![]() Moreover, we aimed to highlight any existing evidence gaps. In this study, we systematically reviewed the literature to identify, appraise, and synthesize the evidence on overdiagnosis of ADHD in children and adolescents. Physical and psychosocial harms (and financial costs) may be experienced directly by the young patients and their family, but economic and opportunity costs are experienced by the wider society. Although the benefits of appropriate diagnosis and treatment of ADHD may be well known, 12 harms are less well appreciated. However, for increased detection to represent current overdiagnosis rather than previous underdiagnosis of ADHD, we also need evidence that these additional cases do not derive a net benefit from diagnosis (ie, these children’s overall health is not improved because the harms of diagnosis and treatment outweigh the benefits 23 - 25). Overdiagnosis of ADHD could happen because of diagnostic inflation 10, 19 by widening the definition to include ambiguous or mild symptoms, by explicitly changing the diagnostic definition, 10, 20 or by implicitly medicalizing behavioral patterns that previously would not have been considered abnormal 1, 21 (eg, those behaviors that are typical of children who are relatively young for their school year 22). 15 - 17 Methods to investigate overdiagnosis in noncancer conditions were published recently 18 but have not been applied to ADHD yet. 7 - 12 The concept of overdiagnosis is well established in cancer, 13, 14 but it also occurs in noncancer conditions. 1 - 6 Disagreement continues about how much of the increased diagnoses can be attributed to true increases in frequency, improved detection, or diagnostic inflation because of misdiagnosis and/or overdiagnosis. Public debate over the appropriateness of attention-deficit/hyperactivity disorder (ADHD) diagnosis has grown along with diagnosis rates. ![]() Evidence gaps remain and future research is needed, in particular research on the long-term benefits and harms of diagnosing and treating ADHD in youths with milder symptoms therefore, practitioners should be mindful of these knowledge gaps, especially when identifying these individuals and to ensure safe and equitable practice and policy. These studies supported a hypothesis of diminishing returns in which the harms may outweigh the benefits for youths with milder symptoms.Ĭonclusions and Relevance This review found evidence of ADHD overdiagnosis and overtreatment in children and adolescents. However, only 5 studies evaluated the critical issue of benefits and harms among the additional, milder cases. A total of 151 studies reported on outcomes of diagnosis and pharmacological treatment (question 5). Twenty-five studies showed that these additional cases may be on the milder end of the ADHD spectrum (question 3), and 83 studies showed that pharmacological treatment of ADHD was increasing (question 4). Evidence that actual ADHD diagnosis had increased was found in 45 studies (question 2). Substantial evidence of a reservoir of ADHD was found in 104 studies, providing a potential for diagnoses to increase (question 1). Of the 334 studies, 61 (18.3%) were secondary and 273 (81.7%) were primary research articles. Two researchers independently reviewed all abstracts and full-text articles, and all included studies were assessed for quality.įindings Of the 12 267 potentially relevant studies retrieved, 334 (2.7%) were included. Studies of children and adolescents (aged ≤18 years) with ADHD that focused on overdiagnosis plus studies that could be mapped to 1 or more framework question were included. MEDLINE, Embase, PsychINFO, and the Cochrane Library databases were searched for studies published in English between January 1, 1979, and August 21, 2020. Objective To systematically identify, appraise, and synthesize the evidence on overdiagnosis of ADHD in children and adolescents using a published 5-question framework for detecting overdiagnosis in noncancer conditions.Įvidence Review This systematic scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Extension for Scoping Reviews and Joanna Briggs Methodology, including the PRISMA-ScR Checklist. Although overdiagnosis is often suggested, no comprehensive evaluation of evidence for or against overdiagnosis has ever been undertaken and is urgently needed to enable evidence-based, patient-centered diagnosis and treatment of ADHD in contemporary health services. ![]() Importance Reported increases in attention-deficit/hyperactivity disorder (ADHD) diagnoses are accompanied by growing debate about the underlying factors.
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