Trends in Recognition of and Service Use for Attention-Deficit Hyperactivity Disorder in Britain, 1999–2004

Abstract

National data suggest that attention-deficit hyperactivity disorder (ADHD) is underdiagnosed in Britain and that parental factors determine service use. This situation may have changed in recent years following policy and research recommendations. This study investigated changes in rates and correlates of service use for ADHD in Britain between 1999 and 2004. Use of various services by children aged five to 16 with ADHD (N=176) who were identified in the cross-sectional, nationally representative 2004 British Child and Adolescent Mental Health Survey was examined. The 2004 sample was compared with a community sample identified in a similar survey conducted in 1999. Most parents (90%) of children with ADHD recognized the presence of a problem, and 55% thought that their child had hyperactivity. Past-year contacts with education-based professionals exceeded those with professionals in specialist health services (74% versus 51%). One-third of children with ADHD were taking medication. Child factors, including severity of ADHD and a comorbid emotional or behavioral disorder, were the main determinants of service use. Parental burden was also associated with specialist service use. Specialist service use increased over five years after adjustment for severity and parental perceptions and burden (odds ratio=1.76, 95% confidence interval=1.13-2.75, p=.013). Barriers to care for ADHD in Britain appear to have been reduced in recent years. Medication for ADHD appears to be used cautiously, and the study found little empirical evidence of overuse. There is a need for health services to provide training and support for education-based professionals to help them recognize and manage children with ADHD.