Study suggests ADHD diagnosis in childhood hasn't improved quality of life for teens

The researchers call for a cautious approach to diagnosis by clinicians, particularly for children with mild or borderline hyperactive and inattentive behaviours.

Researchers from the University of Sydney and Bond University said they are pleased public discussion and new guidelines are creating increased dialogue around ADHD, but felt more research was needed to inform a robust evidence base around diagnosis.

“It’s important to note that this study isn’t examining the effectiveness of specific interventions, it’s looking at diagnosis in relation to quality of life,” said Professor Alexandra Barratt, senior author and Professor of Public Health at the University of Sydney.

“This means we can’t determine what support children received, but what it does show is that those who were diagnosed in childhood reported worse measures on the sense of belonging at school, confidence in their academic abilities and self-efficacy as well as more negative social behaviours compared to those with similar symptoms who had not been diagnosed. They were also more than twice as likely to self-harm.”

The study, which followed up 746 children from ages 6-7 to 14-15 from 2006 to 2018, is published in JAMA Open Network today.

While the researchers did not examine why the adolescents self-reported in this way, they suggest possible harms associated with the diagnosis such as stigma, prejudice, deflection from other problems or the perceived inability to change may have offset benefits from diagnosis or subsequent interventions.

Interestingly, regardless of whether they had an ADHD diagnosis or not, girls and children with the highest levels of hyperactive and inattentive behaviours generally had poorer outcomes.

• To investigate if an ADHD diagnosis is associated with quality of life the team used data from the Longitudinal Study of Australian Children to directly compare 393 Australian teens with an ADHD diagnosis with 393 teens without ADHD diagnosis but with matched hyperactive and inattentive behaviours .
• The study followed the children from diagnosis until they were teenagers and self-reported their perceptions at age 14 or 15.
• The researchers found similar quality of life overall, health, happiness and peer trust.
• However, those with an ADHD diagnosis reported worse sense of school membership, academic self-concept, and self-efficacy, more negative social behaviours and were twice as likely to self-harm.

The researchers suggest that as the study shows youths could potentially be harmed by diagnosis, and interventions to support them may not yet be achieving the desired effects, a cautious clinical approach to ADHD diagnosis in children and adolescents is recommended.

“I think most parties agree that providing support to those who need it is important. Unfortunately, in some instances accessing support is contingent on a diagnosis. This is our point of difference,” said co-author and psychologist Associate Professor Rae Thomas from Bond University.     

“This research suggests that for some children, a diagnostic label of ADHD may be harmful. This might be particularly true for children with mild, but still challenging behaviours. Support should be available to all who need it, with graduated intensity based on need but not necessarily on a diagnosis.”

In particular, the researchers call for increased and targeted support – within and beyond the medical system -  for girls, and for children with high levels of hyperactive and inattentive behaviours, whether they are diagnosed or not.

Declaration: This study was funded by a National Health and Medical Research Council program grant and CRE grant. Dr Bell received funding from an NHMRC Investigator grant. No conflicts of interest are reported.