Abstract

BackgroundRegarding the controversy about the overdiagnosis of Attention Deficit/Hyperactivity Disorder (ADHD) in children and adolescents there are two main directions addressed as issue of age bias and issue of gender bias. In this relation, replication of findings demonstrating significant overdiagnosis is of importance which make the systematic evaluation of such occurrence necessary.ObjectiveThe seminal study by Bruchmüller, Margraf & Schneider, 2012 is replicated here, although in a different cultural context, in this case Iran, as ADHS might be perceived differently there. We assessed both gender bias and the impact of potential overdiagnosis on treatment recommendations.MethodsA total of 344 licensed Iranian psychiatrists (mean age = 45.17, SD = 9.50) participated in this study. Each psychiatrist received a cover letter that introduced the study as well as a case vignette. Overall, there are eight different cases, one child with ADHD and three non-ADHD children, for both a boy (Ali) and a girl (Sara). Participants also received a questionnaire requesting their particular diagnosis, treatment recommendation and the therapist’s sociodemographic information. Chi square tests and multiple logistic regression were applied for data analyses.ResultsOverdiagnosis occurred in both girl and boy children, although overdiagnosis was 2.45 more likely in boys than in girls (p < 0.01). With respect to the psychiatrist’s gender, we detected no difference between males or females, as both overdiagnosed ADHD in boys (pfemale < 0.01 and pmale < 0.01). Furthermore, ADHD overdiagnosis had a direct impact on medication prescription (p < 0.01).ConclusionThis study suggests that diagnosticians should strictly adhere to diagnostic criteria to minimize diagnostic error.

Highlights

  • Attention Deficit/Hyperactivity Disorder (ADHD) and the debate of overdiagnosis Attention deficit hyperactivity disorder (ADHD) is one of the most frequently diagnosed disorders of childhood and adolescence, with a pooled worldwide prevalence rate of ~ 5% [1,2,3]

  • ADHD overdiagnosis had a direct impact on medication prescription (p < 0.01)

  • Overdiagnosis of ADHD Psychiatrists’ information on age, gender and years of job experience are summarized in Tables 1 & 2 for both the cities of Isfahan and Tehran

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Summary

Introduction

ADHD and the debate of overdiagnosis Attention deficit hyperactivity disorder (ADHD) is one of the most frequently diagnosed disorders of childhood and adolescence, with a pooled worldwide prevalence rate of ~ 5% [1,2,3]. Similar analysis for children aged 5 to 11 years showed that prevalence increased from 2.96% in 2007 to 3.74% in 2016. Regarding the controversy about the overdiagnosis of Attention Deficit/Hyperactivity Disorder (ADHD) in children and adolescents there are two main directions addressed as issue of age bias and issue of gender bias. In this relation, replication of findings demonstrating significant overdiagnosis is of importance which make the systematic evaluation of such occurrence necessary

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