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 are creating increased dialogue around ADHD, but felt more research was needed to inform a robust evidence base around diagnosis.
鈥淚t鈥檚 important to note that this study isn鈥檛 examining the effectiveness of specific interventions, it鈥檚 looking at diagnosis in relation to quality of life,鈥 said Professor Alexandra Barratt, senior author and Professor of Public Health at the University of Sydney.
鈥淭his means we can鈥檛 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.鈥
The study, which followed up 746 children from ages 6-7 to 14-15 from 2006 to 2018, is published in 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.
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.
鈥淚 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,鈥 said co-author and psychologist Associate Professor Rae Thomas from Bond University.聽聽聽 聽
鈥淭his 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.鈥
In particular, the researchers call for increased and targeted support 鈥 within and beyond the medical system - 聽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.