ADHD diagnoses are increasing worldwide, in patterns involving both overdiagnosis of some groups and underdiagnosis of others. The current study uses data from a national longitudinal study of Irish children (N = 8568) to examine the sociodemographic, clinical and psychological variables that differentiate children with high hyperactivity/inattention symptoms, who had and had not received a diagnosis of ADHD. Analysis identified no significant differences in the demographic characteristics or socio-emotional wellbeing of 9-year-olds with hyperactivity/inattention who had and who had not received a diagnosis of ADHD. However, by age 13, those who had held a diagnosis at 9 years showed more emotional and peer relationship problems, worse prosocial behaviour, and poorer self-concept. Further research is required to clarify the developmental pathways responsible for these effects.
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Such a scenario may also occur in research contexts in double-blinded clinical trials, which further confounds the extent to which research on treatment outcomes can be generalised to draw conclusions about the outcomes of ADHD diagnosis.
Johnson et al.’s  study of children born preterm found that the more conservative procedure of requiring above-threshold scores in both (rather than either) teacher and parent reports reduced positive ADHD screens in a sample of from 34.2 to 9.6%. Similarly for this study, requiring a score of ≥ 9 in both teacher and parent SDQ reports would have reduced the sample of Undiagnosed ADHD to 81 (.9%) children. This would likely represent an overly conservative estimate of undiagnosed ADHD, given that the accepted prevalence of ADHD in the population is 5%  and the rate of existing clinical diagnosis in this sample was .8%.
They were not added to the Diagnosed ADHD group due to ambiguities caused by a change in question wording in GUI Wave 2, which queried the presence of “Emotional or behavioural disorders (e.g. ADHD/ADD)” instead of ADHD alone. This wording makes it impossible to establish whether these children held an ADHD diagnosis or another emotional or behavioural diagnosis. To preserve the clarity of the analysis, these ambiguous cases were dropped from any analysis involving Wave 2 data.
Unfortunately, since questions about medication were not asked of parents who did not report a mental health condition or disability, equivalent information is not available for the Undiagnosed ADHD group.
GUI did not ask those without a diagnosis whether their child was taking psychotropic medication, so it is not possible to determine whether some undiagnosed children were nevertheless undergoing pharmaceutical intervention. The lack of this data for the undiagnosed group also means it was not possible to include pharmaceutical treatment as a covariate in the analysis.
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The authors declare that they have no conflicts of interest.
The GUI study was conducted in accordance with the 1964 Helsinki Declaration and its later amendments and received ethical approval from the Irish Health Research Board’s Research Ethics Committee. Informed consent was obtained from all participants.
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O’Connor, C., McNicholas, F. What Differentiates Children with ADHD Symptoms Who Do and Do Not Receive a Formal Diagnosis? Results from a Prospective Longitudinal Cohort Study. Child Psychiatry Hum Dev 51, 138–150 (2020) doi:10.1007/s10578-019-00917-1
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