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Italian Journal of Pediatrics
Published in: Italian Journal of Pediatrics 1/2018

Open Access 01-12-2018 | Research

ADHD prevalence estimates in Italian children and adolescents: a methodological issue

Authors: Laura Reale, Maurizio Bonati

Published in: Italian Journal of Pediatrics | Issue 1/2018

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Abstract

Background

Attention deficit hyperactivity disorder (ADHD) is recognized as the most common, and most studied, developmental age disorder. Basic information, such as the most appropriate case definition and the best way to evaluate the disorder’s prevalence rate, however, remains an open issue.

Methods

A comprehensive meta-analysis on the epidemiology of ADHD in Italy, which was lacking from the literature, was therefore performed to attempt to estimate the actual prevalence rate of ADHD, highlighting conceptual and quantitative differences between clinical-diagnosis and survey-based symptoms studies. The Medline, Embase, and PsycINFO databases, and the grey literature, were searched up to January 2018. The review was laid out in three main sections: an overall prevalence estimate, an epidemiological profile of ADHD symptoms, and an attempt to define the actual rate of ADHD diagnosis, as emerged from Italian studies.

Results

A total of 15 unique studies were included. These contributed to estimating the prevalence of ADHD in 67,838 subjects aged 5–17, representing 9 of the 20 regions (45%) of Italy. Overall, the pooled prevalence of ADHD was 2.9% (range: 1.1–16.7%). When distinguishing studies based on case definition, however, we found an average prevalence estimate, based on symptoms criteria, of 5.9% (range: 1.4 to 16.7%) and a best-estimate prevalence rate of 1.4% (range: 1.1 to 3.1%).

