ADHD prevalence estimates in Italian children and adolescents: a methodological issue

Laura Reale,Maurizio Bonati

doi:10.1186/s13052-018-0545-2

Abstract

BackgroundAttention deficit hyperactivity disorder (ADHD) is recognized as the most common, and most studied, developmental age disorder. Basic information, such as the most appropriate case definition and the best way to evaluate the disorder’s prevalence rate, however, remains an open issue.MethodsA comprehensive meta-analysis on the epidemiology of ADHD in Italy, which was lacking from the literature, was therefore performed to attempt to estimate the actual prevalence rate of ADHD, highlighting conceptual and quantitative differences between clinical-diagnosis and survey-based symptoms studies. The Medline, Embase, and PsycINFO databases, and the grey literature, were searched up to January 2018. The review was laid out in three main sections: an overall prevalence estimate, an epidemiological profile of ADHD symptoms, and an attempt to define the actual rate of ADHD diagnosis, as emerged from Italian studies.ResultsA total of 15 unique studies were included. These contributed to estimating the prevalence of ADHD in 67,838 subjects aged 5–17, representing 9 of the 20 regions (45%) of Italy. Overall, the pooled prevalence of ADHD was 2.9% (range: 1.1–16.7%). When distinguishing studies based on case definition, however, we found an average prevalence estimate, based on symptoms criteria, of 5.9% (range: 1.4 to 16.7%) and a best-estimate prevalence rate of 1.4% (range: 1.1 to 3.1%).ConclusionsFollowing the case definition for epidemiological studies of ADHD, counting only subjects with an ADHD diagnosis performed and confirmed by clinical assessment would reduce the wide variability in prevalence estimates, and, above all, would both describe the real rate of subjects suffering from ADHD disorder and avoid misdiagnosis.

Highlights

Attention deficit hyperactivity disorder (ADHD) is recognized as the most common, and most studied, developmental age disorder
A majority of the studies was conducted in school populations (n = 12), while the rest were performed in clinical settings (2 in child and adolescent neuropsychiatric services and 1 in family paediatrician practices), using a whole population approach
The methods used in the studies were rating scales, questionnaires, interviews, or other clinical tools based mainly on Statistical Manual of Mental Disorders (DSM)-IV criteria (11 studies), while the remaining were conducted according to DSM-III-R (2 studies), DSM-III (1 study) and ICD-10 (1 study) criteria

Summary

Introduction

Attention deficit hyperactivity disorder (ADHD) is recognized as the most common, and most studied, developmental age disorder Basic information, such as the most appropriate case definition and the best way to evaluate the disorder’s prevalence rate, remains an open issue. Since measures of prevalence are helpful in assessing health care needs and in planning health care services [2], estimates should be as accurate as possible This is an issue especially in mental health care, where the. ADHD is considered the most common, and most studied, developmental age disorder, even though basic information, such as the most appropriate case definition for estimating its prevalence rate, remains an open issue and leaves room for significant, debates in scientific literature [6, 7].

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