Evidence of potential overdiagnosis and overtreatment of attention deficit hyperactivity disorder (ADHD) in children and adolescents: protocol for a scoping review

Abstract

IntroductionWorldwide, attention deficit hyperactivity disorder (ADHD) diagnosis rates in children and adolescents have been increasing consistently over the past decades, fuelling a debate about the underlying reasons for this trend. While many hypothesise that a substantial number of these additional cases are overdiagnosed, to date there has been no comprehensive evaluation of evidence for or against this hypothesis. Thus, with this scoping review we aim to synthesise published evidence on the topic in order to investigate whether existing literature is consistent with the occurrence of overdiagnosis and/or overtreatment of ADHD in children and adolescents.Methods and analysisThe proposed scoping review will be conducted in the context of a framework of five questions, developed specifically to identify areas in medicine with the potential for overdiagnosis and overtreatment. The review will adhere to the Joanna Briggs Methodology for Scoping Reviews. We will search Medline, Embase, PsycINFO and the Cochrane Library electronic databases for primary studies published in English from 1979 onwards. We will also conduct forward and backward citation searches of included articles. Data from studies that meet our predefined exclusion and inclusion criteria will be charted into a standardised extraction template with results mapped to our predetermined five-question framework in the form of a table and summarised in narrative form.Ethics and disseminationThe proposed study is a scoping review of the existing literature and as such does not require ethics approval. We intend to disseminate the results from the scoping review through publication in a peer-reviewed journal and through conference presentations. Further, we will use the findings from our scoping review to inform future research to fill key evidence gaps identified by this review.

Overdiagnosis of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents

“…A summary of the methods is given here, and the details are published elsewhere. 28 Overdiagnosis is defined here as occurring when a person is clinically diagnosed with a condition, but the net effect of the diagnosis is unfavorable. 18,23,29 Misdiagnosis (when a child is incorrectly labeled with an ADHD diagnosis instead of an alternative condition 10,23 ) and false-positive diagnosis (when a subsequent clinical encounter reveals a wrong initial diagnosis 23 ) are not the focus of this article.…”

“…Because of the broad research question, we conducted a systematic scoping review that adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Extension for Scoping Reviews and Joanna Briggs Methodology, including the provision of a PRISMA-ScR Checklist. A summary of the methods is given here, and the details are published elsewhere …”

Attention-deficit/hyperactivity disorder and other neurodevelopmental disorders in offspring of parents with depression and bipolar disorder

“…Family dysfunction, inconsistent parenting style, and maladaptive communication can be associated with an increased risk of ADHD in offspring at risk (Cussen, Sciberras, Ukoumunne, & Efron, 2012). However, there is growing debate about over-detection of ADHD in young children and an issue of misinterpreting their attentional and behavioral problems (Kazda, Bell, Thomas, McGeechan, & Barratt, 2019) that may be secondary to childhood maltreatment and other adverse environmental factors.…”

“…they may be interested in assessing the offspring at risk) and this may limit generalization of the findings. In addition, there is a risk of over-detection of ADHD in young children with attentional and behavioral problems (Kazda et al, 2019).…”

Prevalence and Epidemiological Characteristics of ADHD in Pre-School and School Age Children in the Province of Tarragona, Spain

“…Heterogeneity can also be found in the use of different classification systems, temporal considerationslifetime, 12-month or current prevalence-severity levels and age ranges. For some researchers the high ADHD prevalence rates and differences between studies suggest a potential over-diagnosis of ADHD (Kazda et al, 2019). In contrast, other authors believe that infra-diagnosis may be present, especially for some age groups (pre-schoolers and adolescents) children of low socioeconomic status, females or those living in certain regions of the country (Danielson et al, 2018;Göbel et al, 2018;Madsen et al, 2018;Nguyen et al, 2019;Rowland et al, 2018;Sayal et al, 2018).…”