Examining the Educational Gap for Children with ADHD and Subthreshold ADHD

Zendarski, Nardia; Guo, Shuaijun; Sciberras, Emma; Efron, Daryl; Quach, Jon; Winter, Leanne; Bisset, Matthew; Middeldorp, Christel M.; Coghill, David

doi:10.1177/1087054720972790

Cited by 23 publications

(21 citation statements)

References 47 publications

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“…30,31 Still, studies suggest that even in children with subthreshold symptoms, impairment can occur, and they could benefit from additional support. 32,33 Unfortunately, our results indicate no beneficial associations of an ADHD diagnosis with adolescents' QOL, which is highly concerning. It implies that the harms associated with an ADHD label (such as stigma, prejudice, deflection from other problems, or the perceived inability to change 8 ) may not be offset by benefits associated with the diagnosis or treatment.…”

Section: Jama Network Open | Pediatricscontrasting

confidence: 58%

“…However, it is also known that medication comes with numerous harms that may outweigh benefits, especially when combined with harms from the diagnosis and in children without major impairment, ie, those with few or borderline H/I behaviors . Still, studies suggest that even in children with subthreshold symptoms, impairment can occur, and they could benefit from additional support …”

Section: Discussionmentioning

confidence: 99%

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Association of Attention-Deficit/Hyperactivity Disorder Diagnosis With Adolescent Quality of Life

et al. 2022

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ImportanceAppropriate diagnosis of attention-deficit/hyperactivity disorder (ADHD) can improve some short-term outcomes in children and adolescents, but little is known about the association of a diagnosis with their quality of life (QOL).ObjectiveTo compare QOL in adolescents with and without an ADHD diagnosis.Design, Setting, and ParticipantsThis cohort study followed an emulated target trial design using prospective, observational data from the Longitudinal Study of Australian Children, a representative, population-based prospective cohort study with biennial data collection from 2006 to 2018 with 8 years of follow-up (ages 6-7 to 14-15 years). Propensity score matching was used to ensure children with and without ADHD diagnosis were well matched on a wide range of variables, including hyperactive/inattentive (H/I) behaviors. Eligible children were born in 1999 to 2000 or 2003 to 2004 and did not have a previous ADHD diagnosis. All incident ADHD cases were matched with controls. Data were analyzed from July 2021 to January 2022.ExposuresIncident parent-reported ADHD diagnosis at age 6 to 7, 8 to 9, 10 to 11, 12 to 13, or 14 to 15.Main Outcomes and MeasuresQuality of life at age 14 to 15 was measured with Child Health Utility 9D (CHU9D) and 8 other prespecified, self-reported measures mapped to the World Health Organization’s QOL domains. Pooled regression models were fitted for each outcome, with 95% CIs and P values calculated using bootstrapping to account for matching and repeat observations.ResultsOf 8643 eligible children, a total of 393 adolescents had an ADHD diagnosis (284 [72.2%] boys; mean [SD] age, 10.03 [0.30] years; mean [SD] H/I Strengths and Difficulties Questionnaire score, 5.05 [2.29]) and were age-, sex-, and H/I score–matched with 393 adolescents without ADHD diagnosis at time zero. Compared with adolescents without diagnosis, those with an ADHD diagnosis reported similar QOL on CHU9D (mean difference, −0.03; 95% CI, −0.07 to 0.01; P = .10), general health (mean difference, 0.11; 95% CI, −0.04 to 0.27; P = .15), happiness (mean difference, −0.18; 95% CI, −0.37 to 0.00; P = .05), and peer trust (mean difference, 0.65; 95% CI, 0.00 to 1.30; P = .05). Diagnosed adolescents had worse psychological sense of school membership (mean difference, −2.58; 95% CI, −1.13 to −4.06; P &lt; .001), academic self-concept (mean difference, −0.14; 95% CI, −0.02 to −0.26; P = .02), and self-efficacy (mean difference, −0.20; 95% CI, −0.05 to −0.33; P = .007); displayed more negative social behaviors (mean difference, 1.56; 95% CI, 0.55 to 2.66; P = .002); and were more likely to harm themselves (odds ratio, 2.53; 95% CI, 1.49 to 4.37; P &lt; .001) than adolescents without diagnosis.Conclusions and RelevanceIn this cohort study, ADHD diagnosis was not associated with any self-reported improvements in adolescents’ QOL compared with adolescents with similar levels of H/I behaviors but no ADHD diagnosis. ADHD diagnosis was associated with worse scores in some outcomes, including significantly increased risk of self-harm. A large, randomized clinical trial with long-term follow-up is needed.

