European Child & Adolescent Psychiatry

, Volume 23, Issue 11, pp 1043–1050 | Cite as

Children diagnosed with attention deficit disorder and their hospitalisations: population data linkage study

  • Desiree SilvaEmail author
  • Lyn Colvin
  • Erika Hagemann
  • Fiona Stanley
  • Carol Bower
Original Contribution


Examine the hospital admission risk in young children who are subsequently diagnosed with attention deficit hyperactivity disorder (ADHD). We conducted a population-based, record linkage study. Records of all non-Aboriginal children under 18 years who met the DSMIV/ICD10 criteria for ADHD and prescribed stimulant medication in Western Australia between 2003 and 2007 (n = 11,902) were linked to two other health data systems—the hospital morbidity data system and the midwives notification system (MNS). The non-ADHD reference population (n = 27,304) was randomly selected from the MNS. Compared with controls, children under 4 years who subsequently were diagnosed and treated for ADHD were 70 % [odds ratio (OR) 1.70; 95 % confidence intervals (CI) 1.62–1.77] more likely to be admitted to hospital under 4 years of age. There was an increased risk for injury or poison (OR 1.73; 95 % CI 1.59–1.88), respiratory disease (OR 1.49; 95 % CI 1.40–1.59), ear disease (OR 2.03; 95 % CI 1.86–2.21), infectious diseases (OR 1.68; 95 % CI 1.53–1.85) and neurological conditions (OR 2.03; 95 % CI 1.68–2.44). Admissions under 4 years of age for head injuries, burns, poisons, all other injuries, diseases of the tonsils and adenoids, asthma and early infections were all more common amongst children subsequently diagnosed with and treated for ADHD. There is significant early hospital morbidity for children subsequently diagnosed with ADHD. Multiple aetiologies and causal pathways need to be considered where some of these may include early infections, inflammatory conditions, epilepsy and injuries. Future studies should look at which of these conditions may be on the causal pathway or likely early markers for ADHD.


ADHD Postnatal risk factors Otitis media Sleep apnoea Injury Poisons Hospitalisation 



Attention deficit hyperactivity disorder


Confidence intervals


Gestational age


Hospital morbidity data system


Midwives notification system


Odds ratio


Stimulant medication


Socio-economic index of disadvantage for areas


Western Australia



We acknowledge the excellent support and partnership between the custodians of the Stimulant Notification Register, Midwives Notification System, Western Australian Data Linkage System and Health Department of Western Australia. We would also like to acknowledge the WA Developmental Pathways Project and the Australian Research Council for facilitating the linkage (LP100200504). Particular thanks to Dr Rebecca Glauert and Jane Valentine for their suggestions and support of this project.

Conflict of interest

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

Supplementary material

787_2014_545_MOESM1_ESM.doc (42 kb)
Supplementary material 1 (DOC 41 kb)


