Abstract
In this journal, Holden, Jenkins-Jones, Poole, Morgan, Coghill and Currie , CAPMH 7:34, 2013, report on the prevalence and financial costs of treating people with attention deficit hyperactivity disorder (ADHD) in the UK over the last ten years. We commend the authors on their thorough cost analysis, and discuss differences in prevalence estimates of diagnosed ADHD, that is the proportion of the child population with an ADHD diagnosis, which varies dramatically between studies. We also discuss the reasons for this. Regional variation in application of diagnostic criteria and clinical subjectivity are likely partial explanations.
Highlights
Holden, Jenkins-Jones, Poole, Morgan, Coghill and Currie [1] perform a thorough analysis of the costs of treating attention deficit hyperactivity disorder (ADHD), and estimate that the added overall cost to the UK healthcare system for each individual with an ADHD diagnosis is approximately £860 p.a
Previous cost analyses have estimated an overall cost of ADHD to various national economies [2,3], and such estimates are based on measured prevalence of ADHD
Perhaps the more pertinent question is not ‘what is the prevalence of diagnosed ADHD’, but whether it is helpful for children to be diagnosed, or for families to have their child diagnosed with ADHD / receive treatment
Summary
Jenkins-Jones, Poole, Morgan, Coghill and Currie [1] perform a thorough analysis of the costs of treating ADHD, and estimate that the added overall cost to the UK healthcare system for each individual with an ADHD diagnosis is approximately £860 p.a. (approx. $1430 US). A more valuable prevalence estimate is that based on the prevalence of children suffering from symptoms of ADHD at clinical levels in the population Such estimates are made by epidemiological studies using validated ADHD rating scales, such as the Connors Scale, or standardised diagnostic measures such as the Development and Well Being Assessment (DAWBA). The identification of ADHD has be shown to vary across geographical region [12], and by ethnicity [13] and gender: girls are less often recognised than boys, as Holden and colleagues point out Such differences, either cultural, in terms of differences in diagnostic criteria, or arising from the ‘subjectivity of clinicians’ to which the article refers, render the question of whether ADHD is under or over-diagnosed a red herring: the answer depends on where you fix the cut-point for clinical ADHD, and this itself is a moving target [14]
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