Skip to main content

Advertisement

Log in

Demographic Characteristics and Psychiatric Comorbidity of Children and Adolescents Diagnosed with ADHD in Specialized Healthcare

  • Original Article
  • Published:
Child Psychiatry & Human Development Aims and scope Submit manuscript

Abstract

Recent studies have shown an increasing incidence of attention-deficit/hyperactivity disorder (ADHD) among children diagnosed in specialized services. This study aims to describe children with ADHD in Finnish specialized healthcare by reporting the demographic characteristics, time trends in diagnosis, psychiatric comorbidity, and the validity of register-based diagnoses. All the singletons born in Finland between 1991 and 2005 and diagnosed with ADHD by 2011 were identified and their psychiatric comorbidity data was obtained from the Finnish Hospital Discharge Register (FHDR). Parents of 69 patients were interviewed via telephone for a diagnostic validation. A total of 10,409 children were identified with ADHD, with a male: female ratio of 5.3:1 and a psychiatric comorbidity rate of 76.7 %. Of the validation sample 88 % met the diagnostic criteria of ADHD for DSM-IV. There is an increasing trend of ADHD diagnosis among both males and females. Psychiatric comorbidity is common and includes a wide range of disorders among children with ADHD. There was an increase of ADHD diagnoses especially among boys. More attention is needed to detect ADHD among girls in health services. Diagnoses in the FHDR show diagnostic validity and their sociodemographic patterns are in line with previous studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA (2007) The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 164(6):942–948

    Article  PubMed  Google Scholar 

  2. Brault MC, Lacourse É (2012) Prevalence of prescribed attention-deficit hyperactivity disorder medications and diagnosis among Canadian preschoolers and school-age children: 1994–2007. Can J Psychiatry 57(2):93–101

    PubMed  Google Scholar 

  3. Atladóttir HO, Parner ET, Schendel D, Dalsgaard S, Thomsen PH, Thorsen P (2007) Time trends in reported diagnoses of childhood neuropsychiatric disorders: a Danish cohort study. Arch Pediatr Adolesc Med 161(2):193–198

    Article  PubMed  Google Scholar 

  4. Robison LM, Skaer TL, Sclar DA, Galin RS (2002) Is attention deficit hyperactivity disorder increasing among girls in the US? Trends in diagnosis and the prescribing of stimulants. CNS Drugs 16(2):129–137

    Article  PubMed  Google Scholar 

  5. Sayal K (2006) Annotation: pathways to care for children with mental health problems. J Child Psychol Psychiatry 47(7):649–659

    Article  PubMed  Google Scholar 

  6. Nussbaum NL (2012) ADHD and female specific concerns: a review of the literature and clinical implications. J Atten Disord 16(2):87–100

    Article  PubMed  Google Scholar 

  7. Getahun D, Jacobsen SJ, Fassett MJ, Chen W, Demissie K, Rhoads GG (2013) Recent trends in childhood attention-deficit/hyperactivity disorder. JAMA Pediatr 167:282–288

    Article  PubMed  Google Scholar 

  8. Rowland AS, Skipper BJ, Umbach DM et al (2013) The prevalence of ADHD in a population-based sample. J Atten Disord 19(9):741–754

    Article  PubMed  PubMed Central  Google Scholar 

  9. Sourander A, Niemelä S, Santalahti P, Helenius H, Piha J (2008) Changes in psychiatric problems and service use among 8-year-old children: a 16-year population-based time-trend study. J Am Acad Child Adolesc Psychiatry 47(3):317–327

    Article  PubMed  Google Scholar 

  10. Willcutt EG (2012) The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics 9(3):490–499

    Article  PubMed  PubMed Central  Google Scholar 

  11. Larson K, Russ SA, Kahn RS, Halfon N (2011) Patterns of comorbidity, functioning, and service use for US children with ADHD, 2007. Pediatrics 127(3):462–470

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kessler RC, Adler L, Barkley R et al (2006) The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry 163:716–723

    Article  PubMed  PubMed Central  Google Scholar 

  13. Faber A, Kalverdijk LJ, de Jong-van den Berg LT, Hugtenburg JG, Minderaa RB, Tobi H (2010) Co-morbidity and patterns of care in stimulant-treated children with ADHD in the Netherlands. Eur Child Adolesc Psychiatry 19(2):159–166

    Article  PubMed  Google Scholar 

  14. Fredriksen M, Dahl AA, Martinsen EW, Klungsoyr O, Faraone SV, Peleikis DE (2014) Childhood and persistent ADHD symptoms associated with educational failure and long-term occupational disability in adult ADHD. Atten Defic Hyperact Disord 6(2):87–99

    Article  PubMed  PubMed Central  Google Scholar 

  15. Larson K, Russ SA, Kahn RS, Halfon N (2011) Patterns of comorbidity, functioning, and service use for US children with ADHD, 2007. Pediatrics 127(3):462–470

