Child, adolescent ADHD likely overdiagnosed

ADHD appeared to be overdiagnosed among children and adolescents, according to results of a systematic scoping review published in JAMA Network Open.

“Our aim was to summarize all previous studies on overdiagnosis of ADHD in children and adolescents, but we actually found very little primary research on the topic,” Luise Kazda, MPH, of the Sydney School of Public Health at The University of Sydney in Australia, told Healio Psychiatry. “Consequently, we used a framework that was specifically developed to identify characteristics consistent with overdiagnosis and subsequent overtreatment and searched for any evidence relevant to this framework. The main rationale for our paper was to examine the evidence for overdiagnosis and to highlight research gaps.”

Kazda and colleagues searched four databases for studies published in English between January 1979 and August 21, 2020, and included those featuring adolescents aged 18 years and children with ADHD. A total of 334 included studies, of which 61 were secondary and 273 were primary research articles, assessed overdiagnosis or were able to be mapped to at least one framework question.

Results showed 104 studies had significant evidence of a reservoir of ADHD, which provided a possibility of an increase in diagnoses (question one). The researchers found evidence of an increase in actual ADHD diagnosis in 45 studies (question two). A total of 25 studies demonstrated these additional cases might exist on the milder end of the ADHD spectrum (question three), and an increase in pharmacological ADHD treatment was apparent in 83 studies (question four). Further, 151 studies provided diagnosis and pharmacological treatment outcomes (question five). However, Kazda and colleagues noted only five studies assessed the “critical issue” of the additional, milder cases’ benefits and harms.

Study results supported the hypothesis of diminishing returns and that harms may be more significant than benefits for youths with milder symptoms.

“Because we discovered large research gaps for long-term outcomes of diagnosis and medication for children with mild ADHD behaviors, as well as some studies that suggested that this group of children in particular does not benefit from a diagnosis, we concluded that a cautious approach to diagnosing these children should be taken.”