Conclusions

Following the case definition for epidemiological studies of ADHD, counting only subjects with an ADHD diagnosis performed and confirmed by clinical assessment would reduce the wide variability in prevalence estimates, and, above all, would both describe the real rate of subjects suffering from ADHD disorder and avoid misdiagnosis.
Literature
1.
Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic Research: Principles and Quantitiative Methods. Belmont CA: Lifetime Learning Publications; 1982.
2.
3.
Wakefield JC. DSM-5, psychiatric epidemiology and the false positives problem. Epidemiol Psychiatr Sci. 2015;24(3):188–96.CrossRefPubMed
4.
Thornicroft G, Mehta N, Clement S, Evans-Lacko S, Doherty M, Rose D, et al. Evidence for effective interventions to reduce mental-health-related stigma and discrimination. Lancet. 2016;387(10023):1123–32.CrossRefPubMed
5.
6.
Swanson JM, Sergeant JA, Taylor E, Sonuga-Barke EJ, Jensen PS, Cantwell DP. Attention-deficit hyperactivity disorder and hyperkinetic disorder. Lancet. 1998;351(9100):429–33.CrossRefPubMed
7.
Thomas R, Mitchell GK, Batstra L. Attention-deficit/hyperactivity disorder: are we helping or harming? Br Med J. 2013;347:f6172.CrossRef
8.
Polanczyk G, Jensen P. Epidemiologic considerations in attention deficit hyperactivity disorder: a review and update. Child Adolesc Psychiatr Clin N Am. 2008;17(2):245–60.CrossRefPubMed
9.
10.
Polanczyk GV, Willcutt EG, Salum GA, Kieling C, Rohde LA. ADHD prevalence estimates across three decades: an updated systematic review and meta-regression analysis. Int J Epidemiol. 2014;43(2):434–42.CrossRefPubMedPubMedCentral
11.
Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA. Annual research review: a meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry. 2015;56(3):345–65.CrossRefPubMed
12.
Thomas R, Sanders S, Doust J, Beller E, Glasziou P. Prevalence of attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Pediatrics. 2015;135:e994–e1001.CrossRefPubMed
13.
Kieling C, Baker-Henningham H, Belfer M, Conti G, Ertem I, Omigbodun O, et al. Child and adolescent mental health worldwide: evidence for action. Lancet. 2011;378:1515–25.CrossRefPubMed
14.
Warkefield JC. Misdiagnosis normality: psychiatry’s failure to address the problem of false positive diagnoses of mental disorder in a changing professional environment. J Ment Health. 2010;19:337–51.CrossRef
15.
Singh I, Wessely S. Childhood: a suitable case for treatment? Lancet Psychiatry. 2015;2(7):661–6.CrossRefPubMed
16.
Mc Cartky M. Most ADHD diagnoses made in US children seem to follow guidelines. Br Med J. 2015;351:h4946.
17.
Rowland AS, Lesesne CA, Abramowitz AJ. The epidemiology of attention-deficit/hyperactivity disorder (ADHD): a public health view. Ment Retard Dev Disabil Res Rev. 2002;8(3):162–70.CrossRefPubMed
18.
Timimi S, Taylor E. ADHD is best understood as a cultural construct. Br J Psychiatry. 2004;184:8–9.CrossRefPubMed
19.
Narad ME, Garner AA, Peugh JL, Tamm L, Antonini TN, Kingery KM, et al. Parent-teacher agreement on ADHD symptoms across development. Psychol Assess. 2015;27:239–48.CrossRefPubMed
20.
Bonati M, Reale L. Reducing overdiagnosis and disease mongering in ADHD in Lombardy. Br Med J. 2013;16:347.
21.
22.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-IV). Washington, DC: American Psychiatric Association; 1994.
23.
Hoy D, Brooks P, Woolf A, Blyth F, March L, Bain C, et al. Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement. J Clin Epidemiol. 2012;65(9):934–9.CrossRefPubMed
24.
Higgins JPT, Thompson SG. Controlling the risk of spurious findings from meta-regression. Stat Med. 2004;23:1663–82.CrossRefPubMed
25.
Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Softw. 2010;36:1–48.CrossRef
26.
O'Leary KD, Vivian D, Nisi A. Hyperactivity in Italy. J Abnorm Child Psychol. 1985;13(4):485–500.CrossRefPubMed
27.
Gallucci F, Bird HR, Berardi C, Gallai V, Pfanner P, Weinberg A. Symptoms of attention-deficit hyperactivity disorder in an Italian school sample: findings of a pilot study. J Am Acad Child Adolesc Psychiatry. 1993;32(5):1051–8.CrossRefPubMed
28.
Camerini GB, Coccia M, Caffo E. Il disturbo da deficit dell'attenzione iperattività: analisi della frequenza in una popolazione scolastica attraverso questionari agli insegnanti. Psichiatria Dell'Infanzia e Dell'Adolescenza. 1996;63:587–94.
29.
Marzocchi GM, Cornoldi C. Una Scala di Facile uso per la Rilevazione dei Comportamenti Problematici dei Bambini con Deficit di Attenzione e Iperattività. Psicol Clin Svilupp. 2000;4:43–63.
30.
Corbo S, Marolla F, Sarno V, Torrioli MG, Vernacotola S. Prevalenza dell'ADHD in bambini seguiti dal Pediatra di Famiglia. Medico e Bambino. 2003;1:22–5.
31.
Ciotti F. La sindrome ipercinetica “pura” fra gli alunni nel territorio cesenate. Quaderni ACP. 2003;4:18–20.
32.