    Article  PubMed  PubMed Central  Google Scholar 

  16. Smalley SL, McGough JJ, Moilanen IK et al (2007) Prevalence and psychiatric comorbidity of attention-deficit/hyperactivity disorder in an adolescent Finnish population. J Am Acad Child Adolesc Psychiatry 46(12):1575–1583

    Article  PubMed  Google Scholar 

  17. Almqvist F, Puura K, Kumpulainen K et al (1999) Psychiatric disorders in 8–9-year-old children based on a diagnostic interview with the parents. Eur Child Adolesc Psychiatry 8(Suppl 4):17–28

    Article  PubMed  Google Scholar 

  18. Vuorenkoski L (2008) Finland Health System review. European Observatory on Health Systems and Policies. Health Syst Transit 10:1–34

    Google Scholar 

  19. Lindblad F, Hjern A (2010) ADHD after fetal exposure to maternal smoking. Nicotine Tob Res 12(4):408–415

    Article  PubMed  Google Scholar 

  20. Li J, Olsen J, Vestergaard M, Obel C (2011) Low Apgar scores and risk of childhood attention deficit hyperactivity disorder. J Pediatr 158(5):775–779

    Article  PubMed  Google Scholar 

  21. Lundström S, Forsman M, Larsson H et al (2014) Childhood neurodevelopmental disorders and violent criminality: a sibling control study. J Autism Dev Disord 44(11):2707–2716

    Article  PubMed  Google Scholar 

  22. Larsson H, Rydén E, Boman M, Långström N, Lichtenstein P, Landén M (2013) Risk of bipolar disorder and schizophrenia in relatives of people with attention-deficit hyperactivity disorder. Br J Psychiatry 203(2):103–106

    Article  PubMed  PubMed Central  Google Scholar 

  23. Pihlajamaa J, Suvisaari J, Henriksson M et al (2008) The validity of schizophrenia diagnosis in the Finnish Hospital Discharge Register: findings from a 10-year birth cohort sample. Nord J Psychiatry 62(3):198–203

    Article  PubMed  Google Scholar 

  24. Lampi KM, Sourander A, Gissler M et al (2008) Brief report: validity of Finnish registry-based diagnoses of autism with the ADI-R. Acta Paediatr 99(9):1425–1428

    Article  Google Scholar 

  25. Leivonen S, Voutilainen A, Hinkka-Yli-Salomäki S et al (2014) A nationwide register study of the characteristics, incidence and validity of diagnosed Tourette syndrome and other tic disorders. Acta Paediatr 103(9):984–990

    Article  PubMed  Google Scholar 

  26. Lampi KM, Banerjee PN, Gissler M et al (2011) Finnish prenatal study of autism and autism spectrum disorders (FIPS-A): overview and design. J Autism Dev Disord 41(8):1090–1096

    Article  PubMed  Google Scholar 

  27. Chudal R, Sucksdorff D, Suominen A et al (2014) Finnish prenatal study of bipolar disorders (FIPS-B): overview, design and description of the sample. Nord J Psychiatry 68(3):169–179

    Article  PubMed  Google Scholar 

  28. Gissler M, Meriläinen J, Vuori E, Hemminki E (2003) Register based monitoring shows decreasing socioeconomic differences in Finnish perinatal health. J Epidemiol Community Health 57(6):433–439

    Article  PubMed  PubMed Central  Google Scholar 

  29. Goodman R, Ford T, Richards H, Gatward R, Meltzer H (2000) The development and well-being assessment: description and initial validation of an integrated assessment of child and adolescent psychopathology. J Child Psychol Psychiatry 41(5):645–655

    Article  PubMed  Google Scholar 

  30. Posserud MB, Ullebø AK, Plessen KJ, Stormark KM, Gillberg C, Lundervold AJ (2013) Influence of assessment instrument on ADHD diagnosis. Eur Child Adolesc Psychiatry

  31. Gyllenberg D, Gissler M, Malm H et al (2014) Specialized service use for psychiatric and neurodevelopmental disorders by age 14 in Finland. Psychiatr Serv 65(3):367–373

    Article  PubMed  PubMed Central  Google Scholar 

  32. Surén P, Bakken IJ, Aase H et al (2012) Autism spectrum disorder, ADHD, epilepsy, and cerebral palsy in Norwegian children. Pediatrics 130(1):e152–e158

    Article  PubMed  PubMed Central  Google Scholar 

  33. Bianchini R, Postorino V, Grasso R et al (2013) Prevalence of ADHD in a sample of Italian students: a population-based study. Res Dev Disabil 34(9):2543–2550

    Article  PubMed  Google Scholar 

  34. Yoshimasu K, Barbaresi WJ, Colligan RC et al (2012) Childhood ADHD is strongly associated with a broad range of psychiatric disorders during adolescence: a population-based birth cohort study. J Child Psychol Psychiatry 53(10):1036–1043

