Ogundele Michael O, Morton Michael J S
Department of Community Paediatrics, King's Mill Hospital, Sutton in Ashfield, Nottingham NG17 4JL, UK.
School of Health & Wellbeing, University of Glasgow, Clarice Pears Building (Level), 90 Byres Road, Glasgow G12 8TB, UK.
Pediatr Rep. 2025 Apr 3;17(2):42. doi: 10.3390/pediatric17020042.
Epidemiological studies have shown that neurodevelopmental disorders (NDDs), such as autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (ADHD) are more prevalent in the general childhood population, compared to cases that are formally diagnosed in clinical cohorts. This suggests that many children and youths have NDD which are never diagnosed clinically, causing impairments in some domains of their daily life. There is increasing recognition of the concept of a "subthreshold" condition, sometimes used to describe the presence of potentially impairing variations in the neurodevelopmental profile that do not meet criteria for a diagnosis. The aim of this narrative review is to appraise the published literature about common themes regarding subthreshold conditions in relation to autism and ADHD, identifying any practical lessons that may be applicable to frontline neurodevelopmental clinicians. We searched electronic databases including PMC and PubMed using various combinations of keywords, including "Subthreshold", "subclinical", "neurodevelopmental", "childhood", "ADHD" and "ASD". The identified themes include definitions, prevalence, assessment tools, lifetime impairments, NDD classification models, management, raising public awareness, and future research directions. The authors propose that a "subthreshold condition" should be recorded when NDDs do not meet current diagnostic criteria if there is evidence of significant, persisting impairment in at least one setting.
流行病学研究表明，与临床队列中正式诊断的病例相比，神经发育障碍（NDDs），如自闭症谱系障碍（ASD）和注意力缺陷多动障碍（ADHD）在普通儿童群体中更为普遍。这表明许多儿童和青少年患有未被临床诊断的神经发育障碍，导致他们日常生活的某些方面出现功能损害。人们越来越认识到“阈下”状况这一概念，有时用于描述神经发育特征中存在潜在损害性变异但不符合诊断标准的情况。本叙述性综述的目的是评估已发表的关于自闭症和多动症阈下状况常见主题的文献，确定可能适用于一线神经发育临床医生的实用经验教训。我们使用包括“阈下”“亚临床”“神经发育”“儿童期”“多动症”和“自闭症谱系障碍”等关键词的各种组合在包括PMC和PubMed在内的电子数据库中进行搜索。确定的主题包括定义、患病率、评估工具、终生功能损害、神经发育障碍分类模型、管理、提高公众意识以及未来研究方向。作者建议，如果有证据表明在至少一种情况下存在显著的、持续的功能损害，而神经发育障碍不符合当前诊断标准时，应记录“阈下状况”。
