric consultation (OR, 3.85; 95% CI, 2.11 to 7.02).

CONCLUSIONS

Youth with ADHD have more psychiatric comorbidities than youth without ADHD. The majority of youth with ADHD received stimulant medications, and a significant number received additional psychotropic medications, with psychiatric consultation predicting medication use.