  1. 1.
    Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA (2007) The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 164:942–948PubMedCrossRefGoogle Scholar
  2. 2.
    Parr JR, Ward A, Inman S (2003) Current practice in the management of attention deficit disorder with hyperactivity (ADHD). Child Care Health Dev 29:215–218PubMedCrossRefGoogle Scholar
  3. 3.
    Banerjee TD, Middleton F, Faraone SV (2007) Environmental risk factors for attention-deficit hyperactivity disorder. Acta Paediatr 96:1269–1274PubMedCrossRefGoogle Scholar
  4. 4.
    Biederman J, Faraone SV (2002) Current concepts on the neurobiology of attention-deficit/hyperactivity disorder. J Atten Disord 6(suppl 1):S7–S16PubMedGoogle Scholar
  5. 5.
    Millichap JG (2008) Etiologic classification of attention-deficit/hyperactivity disorder. Pediatrics 121:e358–e365PubMedCrossRefGoogle Scholar
  6. 6.
    Plomp E, Van Engeland H, Durston S (2009) Understanding genes, environment and their interaction in attention-deficit hyperactivity disorder: is there a role for neuroimaging? Neuroscience 164:230–240PubMedCrossRefGoogle Scholar
  7. 7.
    Getahun D, Rhoads GG, Demissie K, Lu SE, Quinn VP, Fassett MJ et al (2013) In utero exposure to ischemic-hypoxic conditions and attention-deficit/hyperactivity disorder. Pediatrics 131:e53–e61PubMedCrossRefGoogle Scholar
  8. 8.
    Halmoy A, Klungsoyr K, Skjaerven R, Haavik J (2012) Pre- and perinatal risk factors in adults with attention-deficit/hyperactivity disorder. Biol Psychiatry 71:474–481PubMedCrossRefGoogle Scholar
  9. 9.
    Lindstrom K, Lindblad F, Hjern A (2011) Preterm birth and attention-deficit/hyperactivity disorder in schoolchildren. Pediatrics 127:858–865PubMedCrossRefGoogle Scholar
  10. 10.
    Nigg J, Nikolas M, Burt SA (2010) Measured gene-by-environment interaction in relation to attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 49:863–873PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Thapar A, Cooper M, Eyre O, Langley K (2013) What have we learnt about the causes of ADHD? J Child Psychol Psychiatry 54:3–16PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Gustafsson P, Kallen K (2011) Perinatal, maternal, and fetal characteristics of children diagnosed with attention-deficit-hyperactivity disorder: results from a population-based study utilizing the Swedish Medical Birth Register. Dev Med Child Neurol 53:263–268PubMedCrossRefGoogle Scholar
  13. 13.
    Arpino C, Marzio M, D’Argenzio L, Longo B, Curatolo P (2005) Exanthematic diseases during pregnancy and attention-deficit/hyperactivity disorder (ADHD). Eur J Paediatr Neurol 9:363–365PubMedCrossRefGoogle Scholar
  14. 14.
    Badger K, Anderson L, Kagan RJ (2008) Attention deficit-hyperactivity disorder in children with burn injuries. J Burn Care Res 29:724–729PubMedCrossRefGoogle Scholar
  15. 15.
    Birnbaum HG, Kessler RC, Lowe SW, Secnik K, Greenberg PE, Leong SA et al (2005) Costs of attention deficit-hyperactivity disorder (ADHD) in the US: excess costs of persons with ADHD and their family members in 2000. Curr Med Res Opin 21:195–206PubMedCrossRefGoogle Scholar
  16. 16.
    Brehaut JC, Miller A, Raina P, McGrail KM (2003) Childhood behavior disorders and injuries among children and youth: a population-based study. Pediatrics 111:262–269PubMedCrossRefGoogle Scholar
  17. 17.
    Keenan HT, Hall GC, Marshall SW (2008) Early head injury and attention deficit hyperactivity disorder: retrospective cohort study. BMJ 337:a1984PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Mick E, Biederman J, Faraone SV (1996) Is season of birth a risk factor for attention-deficit hyperactivity disorder? J Am Acad Child Adolesc Psychiatry 35:1470–1476PubMedCrossRefGoogle Scholar
  19. 19.
    Millichap JG (1997) Encephalitis virus and attention deficit hyperactivity disorder. J R Soc Med 90:709–710PubMedCentralPubMedGoogle Scholar
