Skip to main content

Advertisement

SpringerLink
Log in

Characteristics of undiagnosed children with parent-reported ADHD behaviour

  • Original Contribution
  • Published:
European Child & Adolescent Psychiatry Aims and scope Submit manuscript

Abstract

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 number of children with parent-reported ADHD behaviour at age 7 and absence of recorded ADHD diagnosis through adolescence, and investigate whether socio-demographic characteristics of this group differed from the children diagnosed with ADHD during follow-up. 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 specific SDQ subscale. Socio-demographic predictors of positive parent-reported SDQ ADHD behaviour and absence of recorded ADHD diagnosis in their children were examined using logistic regression analyses. 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: Capital vs. Southern: 2.04; 95% CI 1.51; 2.73) than children with an ADHD diagnosis. The children showed markedly impairments on all the SDQ subscales. 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Caye A et al (2016) Life span studies of ADHD-conceptual challenges and predictors of persistence and outcome. Curr Psychiatry Rep 18(12):111

    Article  PubMed  Google Scholar 

  2. Biederman J (2005) Attention-deficit/hyperactivity disorder: a selective overview. Biol Psychiatry 57(11):1215–1220

    Article  PubMed  Google Scholar 

  3. Biederman J, Faraone SV (2005) Attention-deficit hyperactivity disorder. Lancet 366(9481):237–248

    Article  PubMed  Google Scholar 

  4. Thapar A et al (2013) What have we learnt about the causes of ADHD? J Child Psychol Psychiatry 54(1):3–16

    Article  PubMed  PubMed Central  Google Scholar 

  5. Polanczyk GV et al (2015) Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry 56(3):345–365

    Article  PubMed  Google Scholar 

  6. Atladottir HO et al (2015) The increasing prevalence of reported diagnoses of childhood psychiatric disorders: a descriptive multinational comparison. Eur Child Adolesc Psychiatry 24(2):173–183

    Article  PubMed  Google Scholar 

  7. Polanczyk G et al (2007) The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 164(6):942–948

    Article  PubMed  Google Scholar 

  8. Bokhari F, Mayes R, Scheffler RM (2005) An analysis of the significant variation in psychostimulant use across the U.S. Pharmacoepidemiol Drug Saf 14(4):267–275

    Article  PubMed  Google Scholar 

  9. Fulton BD et al (2009) National variation of ADHD diagnostic prevalence and medication use: health care providers and education policies. Psychiatr Serv 60(8):1075–1083

    Article  PubMed  Google Scholar 

  10. Madsen KB et al (2015) Geographic analysis of the variation in the incidence of ADHD in a country with free access to healthcare: a Danish cohort study. Int J Health Geogr 14:24

    Article  PubMed  PubMed Central  Google Scholar 

  11. Sciutto MJ, Eisenberg M (2007) Evaluating the evidence for and against the overdiagnosis of ADHD. J Atten Disord 11(2):106–113

    Article  PubMed  Google Scholar 

  12. Froehlich TE et al (2007) Prevalence, recognition, and treatment of attention-deficit/hyperactivity disorder in a national sample of US children. Arch Pediatr Adolesc Med 161(9):857–864

    Article  PubMed  Google Scholar 

  13. Hinshaw SP et al (2006) Prospective follow-up of girls with attention-deficit/hyperactivity disorder into adolescence: evidence for continuing cross-domain impairment. J Consult Clin Psychol 74(3):489–499

    Article  PubMed  Google Scholar 

  14. Skogli EW et al (2013) ADHD in girls and boys–gender differences in co-existing symptoms and executive function measures. BMC Psychiatry 13:298

    Article  PubMed  PubMed Central  Google Scholar 

  15. Staller J, Faraone SV (2006) Attention-deficit hyperactivity disorder in girls: epidemiology and management. CNS Drugs 20(2):107–123

    Article  CAS  PubMed  Google Scholar 

  16. Novik TS et al (2006) Influence of gender on attention-deficit/hyperactivity disorder in Europe–ADORE. Eur Child Adolesc Psychiatry 15(Suppl 1):I15–I24

