Background: Clinicians often experience that children are referred for psychiatric evaluation without fulfiling the diagnostic criteria of any psychiatric disorders. This study investigates factors that might lead children to psychiatric referral without any psychiatric disorder. Method: Children/adolescents who were referred for psychiatric assessment (referred group) (n = 418, mean age = 10.82 years, SD = 3.81) and a control group (n = 48, mean age = 10.38 years, SD = 3.77) were evaluated by the Mini International Neuropsychiatric Interview Kid (MINI Kid) and the Erfassung der Lebensqualit€ at Kindern und Jugendlichen (Measure of Quality of Life for Children and Adolescents). The referred group was further divided into two subgroups: referred subgroup without MINI Kid diagnosis (n = 61) and referred subgroup with MINI Kid diagnosis (n = 357). Subjects less than 18 years old were included and there was no lower age limit. Results: Attention-deficit/hyperactivity disorder (ADHD) symptoms significantly increased the odds for referral as social phobia symptoms significantly decreased the odds for psychiatric referral. Regarding quality of life (QoL), the control group showed significantly less impairment when compared with the referred group; the two referred subgroup with and without diagnosis did not differ significantly. Conclusions: ADHD symptoms, even in a subthreshold level and impaired QoL represent risk factors for psychiatric referral in children. Secondary prevention of children should target to screen subthreshold ADHD symptoms and QoL.
Key Practitioner Message• Clinicians often experience that children are referred for psychiatric evaluation without fulfiling the diagnostic criteria of any psychiatric disorders, thus it is important to evaluate the factors that might lead these children to psychiatric referral.• In our study the presence of the symptoms of attention-deficit/hyperactivity disorder (ADHD) significantly increased, as the presence of symptoms of social phobia significantly decreased the odds for psychiatric referral.• Children who were referred to psychiatric evaluation without fulfiling any psychiatric diagnosis showed significantly more impaired quality of life (QoL) than the control group, but did not differ significantly from children who were referred to psychiatric evaluation and had one or more psychiatric diagnoses.• ADHD symptoms, even in a subthreshold level and impaired QoL represent risk factors for psychiatric referral in children.• Evaluating the symptoms of ADHD, social phobia and QoL in the case of subthreshold psychiatric disorders would be essential in secondary prevention.