  20. 20.
    Rowe R, Maughan B, Goodman R (2004) Childhood psychiatric disorder and unintentional injury: findings from a national cohort study. J Pediatr Psychol 29:119–130PubMedCrossRefGoogle Scholar
  21. 21.
    Xiang H, Stallones L, Chen G, Hostetler SG, Kelleher K (2005) Nonfatal injuries among US children with disabling conditions. Am J Public Health 95:1970–1975PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Youssef NA, Ege M, Angly SS, Strauss JL, Marx CE (2011) Is obstructive sleep apnea associated with ADHD? Ann Clin Psychiatry 23:213–224PubMedGoogle Scholar
  23. 23.
    Department of Health (2012) Western Australia stimulant regulatory scheme 2011 annual report. Pharmaceutical Services Branch, Public Health and Clinical Division, Department of Health, Western AustraliaGoogle Scholar
  24. 24.
    Nguyen N, Gee V, Le M (2008) Perinatal statistics in Western Australia, 2007. In: 25th Annual report of the Western Australian Midwives’ Notification System. Department of Health, Western AustraliaGoogle Scholar
  25. 25.
    Morgan PL, Staff J, Hillemeier MM, Farkas G, Maczuga S (2013) Racial and ethnic disparities in ADHD diagnosis from kindergarten to eighth grade. Pediatrics 132:85–93PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    National Coding Centre (1996) Australian version of the international classification of diseases TR, clinical modification (ICD-9-CM), 2nd edn. National Coding Centre, SydneyGoogle Scholar
  27. 27.
    National Centre for Classification in Health (1999) International statistical classification of diseases and related health problems TR, Australian modification (ICD-10-AM). National Centre for Classification in Health, SydneyGoogle Scholar
  28. 28.
    Australian Bureau of Statistics (2001) Technical paper: census of population and housing: socio-economic indexes for areas (SEIFA), Cat 2039.0.55.001. Australian Bureau of Statistics, CanberraGoogle Scholar
  29. 29.
    Hakkaart-van Roijen L, Zwirs BW, Bouwmans C, Tan SS, Schulpen TW, Vlasveld L et al (2007) Societal costs and quality of life of children suffering from attention deficient hyperactivity disorder (ADHD). Eur Child Adolesc Psychiatry 16:316–326PubMedCrossRefGoogle Scholar
  30. 30.
    Gustafsson LH (1977) Childhood accidents. Three epidemiological studies on the etiology. Scand J Soc Med 5:5–13PubMedGoogle Scholar
  31. 31.
    Biederman J, Milberger S, Faraone SV, Guite J, Warburton R (1994) Associations between childhood asthma and ADHD: issues of psychiatric comorbidity and familiality. J Am Acad Child Adolesc Psychiatry 33:842–848PubMedCrossRefGoogle Scholar
  32. 32.
    Fasmer OB, Riise T, Eagan TM, Lund A, Dilsaver SC, Hundal O et al (2011) Comorbidity of asthma with ADHD. J Atten Disord 15:564–571PubMedCrossRefGoogle Scholar
  33. 33.
    Barnes ME, Huss EA, Garrod KN, Van Raay E, Dayyat E, Gozal D et al (2009) Impairments in attention in occasionally snoring children: an event-related potential study. Dev Neuropsychol 34:629–649PubMedCentralPubMedCrossRefGoogle Scholar
  34. 34.
    Beebe DW (2006) Neurobehavioral morbidity associated with disordered breathing during sleep in children: a comprehensive review. Sleep 29:1115–1134PubMedGoogle Scholar
  35. 35.
    Greene MG, Carroll JL (1997) Consequences of sleep-disordered breathing in childhood. Curr Opin Pulm Med 3:456–463PubMedCrossRefGoogle Scholar
  36. 36.
    Tan HL, Gozal D, Kheirandish-Gozal L (2013) Obstructive sleep apnea in children: a critical update. Nat Sci Sleep 5:109–123PubMedCentralPubMedGoogle Scholar
  37. 37.
    Owens JA (2005) The ADHD and sleep conundrum: a review. J Dev Behav Pediatr 26:312–322PubMedCrossRefGoogle Scholar
  38. 38.
    Goraya JS, Cruz M, Valencia I, Kaleyias J, Khurana DS, Hardison HH et al (2009) Sleep study abnormalities in children with attention deficit hyperactivity disorder. Pediatr Neurol 40:42–46PubMedCrossRefGoogle Scholar