    Article  PubMed  Google Scholar 

  17. Huss M et al (2008) How often are German children and adolescents diagnosed with ADHD? Prevalence based on the judgment of health care professionals: results of the German health and examination survey (KiGGS). Eur Child Adolesc Psychiatry 17(Suppl 1):52–58

    Article  PubMed  Google Scholar 

  18. Rydell AM (2010) Family factors and children’s disruptive behaviour: an investigation of links between demographic characteristics, negative life events and symptoms of ODD and ADHD. Soc Psychiatry Psychiatr Epidemiol 45(2):233–244

    Article  PubMed  Google Scholar 

  19. Margari F et al (2013) Parents psychopathology of children with attention deficit hyperactivity disorder. Res Dev Disabil 34(3):1036–1043

    Article  PubMed  Google Scholar 

  20. Vostanis P et al (2006) Relationship between parental psychopathology, parenting strategies and child mental health–findings from the GB national study. Soc Psychiatry Psychiatr Epidemiol 41(7):509–514

    Article  PubMed  Google Scholar 

  21. Cuffe SP, Moore CG, McKeown RE (2005) Prevalence and correlates of ADHD symptoms in the national health interview survey. J Atten Disord 9(2):392–401

    Article  PubMed  Google Scholar 

  22. Tremmery S et al (2007) The use of health care services and psychotropic medication in a community sample of 9-year-old schoolchildren with ADHD. Eur Child Adolesc Psychiatry 16(5):327–336

    Article  PubMed  Google Scholar 

  23. Biederman J et al (2002) Influence of gender on attention deficit hyperactivity disorder in children referred to a psychiatric clinic. Am J Psychiatry 159(1):36–42

    Article  PubMed  Google Scholar 

  24. Bruchmuller K, Margraf J, Schneider S (2012) Is ADHD diagnosed in accord with diagnostic criteria? Overdiagnosis and influence of client gender on diagnosis. J Consult Clin Psychol 80(1):128–138

    Article  PubMed  Google Scholar 

  25. Dalsgaard S, Nielsen HS, Simonsen M (2014) Consequences of ADHD medication use for children’s outcomes. J Health Econ 37:137–151

    Article  PubMed  Google Scholar 

  26. Dalsgaard S et al (2015) Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: a nationwide cohort study. Lancet 385(9983):2190–2196

    Article  PubMed  Google Scholar 

  27. Purdie N, Hattie J, Carroll A (2002) A review of the research on interventions for attention deficit hyperactivity disorder: what works best? Rev Educ Res 72(1):61–99

    Article  Google Scholar 

  28. Swanson J et al (2008) Evidence, interpretation, and qualification from multiple reports of long-term outcomes in the Multimodal Treatment study of Children With ADHD (MTA): part I: executive summary. J Atten Disord 12(1):4–14

    Article  PubMed  Google Scholar 

  29. Hinshaw SP, Arnold LE (2015) Attention-deficit hyperactivity disorder, multimodal treatment, and longitudinal outcome: evidence, paradox, and challenge. Wiley Interdiscip Rev Cogn Sci 6(1):39–52

    Article  PubMed Central  Google Scholar 

  30. Nohr EA et al (2006) Does low participation in cohort studies induce bias? Epidemiology 17(4):413–418

    Article  PubMed  Google Scholar 

  31. Olsen J et al (2001) The Danish National Birth Cohort–its background, structure and aim. Scand J Public Health 29(4):300–307

    Article  CAS  PubMed  Google Scholar 

  32. Andersen TF et al (1999) The Danish National Hospital Register. A valuable source of data for modern health sciences. Dan Med Bull 46(3):263–268

    CAS  PubMed  Google Scholar 

  33. Munk-Jorgensen P, Mortensen PB (1997) The Danish psychiatric central register. Dan Med Bull 44(1):82–84

    CAS  PubMed  Google Scholar 

  34. Kildemoes HW, Sorensen HT, Hallas J (2011) The Danish National Prescription Registry. Scand J Public Health 39(7 Suppl):38–41

