Original Contribution

European Child & Adolescent Psychiatry

, Volume 23, Issue 8, pp 627-636

First online:

Subthreshold attention-deficit/hyperactivity disorder is associated with functional impairments across domains: a comprehensive analysis in a large-scale community study

  • Soon-Beom HongAffiliated withMelbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne HealthFlorey Institute of Neuroscience and Mental HealthDivision of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine
  • , Dominic DwyerAffiliated withMelbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health
  • , Jae-Won KimAffiliated withDivision of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine
  • , Eun-Jin ParkAffiliated withDepartment of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine
  • , Min-Sup ShinAffiliated withDivision of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine
  • , Boong-Nyun KimAffiliated withDivision of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine
  • , Hee-Jeong YooAffiliated withDivision of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine
  • , In-Hee ChoAffiliated withDepartment of Psychiatry, Gil Medical Center, Gachon University of Medicine and Science
  • , Soo-Young BhangAffiliated withDepartment of Psychiatry, Gangnam Eulji Hospital, Eulji University
    • , Yun-Chul HongAffiliated withDepartment of Preventive Medicine, Institute of Environmental Medicine, Seoul National University College of Medicine
    • , Christos PantelisAffiliated withMelbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne HealthFlorey Institute of Neuroscience and Mental Health
    • , Soo-Churl ChoAffiliated withDivision of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine Email author 

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Abstract

This study compared children who experience attention-deficit/hyperactivity disorder (ADHD) symptoms but do not meet criteria (i.e., subthreshold ADHD) with those with the full syndrome and healthy controls. Presence of ADHD symptoms was determined in a nationwide community sample of 921 children, aged 8–11 years. The main outcome measures comprised attentional symptoms, comorbidity profiles, academic performance, and neurocognitive ability (i.e., ADHD Rating Scale, Child Behavior Checklist, Learning Disability Evaluation Scale, and Stroop Color-Word Test, respectively). Subthreshold ADHD was equally prevalent in boys and girls, and more prevalent in low-income families. Throughout all the outcome measurements, subthreshold ADHD was both a significantly milder condition than full syndrome ADHD and a significantly more severe condition than non-ADHD status. The findings were consistent across the total as well as the subtest scores, and after correction for multiple comparisons (p < 0.0017). Children with subthreshold ADHD were found to experience significant symptoms and functional impairments. The results of this study support the clinical relevance of subthreshold ADHD in a childhood population. Subthreshold diagnostic criteria for ADHD may be more sensitive in detecting ADHD symptoms in girls than the full syndrome criteria, and subthreshold clinical, cognitive, and behavioral symptoms of ADHD may occur in a subset of children who are possibly more sensitive to their environment. Further consideration about the diagnostic threshold for ADHD may particularly benefit girls and children in low-income families.

Keywords

Attention-deficit/hyperactivity disorder Diagnostic and statistical manual of mental disorders Socioeconomic status Subthreshold