  39. 39.
    Wei JL, Mayo MS, Smith HJ, Reese M, Weatherly RA (2007) Improved behavior and sleep after adenotonsillectomy in children with sleep-disordered breathing. Arch Otolaryngol Head Neck Surg 133:974–979PubMedCrossRefGoogle Scholar
  40. 40.
    Huang YS, Guilleminault C, Li HY, Yang CM, Wu YY, Chen NH (2007) Attention-deficit/hyperactivity disorder with obstructive sleep apnea: a treatment outcome study. Sleep Med 8:18–30PubMedCrossRefGoogle Scholar
  41. 41.
    Giordani B, Chervin RD (2008) Sleep-disordered breathing and neurobehavioral outcomes: in search of clear markers for children at risk. JAMA 299:2078–2080PubMedCrossRefGoogle Scholar
  42. 42.
    Kuehni CE, Strippoli MP, Chauliac ES, Silverman M (2008) Snoring in preschool children: prevalence, severity and risk factors. Eur Respir J 31:326–333PubMedCrossRefGoogle Scholar
  43. 43.
    Adesman AR, Altshuler LA, Lipkin PH, Walco GA (1990) Otitis media in children with learning disabilities and in children with attention deficit disorder with hyperactivity. Pediatrics 85:442–446PubMedGoogle Scholar
  44. 44.
    Hersher L (1978) Minimal brain dysfunction and otitis media. Percept Mot Skills 47:723–726PubMedCrossRefGoogle Scholar
  45. 45.
    Asbjornsen A, Holmefjord A, Reisaeter S, Moller P, Klausen O, Prytz B et al (2000) Lasting auditory attention impairment after persistent middle ear infections: a dichotic listening study. Dev Med Child Neurol 42:481–486PubMedCrossRefGoogle Scholar
  46. 46.
    Benros ME, Waltoft BL, Nordentoft M, Ostergaard SD, Eaton WW, Krogh J et al (2013) Autoimmune diseases and severe infections as risk factors for mood disorders: a nationwide study. JAMA Psychiatry 70:812–820PubMedCrossRefGoogle Scholar
  47. 47.
    Hagberg H, Gressens P, Mallard C (2012) Inflammation during fetal and neonatal life: implications for neurologic and neuropsychiatric disease in children and adults. Ann Neurol 71:444–457PubMedCrossRefGoogle Scholar
  48. 48.
    Girard S, Kadhim H, Roy M, Lavoie K, Brochu ME, Larouche A et al (2009) Role of perinatal inflammation in cerebral palsy. Pediatr Neurol 40:168–174PubMedCrossRefGoogle Scholar
  49. 49.
    Mann JR, McDermott S (2011) Are maternal genitourinary infection and pre-eclampsia associated with ADHD in school-aged children? J Atten Disord 15:667–673PubMedCrossRefGoogle Scholar
  50. 50.
    Chau V, Brant R, Poskitt KJ, Tam EW, Synnes A, Miller SP (2012) Postnatal infection is associated with widespread abnormalities of brain development in premature newborns. Pediatr Res 71:274–279PubMedCentralPubMedCrossRefGoogle Scholar
  51. 51.
    Gurevitz M, Geva R, Varon M, Leitner Y (2014) Early markers in infants and toddlers for development of ADHD. J Atten Disord 18(1):14–22PubMedCrossRefGoogle Scholar
  52. 52.
    Davis SM, Katusic SK, Barbaresi WJ, Killian J, Weaver AL, Ottman R et al (2010) Epilepsy in children with attention-deficit/hyperactivity disorder. Pediatr Neurol 42:325–330PubMedCentralPubMedCrossRefGoogle Scholar
  53. 53.
    Hamoda HM, Guild DJ, Gumlak S, Travers BH, Gonzalez-Heydrich J (2009) Association between attention-deficit/hyperactivity disorder and epilepsy in pediatric populations. Expert Rev Neurother 9:1747–1754PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Desiree Silva
    • 1
    • 2
    • 3
    Email author
  • Lyn Colvin
    • 1
  • Erika Hagemann
    • 4
  • Fiona Stanley
    • 1
    • 2
  • Carol Bower
    • 1
    • 2
  1. 1.Telethon Kids InstituteUniversity of Western AustraliaWest PerthAustralia
  2. 2.School of Paediatrics and Child HealthUniversity of Western AustraliaPerthAustralia
  3. 3.Joondalup Health Campus, University of Western AustraliaPerth Australia
  4. 4.Fremantle Speech Pathology ServicesFremantleAustralia

Personalised recommendations