Madeddu F, Dazzi S, Prunas A, Barzaghi A, Ripamonti C, Schadee H. Prevalenza del Disturbo da Deficit dell’Attenzione/Iperattività in un ampio campione di preadolescenti italiani. Minerva Psichiatr. 2006;47(3):209–20.
33.
Mugnaini D, Masi G, Brovedani P, Chelazzi C, Matas M, Romagnoli C, et al. Teacher reports of ADHD symptoms in Italian children at the end of first grade. Eur Psychiatry. 2006;21(6):419–26.CrossRefPubMed
34.
Zuddas A, Marzocchi GM, Oosterlaan J, Cavolina P, Ancilletta B, Sergeant J. Factor structure and cultural aspects of disruptive behaviour disorders symptoms in Italian children. Eur Psychiatry. 2006;21:410–8.CrossRefPubMed
35.
Faravelli C, Lo Sauro C, Castellini G, Ricca V, Pallanti S. Prevalence and correlates of mental disorders in a school-survey sample. Clin Pract Epidemiol Ment Health. 2009;5:1–8.CrossRefPubMedPubMedCentral
36.
37.
Bianchini R, Postorino V, Grasso R, Santoro B, Migliore S, Burlò C, Tata C, Mazzone L. Prevalence of ADHD in a sample of Italian students: a population-based study. Res Dev Disabil. 2013;34(9):2543–50.CrossRefPubMed
38.
Gritti A, Bravaccio C, Signoriello S, Salerno F, Pisano S, Catone G, et al. Epidemiological study on behavioural and emotional problems in developmental age: prevalence in a sample of Italian children, based on parent and teacher reports. Ital J Pediatr. 2014;40:19.CrossRefPubMedPubMedCentral
39.
Donfrancesco R, Marano A, Calderoni D, Mugnaini D, Thomas F, Di Trani M, et al. Prevalence of severe ADHD: an epidemiological study in the Italian regions of Tuscany and Latium. Epidemiol Psychiatr Sci. 2015;24(6):525–33.CrossRefPubMed
40.
Zucchetti G, Ortega E, Scholte RHJ, Rabaglietti E. The mediating role of aggressive behaviour, emotional and Behavioural instability on the association between ADHD symptoms and best friend conflicts. Curr Psychol. 2015;34:97–111.CrossRef
41.
Siontis KC, Hernandez-Boussard T, Ioannidis JP. Overlapping meta-analyses on the same topic: survey of published studies. Br Med J. 2013;347:f4501.CrossRef
42.
Conrad P, Bergey MR. The impending globalization of ADHD: notes on the expansion and growth of a medicalized disorder. Soc Sci Med. 2014;122:31–43.CrossRefPubMed
43.
Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA. The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry. 2007;164:942–8.CrossRefPubMed
44.
Goldman LS, Genel M, Bezman RJ, Slanetz PJ. Diagnosis and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Council on Scientific Affairs, American Medical Association. JAMA. 1998;279(14):1100–7.CrossRefPubMed
45.
Elia J, Ambrosini PJ, Rapoport JL. Treatment of attention-deficit-hyperactivity disorder. N Engl J Med. 1999;340(10):780–8.CrossRefPubMed
46.
Brown RT, Freeman WS, Perrin JM, Stein MT, Amler RW, Feldman HM, et al. Prevalence and assessment of attention-deficit/hyperactivity disorder in primary care settings. Pediatrics. 2001;107(3):E43.CrossRefPubMed
47.
Faraone SV, Sergeant J, Gillberg C, Biederman J. The worldwide prevalence of ADHD: is it an American condition? World Psychiatry. 2003;2(2):104–13.PubMedPubMedCentral
48.
Erskine HE, Ferrari AJ, Polanczyk GV, Moffitt TE, Murray CJ, Vos T, et al. The global burden of conduct disorder and attention-deficit/hyperactivity disorder in 2010. J Child Psychol Psychiatry. 2014;55(4):328–36.CrossRefPubMed
49.
Skounti M, Philalithis A, Galanakis E. Variations in prevalence of attention deficit hyperactivity disorder worldwide. Eur J Pediatr. 2007;166(2):117–23.CrossRefPubMed
50.
McKeown RE, Holbrook JR, Danielson ML, Cuffe SP, Wolraich ML, Visser SN. The impact of case definition on attention-deficit/hyperactivity disorder prevalence estimates in community-based samples of school-aged children. J Am Acad Child Adolesc Psychiatry. 2015;54(1):53–61.CrossRefPubMed
51.
Rohde LA, Szobot C, Polanczyk G, Schmitz M, Martins S, Tramontina S. Attention-deficit/hyperactivity disorder in a diverse culture: do research and clinical findings support the notion of a cultural construct for the disorder? Biol Psychiatry. 2005;57(11):1436–41.CrossRefPubMed
52.
Gaynes BN, Christian R, Saavedra LM, Wines R, Jonas DE, Viswanathan M, et al. Attention-deficit/hyperactivity disorder: identifying high priority future research needs. J Psychiatr Pract. 2014;20(2):104–17.CrossRefPubMed
53.
Mental Health Foundation. Better Mental Health for All: A Public Health Approach to Mental Health Improvement. London: Faculty of Public Health and Mental Health Foundation. https://​www.​mentalhealth.​org.​uk/​publications/​better-mental-health-all-public-health-approach-mental-health-improvement; 2016. Accessed 3 Aug 2018.
Metadata
Title
ADHD prevalence estimates in Italian children and adolescents: a methodological issue
Authors
Laura Reale
Maurizio Bonati
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Italian Journal of Pediatrics / Issue 1/2018
Electronic ISSN: 1824-7288
DOI
https://doi.org/10.1186/s13052-018-0545-2

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