ADHD in Children
Visual Abstract
Characteristics of undiagnosed children with parent-reported ADHD behaviour
Undiagnosed ADHD in Children
Kathrine Bang Madsen , Mette Holmelin Ravn , Jon Arnfred , Jørn Olsen , Charlotte Ulrikka Rask , Carsten Obel
Summarized by:
March 15, 2023
study source
Eur Child Adolesc Psychiatry
Feb 2018
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What they studied
Researchers examined children born in Denmark to see how often those with strong ADHD symptoms go undiagnosed and what were the risk factors for not getting diagnosed.
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What they found
While generally, ADHD diagnoses aligned with symptoms, children in certain regions of the country were more likely to go undiagnosed, as were girls and children with mothers of low socioeconomic status.
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What this means
Even in wealthy countries, there are systemic barriers to the diagnosis and treatment of ADHD, particularly when it comes to gender and socioeconomic status.
Characteristics of undiagnosed children with parent-reported ADHD behaviour
Objectives
Many kids with ADHD go undiagnosed for one reason or another. There has not been much research before this study on ADHD underdiagnosis. This study wanted to see how often children with ADHD go undiagnosed, and what risk factors are associated with underdiagnosis.
Study Quote
There is an ongoing public debate on the diagnosis of attention deficit hyperactivity disorder (ADHD) in which critics have claimed that the disorder is over-diagnosed, while the potential under-diagnosis of children with ADHD has received little attention. In this study we estimate the ...
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Methods
Researchers collected data from a national childbirth dataset in Denmark. They collected information on ADHD symptoms from a parent questionnaire, the SDQ.
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The SDQ is a brief screening tool for emotional and behavioural problems.. The questions cover five subscales: hyperactivity/inattention, conduct problems, emotional symptoms, peer relationship problems and prosocial behavior, each rated as the sum score of five items
One of the strengths of the study was that they were able to systematically gather information on ADHD diagnosis through medical records and pharmacy records.
In doing so, researchers can cross reference these records with parents' assessments of ADHD symptoms.
Study Quote
Our study was based on data from the Danish National Birth Cohort, where parents of 51,527 children completed questionnaires, including the Strength and Difficulties Questionnaire (SDQ). ADHD diagnosis was identified through Danish registers and parent-reported ADHD behaviour by the spec...
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Results
While the ADHD symptom questionnaire was generally effective, researchers did find that many with ADHD symptoms were not diagnosed with ADHD. In contrast, many diagnosed with ADHD did not appear to have strong symptoms.
There was a significant relationship between geography and ADHD diagnosis. Children with ADHD in the southern region of Denmark were more than twice as likely to go undiagnosed than those in the capital of Denmark.
One potential explanation is that doctors in certain regions and hospitals may be more reluctant to diagnose ADHD.
While there are standardized tests for ADHD, the diagnostic process can still be quite subjective.
Gender and socioeconomic status also played a role. Girls were more than twice as likely to go undiagnosed as boys.
Children with mothers of low socioeconomic status were around 50% less likely to get diagnosed.
A study in Denmark found girls, children from families of lower socioeconomic status, and children living in certain regions of the country were significantly less likely to get diagnosed with ADHD.
Many with ADHD symptoms who did not have an official ADHD diagnosis had other conditions.
Study Quote
Children with parent-reported ADHD behaviour and no diagnosis (1.3%) were more likely to be girls (OR 1.83; 95% CI 1.45; 2.29), more likely to have mothers with a low socioeconomic status (OR high vs. low 1.49; 95% CI 1.10; 2.02), and to live in certain regions of the country (OR: Capita...
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Conclusions
These results show that certain groups of children are less likely to get diagnosed with ADHD.
The gender difference is striking and suggests a systematic underdiagnosis of girls with ADHD. A potential explanation suggested by the authors is that girls with ADHD may be less disruptive than boys with ADHD, leading to a lower likelihood of getting diagnosed:
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It has been suggested that the under-identification of girls may be due to gender differences in the phenotypic expression of ADHD with girls presenting with less disruptive behaviour resulting in less problem-recognition by parents and teachers
Studies like these help identify biases and stereotypes that can get in the way of accurate diagnosis and treatment for those who need it.
Study Quote
The results demonstrate a considerable number of children with ADHD symptoms who potentially go undetected and underline the influence of socio-demographic factors in the pathway to a diagnosis of ADHD.