Study finds early ADHD diagnosis risks ‘negative impact’

A study has found that young people with an ADHD diagnosis at age nine were faring worse by age 13 than others who also appeared to have the condition but did not have a formal diagnosis.
Study finds early ADHD diagnosis risks ‘negative impact’

A study has found that young people with an ADHD diagnosis at age nine were faring worse by age 13 than others who also appeared to have the condition but did not have a formal diagnosis.

The analysis of data from the Growing Up in Ireland longitudinal study indicated that as many as half of the children with an ADHD diagnosis at age nine did not have any specialist mental health supports despite confirmation of the condition.

One of the co-authors of the study, Dr Cliódhna O’Connor, a lecturer and assistant professor in the UCD School of Psychology, said one possible explanation for the divergence in fortunes by age 13 was that the diagnosis — particularly without supports — became a label that “sets the child on a negative social and emotional trajectory”.

According to the study, published in the Journal of Child Psychiatry and Human Development, “ADHD (Attention deficit hyperactivity disorder) diagnoses are increasing worldwide, in patterns involving both over-diagnosis of some groups and under-diagnosis of others.”

It used data from the Growing Up in Ireland study of 8,568 children to examine sociodemographic, clinical, and psychological variables that differentiate children with high hyperactivity/inattention symptoms, who had and had not received a diagnosis of ADHD.

The study states: “Analysis identified no significant differences in the demographic characteristics or socio-emotional wellbeing of nine-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 nine showed more emotional and peer relationship problems, worse prosocial behaviour, and poorer self-concept.

Dr O’Connor said the data used was old, in that the children were aged nine in 2008 and 13 in 2012, and fresh waves of data were now available for analysis.

Regarding the undiagnosed group, she said that “we implemented quite a high threshold” for inclusion, meaning there was “a high likelihood that a lot of them would qualify for an ADHD diagnosis”.

She said there were three possible explanations for the divergence between the two groups at age 13. One is that the group with a diagnosis at age nine were displaying more challenging psychological features that may not show in the data.

Another was that a “confounding factor” could be at play, such as the possibility of an issue within the family.

The final possible factor was that “the diagnosis itself sets the child on a negative social and emotional trajectory” — which she said was effectively linked to stigma and negative perceptions.

The actual prevalence rate of ADHD is 5% and Dr O’Connor said levels of perceived stigma would likely have been greater when the data was captured, but she said there was evidence within the sample of children with a diagnosis not getting any specialist mental health supports.

“Only half of the diagnosed group had more than one contact with a mental health professional in the previous year,” she said, adding that 41.1% had been prescribed medication.

“That could be a big issue,” she said, saying that with a diagnosis but no accompanying supports “you are just left with this label”.

One conclusion is that the services should be there and there should be effective treatment.

A smaller indication within the study was the idea of a more gradual or phased approach to diagnosis, with supports provided first and a diagnosis following only if there was no response to those interventions, with the result of more pronounced assistance then being provided.

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