    Article  PubMed  PubMed Central  Google Scholar 

  35. Gershon J (2002) A meta-analytic review of gender differences in ADHD. J Atten Disord 5(3):143–154

    Article  PubMed  Google Scholar 

  36. Efron D, Sciberras E, Anderson V et al (2014) Functional status in children with ADHD at age 6–8: a controlled community study. Pediatrics 134(4):e992–e1000

    Article  PubMed  Google Scholar 

  37. Ohan JL, Visser TA (2009) Why is there a gender gap in children presenting for attention deficit/hyperactivity disorder services? J Clin Child Adolesc Psychol 38(5):650–660

    Article  PubMed  Google Scholar 

  38. Atladóttir HO, Gyllenberg D, Langridge A et al (2014) The increasing prevalence of reported diagnoses of childhood psychiatric disorders: a descriptive multinational comparison. Eur Child Adolesc Psychiatry

  39. Hjern A, Weitoft GR, Lindblad F (2010) Social adversity predicts ADHD-medication in school children—a national cohort study. Acta Paediatr 99(6):920–924

    Article  PubMed  Google Scholar 

  40. Russell G, Ford T, Rosenberg R, Kelly S (2014) The association of attention deficit hyperactivity disorder with socioeconomic disadvantage: alternative explanations and evidence. J Child Psychol Psychiatry 55(5):436–445

    Article  PubMed  Google Scholar 

  41. DuPaul GJ, Gormley MJ, Laracy SD (2013) Comorbidity of LD and ADHD: implications of DSM-5 for assessment and treatment. J Learn Disabil 46(1):43–51

    Article  PubMed  Google Scholar 

  42. Helland WA, Posserud MB, Helland T, Heimann M, Lundervold AJ (2012). Language impairments in children with ADHD and in children with reading disorder. J Atten Disord

  43. Gurevitz M, Geva R, Varon M, Leitner Y (2014) Early markers in infants and toddlers for development of ADHD. J Atten Disord 18(1):14–22

    Article  PubMed  Google Scholar 

  44. Hazell P (1997) The overlap of attention deficit hyperactivity disorder with other common mental disorders. J Paediatr Child Health 33(2):131–137

    Article  PubMed  Google Scholar 

  45. Taanila A, Ebeling H, Tiihala M et al (2014) Association between childhood specific learning difficulties and school performance in adolescents with and without ADHD symptoms: a 16-year follow-up. J Atten Disord 18(1):61–72

    Article  PubMed  Google Scholar 

  46. Biederman J (2005) Attention-deficit/hyperactivity disorder: a selective overview. Biol Psychiatry 57(11):1215–1220

    Article  PubMed  Google Scholar 

  47. Jensen CM, Steinhausen HC (2015) Comorbid mental disorders in children and adolescents with attention-deficit/hyperactivity disorder in a large nationwide study. Atten Defic Hyperact Disord 7(1):27–38

    Article  PubMed  Google Scholar 

  48. Tai YM, Chiu HW (2009) Comorbidity study of ADHD: applying association rule mining (ARM) to National Health Insurance Database of Taiwan. Int J Med Inform 78(12):e75–e83

    Article  PubMed  Google Scholar 

  49. Matson JL, Rieske RD, Williams LW (2013) The relationship between autism spectrum disorders and attention-deficit/hyperactivity disorder: an overview. Res Dev Disabil 34(9):2475–2484

    Article  PubMed  Google Scholar 

  50. Dalsgaard S (2013) Attention-deficit/hyperactivity disorder (ADHD). Eur Child Adolesc Psychiatry 22 Suppl 1:S43–S48

    Article  PubMed  Google Scholar 

  51. Todd RD, Huang H, Henderson CA (2008) Poor utility of the age of onset criterion for DSM-IV attention deficit/hyperactivity disorder: recommendations for DSM-V and ICD-11. J Child Psychol Psychiatry 49(9):942–949

    Article  PubMed  Google Scholar 

  52. Savio K, Pietra GLD, Oddone E, Reggiani M, Leone MA (2013) Reliability of the modified Rankin Scale applied by telephone. Neurol Int 2013(5):6–7

    Google Scholar 

Download references

Acknowledgments

The study was supported by grants from Jane and Aatos Erkko Foundation and Finnish Academy. Petteri Joelsson and Roshan Chudal received research funding from the University of Turku Graduate School (UTUGS). David Gyllenberg has received research Grants from the Sigrid Juselius Foundation, the Foundation for Pediatric Research in Finland and the Finnish Medical Foundation. The study was conducted at University of Turku, Finland.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Petteri Joelsson.

Ethics declarations

Conflict of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Joelsson, P., Chudal, R., Gyllenberg, D. et al. Demographic Characteristics and Psychiatric Comorbidity of Children and Adolescents Diagnosed with ADHD in Specialized Healthcare. Child Psychiatry Hum Dev 47, 574–582 (2016). https://doi.org/10.1007/s10578-015-0591-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10578-015-0591-6

Keywords

Navigation