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Section: Jama Network Open | Pediatricscontrasting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Association of Attention-Deficit/Hyperactivity Disorder Diagnosis With Adolescent Quality of Life

et al. 2022

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“…The prevalence rate of subthreshold ADHD is about 17.7%, which is much higher than that of full syndrome ADHD which is about 9.4% ( Kirova et al, 2019 ). The concomitant symptoms and problems may have negative impacts on their academic and social lives as well as mental health ( Fergusson et al, 2010 ; Malmberg et al, 2011 ; Mulraney et al, 2021 ; Zendarski et al, 2022 ). However, due to the lack of a diagnostic label, the symptoms of children with subthreshold ADHD typically gain less attention than those of children with ADHD, and it is difficult for the former to get effective intervention in time and to obtain guidance in the clinic, school and family.…”

Section: Introductionmentioning

confidence: 99%

Cognitive Control Deficits in Children With Subthreshold Attention-Deficit/Hyperactivity Disorder

Chen

Liu

et al. 2022

Front. Hum. Neurosci.

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Subthreshold Attention-Deficit/Hyperactivity Disorder (ADHD) is defined as a neurobiological condition with some core inattentive or hyperactive/impulsive symptoms of ADHD which do not meet the full diagnosis clinically. Although it has been well documented that deficits in cognitive control, a high-level cognitive construct closely related to attention, are frequently found among children with ADHD, whether subthreshold ADHD is also associated with similar deficits remains unclear. In this study, we examined the attention functions and the cognitive control capacity (CCC) in children with ADHD (n = 39), those with subthreshold ADHD (n = 34), and typically developing peers (TD, n = 36). The results showed that the ADHD and subthreshold ADHD groups exhibited similar patterns of the impaired executive function of attention (revealed as an augment in flanker conflict effect) and reduced cognitive control capacity, and no significant difference was found between the two groups. These findings suggest that although children with subthreshold ADHD have not met the full criteria of ADHD, they showed reduced efficiency in cognitive control and attention function, similar to children with ADHD.

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“…Almost every classroom includes students with subthreshold or clinical levels of symptoms of attention-deficit/ hyperactivity disorder (ADHD), together representing about 20% of all school-aged children (Kirova et al, 2019;Polanczyk et al, 2014). These children suffer from problems with inattention, hyperactivity, and/or impulsivity (American Psychiatric Association, 2013) that are related to academic, behavioral, and/or social problems in the classroom (Kirova et al, 2019;Zendarski et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Teacher Feedback, Student ADHD Behavior, and the Teacher–Student Relationship: Are These Related?

Staff

Oosterlaan

Oord

et al. 2022

School Mental Health

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This cross-sectional study aimed to compare positive and corrective teacher feedback toward children with attention-deficit/hyperactivity disorder (ADHD) and typically developing children, and to examine whether the quality of the teacher–student relationship moderated associations between child behavior and teacher feedback. We observed and coded classroom ADHD behaviors of 55 children with ADHD and 34 typically developing children (TDC; 6–12 years), as well as the levels of positive and corrective teacher feedback they received. Teachers rated closeness and conflict using the Student–Teacher Relationship Scale in the ADHD group. Multilevel analyses revealed that teachers provided significantly more corrective feedback to children in the ADHD compared to the TDC group. Children in the ADHD group received more corrective than positive feedback, but this pattern was reversed for the TDC group. Multiple regression analyses in the ADHD group indicated that lower levels of positive feedback were related to higher levels of motor hyperactivity. Higher levels of corrective feedback were associated with higher levels of verbal hyperactivity. Closeness moderated this association: Corrective feedback was related to levels of verbal hyperactivity only if teachers experienced less closeness in the relationship with the child. None of the other moderation effects were significant. Teachers provided more corrective feedback to children with ADHD than to typically developing children, and teacher feedback toward children with ADHD was associated with levels of hyperactivity. A close teacher–student relationship may serve as protective factor for the receipt of corrective feedback in this group, but experimental studies are needed to confirm this hypothesis.

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Examining the Educational Gap for Children with ADHD and Subthreshold ADHD

Cited by 23 publications

References 47 publications

Association of Attention-Deficit/Hyperactivity Disorder Diagnosis With Adolescent Quality of Life

Association of Attention-Deficit/Hyperactivity Disorder Diagnosis With Adolescent Quality of Life

Cognitive Control Deficits in Children With Subthreshold Attention-Deficit/Hyperactivity Disorder

Teacher Feedback, Student ADHD Behavior, and the Teacher–Student Relationship: Are These Related?

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