    Article  PubMed  Google Scholar 

  35. WHO (1992) The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. World Health Organization, Geneva

  36. Goodman R (1997) The Strengths and Difficulties Questionnaire: a research note. J Child Psychol Psychiatry 38(5):581–586

    Article  CAS  PubMed  Google Scholar 

  37. Goodman R (1999) The extended version of the strengths and difficulties Questionnaire as a guide to child psychiatric caseness and consequent burden. J Child Psychol Psychiatry 40(5):791–799

    Article  CAS  PubMed  Google Scholar 

  38. Goodman R et al (2004) Using the Strengths and Difficulties Questionnaire (SDQ) multi-informant algorithm to screen looked-after children for psychiatric disorders. Eur Child Adolesc Psychiatry 13(Suppl 2):II25–II31

    PubMed  Google Scholar 

  39. Goodman R, Renfrew D, Mullick M (2000) Predicting type of psychiatric disorder from Strengths and Difficulties Questionnaire (SDQ) scores in child mental health clinics in London and Dhaka. Eur Child Adolesc Psychiatry 9(2):129–134

    Article  CAS  PubMed  Google Scholar 

  40. Niclasen J et al (2013) A confirmatory approach to examining the factor structure of the Strengths and Difficulties Questionnaire (SDQ): a large scale cohort study. J Abnorm Child Psychol 41(3):355–365

    Article  PubMed  Google Scholar 

  41. Niclasen J et al (2012) Psychometric properties of the Danish Strength and Difficulties Questionnaire: the SDQ assessed for more than 70,000 raters in four different cohorts. PLoS One 7(2):e32025

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Goodman R (2001) Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry 40(11):1337–1345

    Article  CAS  PubMed  Google Scholar 

  43. Rimvall MK et al (2014) Predicting ADHD in school age when using the Strengths and Difficulties Questionnaire in preschool age: a longitudinal general population study, CCC2000. Eur Child Adolesc Psychiatry 23(11):1051–1060

    Article  PubMed  Google Scholar 

  44. Ullebo AK et al (2011) Screening for the attention deficit hyperactivity disorder phenotype using the strength and difficulties questionnaire. Eur Child Adolesc Psychiatry 20(9):451–458

    Article  PubMed  Google Scholar 

  45. Nohr EA et al (2007) Obesity, gestational weight gain and preterm birth: a study within the Danish National Birth Cohort. Paediatr Perinat Epidemiol 21(1):5–14

    Article  PubMed  Google Scholar 

  46. A De Los Reyes, Kazdin AE (2005) Informant discrepancies in the assessment of childhood psychopathology: a critical review, theoretical framework, and recommendations for further study. Psychol Bull 131(4):483–509

    Article  Google Scholar 

  47. Stone LL et al (2010) Psychometric properties of the parent and teacher versions of the strengths and difficulties questionnaire for 4- to 12-year-olds: a review. Clin Child Fam Psychol Rev 13(3):254–274

    Article  PubMed  PubMed Central  Google Scholar 

  48. Foy JM, Earls MF (2005) A process for developing community consensus regarding the diagnosis and management of attention-deficit/hyperactivity disorder. Pediatrics 115(1):e97–e104

    Article  PubMed  Google Scholar 

  49. Hjern A, Weitoft GR, Lindblad F (2010) Social adversity predicts ADHD-medication in school children–a national cohort study. Acta Paediatr 99(6):920–924

    Article  CAS  PubMed  Google Scholar 

  50. Russell G et al (2014) The association of attention deficit hyperactivity disorder with socioeconomic disadvantage: alternative explanations and evidence. J Child Psychol Psychiatry 55(5):436–445

    Article  PubMed  Google Scholar 

  51. Bussing R et al (2005) Exploring help-seeking for ADHD symptoms: a mixed-methods approach. Harv Rev Psychiatry 13(2):85–101

