How Do Children with ADHD Use Healthcare Services Before Diagnosis?

What you need to know

• Children with ADHD use healthcare services twice as often as other children in the two years before diagnosis.
• These children visit doctors for a wide range of physical and mental health reasons.
• More frequent healthcare visits may provide opportunities for earlier ADHD diagnosis.

Higher Healthcare Use Before ADHD Diagnosis

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental condition affecting 3-5% of children and young people. It’s characterized by persistent inattention, hyperactivity, and impulsivity that interfere with daily functioning and development. While ADHD is typically diagnosed around age 7-9, symptoms are often present earlier.

A new study published in Archives of Disease in Childhood has found that in the two years before being diagnosed, children with ADHD use healthcare services about twice as often as children without ADHD. This higher rate of healthcare use may provide opportunities for earlier identification and diagnosis of ADHD.

Study Details

Researchers analyzed medical records from over 8,000 children diagnosed with ADHD and over 40,000 matched controls without ADHD. They looked at healthcare contacts in the two years before ADHD diagnosis, including:

• General practitioner (GP) visits
• Prescriptions
• Hospital admissions
• Hospital procedures

The study found that children later diagnosed with ADHD had:

• Twice as many GP visits (8 vs 4 per year)
• 1.5 times more prescriptions
• Nearly twice as many hospital admissions and procedures

Wide Range of Healthcare Reasons

Interestingly, children who went on to be diagnosed with ADHD visited doctors for a wide variety of physical and mental health reasons, not just behavioral issues. Some key findings include:

• 25 times higher odds of GP visits for mental and behavioral issues
• 30 times higher odds of behavior-related codes in medical records
• 11 times higher odds of learning disability codes
• 10 times higher odds of hospital admissions for mental/behavioral disorders

But there were also increased visits for many physical health issues:

• 1.5 times higher odds of GP visits for eye, ear, nose, throat, and oral conditions
• 1.3 times higher odds of asthma-related visits
• 1.2 times higher odds of eczema-related visits

This suggests that children with undiagnosed ADHD may have higher healthcare needs across multiple domains of physical and mental health.

Potential for Earlier Diagnosis

The study authors note that these frequent healthcare contacts in the years before ADHD diagnosis may represent missed opportunities for earlier identification. General practitioners and other healthcare providers may be able to recognize patterns of frequent visits across various health issues as a potential sign of underlying ADHD.

Earlier diagnosis could allow for earlier intervention and support, potentially improving long-term outcomes. ADHD is associated with academic difficulties, relationship problems, injuries, and mental health issues when left unaddressed.

Sex Differences

The study found some interesting differences between boys and girls with ADHD:

• The overall ratio of boys to girls diagnosed was about 5:1
• Compared to boys, girls with ADHD had higher rates of:
  • Injuries
  • Hospital admissions for respiratory conditions
  • Prescriptions for nervous system medications
  • Recorded autism and language impairments

This aligns with other research suggesting ADHD may present differently in girls and be underdiagnosed. The authors note these sex differences warrant further research.

Age Differences

The researchers also looked at differences between younger children (ages 4-11) and older children/adolescents (ages 12-17) with ADHD:

Younger children with ADHD had higher rates of:

• GP visits for respiratory issues, injuries, and infections
• Prescriptions for nervous system and eye-related medications
• Recorded tics, abdominal pain, behavioral issues, and self-harm
• Hospital visits for injuries and external causes
• Hospital procedures related to bones and joints

This suggests the healthcare needs and presentations of ADHD may shift as children get older.

Implications for Practice

The study authors note several key implications for healthcare practice:

1. Healthcare providers should be aware that children who attend frequently for a variety of reasons may have unrecognized ADHD.

2. Integrated care systems across health, education, and social services should be alert to serving the needs of children with possible ADHD symptoms.

3. Parents and caregivers with concerns about ADHD should be encouraged to discuss these with their doctor or specialist services.

4. Care pathways should aim to be holistic, considering physical, mental health and behavioral difficulties together rather than in isolation.

Conclusions

• Children diagnosed with ADHD use healthcare services twice as often in the two years before diagnosis compared to peers without ADHD.
• These children visit doctors for a wide range of physical and mental health reasons beyond just behavioral issues.
• More frequent healthcare visits across various domains may provide opportunities for earlier ADHD identification and diagnosis.

While this study cannot prove causation, it highlights important patterns in healthcare use that may help improve timely diagnosis and support for children with ADHD. Further research is needed to develop and test interventions for earlier identification in primary care settings.