TY - JOUR
T1 - Increased diagnosis of attention-deficit hyperactivity disorder despite stable hyperactive/inattentive behaviours
T2 - evidence from two birth cohorts of Australian children
AU - Kazda, Luise
AU - McGeechan, Kevin
AU - Bell, Katy
AU - Thomas, Rae
AU - Barratt, Alexandra
N1 - Funding Information:
The authors thank the Australian Government Department of Social Services for providing access to the LSAC data and all the families participating in the LSAC. L.K. receives a PhD scholarship from Wiser Healthcare (funded by the National Health and Medical Research Council (NHMRC) Program Grant 1113532 and CRE Grant 1104136). K.B. receives funding from an NHMRC Investigator Grant 1174523. The remaining authors have declared that they have no competing or potential conflicts of interest. Open access publishing facilitated by The University of Sydney, as part of the Wiley ‐ The University of Sydney agreement via the Council of Australian University Librarians.
Funding Information:
The authors thank the Australian Government Department of Social Services for providing access to the LSAC data and all the families participating in the LSAC. L.K. receives a PhD scholarship from Wiser Healthcare (funded by the National Health and Medical Research Council (NHMRC) Program Grant 1113532 and CRE Grant 1104136). K.B. receives funding from an NHMRC Investigator Grant 1174523. The remaining authors have declared that they have no competing or potential conflicts of interest. Open access publishing facilitated by The University of Sydney, as part of the Wiley - The University of Sydney agreement via the Council of Australian University Librarians.
Funding Information:
This study was funded by the National Health and Medical Research Council (NHMRC) Program Grant 1113532 and CRE Grant 1104136. The funder had no role in the study design, in the collection, analysis and interpretation of data, in the writing of the report or in the decision to submit the article for publication. We confirm the independence of researchers from funders.
Publisher Copyright:
© 2022 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.
PY - 2023/8
Y1 - 2023/8
N2 - Background: Globally, ADHD diagnoses have increased substantially and there is concern that this trend does not necessarily reflect improved detection of cases but that overdiagnosis may be occurring. We directly compared ADHD diagnoses with ADHD-related behaviours and looked for changes across time among Australian children in a large, population-based prospective cohort study. Methods: We conducted a secondary analysis of the Longitudinal Study of Australian Children, including 4,699 children born 1999/2000 (cohort 1) and 4,425 children born 2003/2004 (cohort 2), followed from 4 to 13 years of age. We compared pre-diagnosis parent-reported hyperactive/inattentive behaviour scores between newly diagnosed (incident cases) and undiagnosed children and fitted Cox's proportional hazards regression models to examine the relationship between birth cohorts 1 and 2 and the risk of incident ADHD diagnosis. Results: Cumulative incident ADHD diagnoses increased from 4.6% in cohort 1 (born in 1999/2000) to 5.6% in cohort 2 (born in 2003/2004), while hyperactive/inattentive behaviour scores remained steady. Among ADHD diagnosed children, 26.5% (88/334) recorded pre-diagnosis behaviours in the normal range, 27.6% (n = 92) had borderline scores and 45.8% (n = 153) scored within the clinical range. Children born in 2003/2004 were more likely to be diagnosed with ADHD compared with those born in 1999/2000 (aHR = 1.33, 95% CI = 1.06–1.67, p =.012), regardless of their ADHD behaviour score (p =.972). Conclusions: Diagnostic increases were not driven by rises in hyperactive/inattentive behaviours. A quarter of all children with an ADHD diagnosis recorded pre-diagnosis behaviours within the normal range. The increased likelihood of being diagnosed with ADHD for children from the later birth cohort was observed for children across the full range of ADHD-related behaviours.
AB - Background: Globally, ADHD diagnoses have increased substantially and there is concern that this trend does not necessarily reflect improved detection of cases but that overdiagnosis may be occurring. We directly compared ADHD diagnoses with ADHD-related behaviours and looked for changes across time among Australian children in a large, population-based prospective cohort study. Methods: We conducted a secondary analysis of the Longitudinal Study of Australian Children, including 4,699 children born 1999/2000 (cohort 1) and 4,425 children born 2003/2004 (cohort 2), followed from 4 to 13 years of age. We compared pre-diagnosis parent-reported hyperactive/inattentive behaviour scores between newly diagnosed (incident cases) and undiagnosed children and fitted Cox's proportional hazards regression models to examine the relationship between birth cohorts 1 and 2 and the risk of incident ADHD diagnosis. Results: Cumulative incident ADHD diagnoses increased from 4.6% in cohort 1 (born in 1999/2000) to 5.6% in cohort 2 (born in 2003/2004), while hyperactive/inattentive behaviour scores remained steady. Among ADHD diagnosed children, 26.5% (88/334) recorded pre-diagnosis behaviours in the normal range, 27.6% (n = 92) had borderline scores and 45.8% (n = 153) scored within the clinical range. Children born in 2003/2004 were more likely to be diagnosed with ADHD compared with those born in 1999/2000 (aHR = 1.33, 95% CI = 1.06–1.67, p =.012), regardless of their ADHD behaviour score (p =.972). Conclusions: Diagnostic increases were not driven by rises in hyperactive/inattentive behaviours. A quarter of all children with an ADHD diagnosis recorded pre-diagnosis behaviours within the normal range. The increased likelihood of being diagnosed with ADHD for children from the later birth cohort was observed for children across the full range of ADHD-related behaviours.
KW - adolescents
KW - Attention-deficit hyperactivity disorder
KW - Australia
KW - children
KW - epidemiology
UR - http://www.scopus.com/inward/record.url?scp=85138302321&partnerID=8YFLogxK
U2 - 10.1111/jcpp.13700
DO - 10.1111/jcpp.13700
M3 - Article
C2 - 36065471
AN - SCOPUS:85138302321
SN - 0021-9630
VL - 64
SP - 1140
EP - 1148
JO - Journal of Child Psychology and Psychiatry and Allied Disciplines
JF - Journal of Child Psychology and Psychiatry and Allied Disciplines
IS - 8
ER -