    Article  PubMed  Google Scholar 

  52. Zwaanswijk M et al (2003) Help seeking for emotional and behavioural problems in children and adolescents: a review of recent literature. Eur Child Adolesc Psychiatry 12(4):153–161

    Article  PubMed  Google Scholar 

  53. Furuya Y et al (2015) Health literacy, socioeconomic status and self-rated health in Japan. Health Promot Int 30(3):505–513

    Article  PubMed  Google Scholar 

  54. Wang LJ et al (2016) Impact of negative media publicity on attention-deficit/hyperactivity disorder medication in Taiwan. Pharmacoepidemiol Drug Saf 25(1):45–53

    Article  PubMed  Google Scholar 

  55. Thapar AK, Thapar A (2003) Attention-deficit hyperactivity disorder. Br J Gen Pract 53(488):225–230

    PubMed  PubMed Central  Google Scholar 

  56. Ball C (2001) Attention-deficit hyperactivity disorder and the use of methylphenidate—a survey of the views of general practitioners. Psychiatr Bull 25(8):301–304

    Article  Google Scholar 

  57. Pescosolido BA et al (2008) Public knowledge and assessment of child mental health problems: findings from the National Stigma Study-Children. J Am Acad Child Adolesc Psychiatry 47(3):339–349

    Article  PubMed  Google Scholar 

  58. Fridman M et al (2017) Access to diagnosis, treatment, and supportive services among pharmacotherapy-treated children/adolescents with ADHD in Europe: data from the Caregiver Perspective on Pediatric ADHD survey. Neuropsychiatr Dis Treat 13:947–958

    Article  PubMed  PubMed Central  Google Scholar 

  59. Jacobsen TN, Nohr EA, Frydenberg M (2010) Selection by socioeconomic factors into the Danish National Birth Cohort. Eur J Epidemiol 25(5):349–355

    Article  PubMed  Google Scholar 

  60. Pottegard A et al (2012) The use of medication against attention deficit hyperactivity disorder in Denmark: a drug use study from a national perspective. Eur J Clin Pharmacol 68(10):1443–1450

    Article  CAS  PubMed  Google Scholar 

  61. Madsen KB, Hohwü L, Zhu JL, Olsen J, Obel C (2017) Social selection in cohort studies and later representation of childhood psychiatric diagnoses – the Danish National Birth Cohort. Scand J Publ Health (accepted)

Download references

Acknowledgements

The Danish National Research Foundation has established the Danish Epidemiology Science Centre that initiated and created the Danish National Birth Cohort. The cohort is a result of a major grant from this Foundation. Additional support for the Danish National Birth Cohort was obtained from the Pharmacy Foundation, the Egmont Foundation, the March of Dimes Birth Defects Foundation, the Augustinus Foundation and the Health Foundation.

Author information

Authors and Affiliations

  1. Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark

    Kathrine Bang Madsen, Mette Holmelin Ravn, Jon Arnfred & Carsten Obel

  2. Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark

    Jørn Olsen

  3. Child and Adolescent Psychiatric Center, Aarhus University Hospital, Skovagervej 2, 8240, Risskov, Denmark

    Charlotte Ulrikka Rask

  4. Department of Clinical Medicine, Aarhus University, Barthsgade 5, 8200, Aarhus N, Denmark

    Charlotte Ulrikka Rask

  5. Center for Collaborative Health, Aarhus University, Høegh Guldbergsgade 6, 8000, Aarhus C, Denmark

    Carsten Obel

Authors
  1. Kathrine Bang Madsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mette Holmelin Ravn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jon Arnfred
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jørn Olsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Charlotte Ulrikka Rask
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Carsten Obel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kathrine Bang Madsen.

Ethics declarations

Ethical approval

The Danish Data Protection Agency and the DNBC Steering Committee approved the study.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Madsen, K.B., Ravn, M.H., Arnfred, J. et al. Characteristics of undiagnosed children with parent-reported ADHD behaviour. Eur Child Adolesc Psychiatry 27, 149–158 (2018). https://doi.org/10.1007/s00787-017-1029-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-017-1029-4

Keywords

Search

Navigation