Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Qld, Australia.
J Child Psychol Psychiatry. 2023 Aug;64(8):1140-1148. doi: 10.1111/jcpp.13700. Epub 2022 Sep 5.
Globally, ADHD diagnoses have increased substantially and there is concern that this trend does not necessarily reflect improved detection of cases but that overdiagnosis may be occurring. We directly compared ADHD diagnoses with ADHD-related behaviours and looked for changes across time among Australian children in a large, population-based prospective cohort study.
We conducted a secondary analysis of the Longitudinal Study of Australian Children, including 4,699 children born 1999/2000 (cohort 1) and 4,425 children born 2003/2004 (cohort 2), followed from 4 to 13 years of age. We compared pre-diagnosis parent-reported hyperactive/inattentive behaviour scores between newly diagnosed (incident cases) and undiagnosed children and fitted Cox's proportional hazards regression models to examine the relationship between birth cohorts 1 and 2 and the risk of incident ADHD diagnosis.
Cumulative incident ADHD diagnoses increased from 4.6% in cohort 1 (born in 1999/2000) to 5.6% in cohort 2 (born in 2003/2004), while hyperactive/inattentive behaviour scores remained steady. Among ADHD diagnosed children, 26.5% (88/334) recorded pre-diagnosis behaviours in the normal range, 27.6% (n = 92) had borderline scores and 45.8% (n = 153) scored within the clinical range. Children born in 2003/2004 were more likely to be diagnosed with ADHD compared with those born in 1999/2000 (aHR = 1.33, 95% CI = 1.06-1.67, p = .012), regardless of their ADHD behaviour score (p = .972).
Diagnostic increases were not driven by rises in hyperactive/inattentive behaviours. A quarter of all children with an ADHD diagnosis recorded pre-diagnosis behaviours within the normal range. The increased likelihood of being diagnosed with ADHD for children from the later birth cohort was observed for children across the full range of ADHD-related behaviours.
全球范围内，ADHD 的诊断数量大幅增加，人们担心这种趋势不一定反映出病例检出率的提高，而可能是过度诊断。我们通过一项大型的基于人群的前瞻性队列研究，直接比较了 ADHD 诊断与 ADHD 相关行为，并观察了澳大利亚儿童随时间的变化。
我们对澳大利亚儿童纵向研究进行了二次分析，该研究包括 1999/2000 年出生的 4699 名儿童（队列 1）和 2003/2004 年出生的 4425 名儿童（队列 2），随访时间为 4 至 13 岁。我们比较了新诊断（新发病例）和未诊断儿童的父母报告的多动/注意力不集中行为评分，并使用 Cox 比例风险回归模型检查了队列 1 和队列 2 与 ADHD 新发诊断风险之间的关系。
累积 ADHD 诊断发生率从队列 1（1999/2000 年出生）的 4.6%增加到队列 2（2003/2004 年出生）的 5.6%，而多动/注意力不集中行为评分保持稳定。在 ADHD 确诊儿童中，26.5%（88/334）的儿童在确诊前行为处于正常范围，27.6%（n=92）的儿童行为处于边缘状态，45.8%（n=153）的儿童行为处于临床范围。与 1999/2000 年出生的儿童相比，2003/2004 年出生的儿童更有可能被诊断为 ADHD（调整后危险比[aHR]为 1.33，95%置信区间[CI]为 1.06-1.67，p=0.012），而与 ADHD 行为评分无关（p=0.972）。
诊断增加并非源于多动/注意力不集中行为的增加。四分之一的 ADHD 诊断儿童在确诊前的行为处于正常范围内。对于来自较晚出生队列的儿童，无论 ADHD 相关行为的范围如何，他们被诊断为 ADHD 的可能性都更高。
