Attention deficit hyperactivity disorder: overdiagnosed or diagnoses missed? | Archives of Disease in Childhood

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Attention deficit hyperactivity disorder: overdiagnosed or diagnoses missed?

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Prevalence and Aetiology of ADHD
Michael A Colvin
Published on: 3 August 2017
The Prevalence of ADHD is 5% in Childhood.
Michael A. Colvin
Published on: 20 March 2017
Re: What we may have missed
Eric Taylor
Published on: 20 March 2017
What we may have missed
Michael A. Colvin
Published on: 20 March 2017

Published on: 3 August 2017
Prevalence and Aetiology of ADHD
- Michael A Colvin, Paediatrician NHS Forth Valley
I would like to thank Professor Taylor for his response, and apologise if my second response seems rude. I thought the first one had been overlooked.

We do indeed agree that there is a large unmet need due to the under-recognition of ADHD and, I would suggest, other developmental disorders with a supposed genetic aetiology which seem to be more common than they were. The question of aetiology is, of course, pertinent to the epidemiology and the service needs assessment. Urgent too, if children's community services are not to be overwhelmed.

Conflict of Interest:
None declared.
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Published on: 20 March 2017
The Prevalence of ADHD is 5% in Childhood.
- Michael A. Colvin, Paediatrician
Professor Taylor, quoting a sound meta-analysis by Polanczyk et al published 16 years previously, declares that the prevalence of ADHD is around 5%. He appears convinced that the prevalence has not changed and does not change, and he explains that rates which differ from around 5% are either due to over-diagnosis or under-diagnosis.
I hope I am not being impudent in suggesting that the professor has a rather in...
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Professor Taylor, quoting a sound meta-analysis by Polanczyk et al published 16 years previously, declares that the prevalence of ADHD is around 5%. He appears convinced that the prevalence has not changed and does not change, and he explains that rates which differ from around 5% are either due to over-diagnosis or under-diagnosis.
I hope I am not being impudent in suggesting that the professor has a rather inflexible view on the epidemiology of ADHD. As ADHD is not an aetiological diagnosis, might it not vary considerably by place and over time? We are invited to adjust our view of normality such that a magic 5% fall beyond threshold, regardless of how many children are swinging from the chandeliers.
Conflict of Interest:
None declared
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Conflict of Interest:
None declared.
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Published on: 20 March 2017
Re: What we may have missed
- Eric Taylor, Professor
Thanks to Dr Colvin for his interest. I should like to clarify that an "unspoken assumption" of genetic determinism did not underlie my review. I agree with his points on the aetiology: the balance of genetic and environmental influences and their interaction deserve much more study. The aetiology, however, is an issue rather separate from prevalence. Even if countries did differ in their actual rates (rather than just...
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Thanks to Dr Colvin for his interest. I should like to clarify that an "unspoken assumption" of genetic determinism did not underlie my review. I agree with his points on the aetiology: the balance of genetic and environmental influences and their interaction deserve much more study. The aetiology, however, is an issue rather separate from prevalence. Even if countries did differ in their actual rates (rather than just the rates of diagnosis in practice), the explanation could equally be in genetic or environmental diversity. The suggestion, that the actual rate of ADHD is broadly similar across countries, did not derive from theories of cause, but from the cited metaanalyses of epidemiological research. Those meta-analyses conclude that geographical location plays only a small and limited role in the variability of prevalence (eg as between estimates from North America on one hand and Africa and the Middle East on the other). That conclusion is provisional in the presence of uncertainties about case identification and the strong influences of methodology on prevalence results.
I hope the questions raised will not distract readers from the key argument that there is substantial and avoidable under-recognition and under-treatment of ADHD in the UK. I am glad that Dr Colvin agrees and indeed regards it as obvious. I hope other readers will do the same and convey their concern to commissioners and providers of services in health and education.
Conflict of Interest:
None declared
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Conflict of Interest:
None declared.
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Published on: 20 March 2017
What we may have missed
- Michael A. Colvin, Paediatrician
Two alternative explanations are given by Professor Taylor for the global problem with ADHD diagnosis, but he overlooks one interesting possibility- perhaps the reported prevalences are about right. That is, perhaps the rates really do vary considerably between populations and are rising in the USA and in other countries.
Professor Taylor recognises some obvious facts. Firstly, there is a large unmet need. Seco...
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Two alternative explanations are given by Professor Taylor for the global problem with ADHD diagnosis, but he overlooks one interesting possibility- perhaps the reported prevalences are about right. That is, perhaps the rates really do vary considerably between populations and are rising in the USA and in other countries.
Professor Taylor recognises some obvious facts. Firstly, there is a large unmet need. Secondly the reported rates are very high in some places and are changing quite rapidly. Thirdly, places where medical treatment is well established have higher prevalence.
It can be pointed out that a large unmet need might be due to a rising prevalence and that wealthy places with higher prevalence are likely to have more established treatments. In short, we are offered no good reason to disbelieve the data.
The unspoken reason why the prevalence data is questioned is that it doesn't fit with our aetiological model. ADHD is supposedly genetic. Professor Taylor, however, points out that the diagnosis for an individual is not made based on aetiology and can't be disproved by aetiology. It is made on well established behavioural diagnostic criteria.
Are we not left with the serious possibility that our aetiological model is wrong. Genetics are involved with every condition. Might not twin studies identify epigenetic as well as genomic processes? Epigenetics is a science which is moving the ground beneath our feet. If we should not dither in rigid constructions when the roof is falling in.
Conflict of Interest:
None declared
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Conflict of Interest:
None declared.
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