European Child & Adolescent Psychiatry

, Volume 23, Issue 8, pp 627–636

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

  • Soon-Beom Hong
  • Dominic Dwyer
  • Jae-Won Kim
  • Eun-Jin Park
  • Min-Sup Shin
  • Boong-Nyun Kim
  • Hee-Jeong Yoo
  • In-Hee Cho
  • Soo-Young Bhang
  • Yun-Chul Hong
  • Christos Pantelis
  • Soo-Churl Cho
Original Contribution

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 

Abbreviations

ADHD

Attention-deficit/hyperactivity disorder

ADHD-RS

ADHD Rating Scale

ANOVA

Analysis of variance

CBCL

Child Behavior Checklist

DISC-IV

Diagnostic Interview Schedule for Children Version IV

DSM-IV

Diagnostic and statistical manual of mental disorders, 4th edition

IQ

Intelligence quotient

LDES

Learning Disability Evaluation Scale

KEDI-WISC

Korean Educational Development Institute’s Wechsler Intelligence Scales for Children

SES

Socioeconomic status

Supplementary material

787_2013_501_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 17 kb)

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Soon-Beom Hong
    • 1
    • 2
    • 3
  • Dominic Dwyer
    • 1
  • Jae-Won Kim
    • 3
  • Eun-Jin Park
    • 4
  • Min-Sup Shin
    • 3
  • Boong-Nyun Kim
    • 3
  • Hee-Jeong Yoo
    • 3
  • In-Hee Cho
    • 5
  • Soo-Young Bhang
    • 6
  • Yun-Chul Hong
    • 7
  • Christos Pantelis
    • 1
    • 2
  • Soo-Churl Cho
    • 3
  1. 1.Melbourne Neuropsychiatry Centre, Department of PsychiatryUniversity of Melbourne and Melbourne HealthParkvilleAustralia
  2. 2.Florey Institute of Neuroscience and Mental HealthParkvilleAustralia
  3. 3.Division of Child and Adolescent Psychiatry, Department of PsychiatrySeoul National University College of MedicineSeoulRepublic of Korea
  4. 4.Department of Psychiatry, Ilsan Paik HospitalInje University College of MedicineGoyangRepublic of Korea
  5. 5.Department of Psychiatry, Gil Medical CenterGachon University of Medicine and ScienceIncheonRepublic of Korea
  6. 6.Department of Psychiatry, Gangnam Eulji HospitalEulji UniversitySeoulRepublic of Korea
  7. 7.Department of Preventive Medicine, Institute of Environmental MedicineSeoul National University College of MedicineSeoulRepublic of Korea

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