Study: ADHD Symptoms in Children Missed by Clinicians for Up to Two Years

January 24, 2024

ADHD symptoms in children and adolescents are routinely overlooked by general practitioners (GPs), who see these patients more often than they do their neurotypical peers in the two years preceding a diagnosis, according to the journal Archives of Disease in Childhood. With better training in ADHD, GPs could recognize these frequent visits — for everything from asthma and eczema to behavioral disorders — as possible indicators of ADHD and opportunities for early evaluation, say the researchers behind the study. ¹

The study found that children ultimately diagnosed with ADHD seek medical care, consult healthcare providers, undergo surgery, and get admitted to hospitals at double the rate of their neurotypical peers in the years preceding diagnosis. They also show increased rates of physical conditions, such as asthma and eczema; behavioral and mental health issues; learning differences, such as dyspraxia and dyslexia; autism; tics; and insomnia before receiving an ADHD diagnosis.

The research team from the University of Nottingham and King’s College London reported that reasons for delays in ADHD diagnosis referrals stemmed from GPs’ difficulty recognizing ADHD symptoms in children and a lack of specific recommendations for earlier ADHD detection in current guidelines from organizations such as the National Institute for Health and Care Excellence and the American Academy of Pediatrics. ²,³,⁴

William W. Dodson, M.D., LF-APA, clinician, writer, speaker, and consultant on ADHD medicine, says the lack of training hinders pediatricians and nurse practitioners as well as psychiatrists. “Around 93% of adult psychiatrists, when asked, report that they’ve never had any ADHD training, either in their residency or in their continuing medical education, whether in children, adolescents, or adults,” he says.

Inadequate training in early signs of ADHD may cause GPs to miss opportunities to identify and evaluate ADHD symptoms in children. “The peak age for diagnosis of ADHD is at 7 to 9 years,” the study’s authors wrote. “Yet, it is likely to have been present from an earlier age, with persistent symptoms.”

Untreated ADHD is associated with poor relationships and social functioning, low self-esteem, academic under-attainment, and injuries. In addition, children with ADHD may incur greater healthcare costs before their diagnosis.⁵

“The study underscores the importance of conducting additional research to identify children with ADHD at an earlier stage, thereby enabling them to receive more timely and effective treatments, including therapeutic interventions and medications,” the study’s authors wrote.

The clinical practice guidelines for ADHD, developed by the American Academy of Child and Adolescent Psychiatry (AACAP), recommend medication as the first-line treatment for ADHD in school-age children, citing a formal review of 78 studies on the treatment of ADHD, which “consistently supported the superiority of stimulant over the non-drug treatment.” (Footnote 5) According to the American Academy of Pediatrics (AAP), 80% of the children who use stimulant medications, either alone or combined with behavior therapy, increase focus and decrease impulsivity.⁶,⁷

“Treatment with ADHD stimulant medication prior to age 9 may actually decrease your child’s likelihood of abusing drugs and alcohol later in life, according to research,” says Timothy Wilens, M.D., an associate professor of psychiatry at Harvard Medical School. “Considerable evidence also suggests that children taking ADHD medication commonly experience improvements to academic and social functioning, which translates to improved self-esteem, lower rates of self-medication with drugs or alcohol, and decreased risk of substance abuse.”⁸

The population-based matched case-control study analyzed the medical records from 1998-2015 of 8,127 children and adolescents aged 4 to 17 years who were diagnosed with ADHD and 40,136 without ADHD from the Clinical Practice Research Datalink, a primary care database of 60 million patients in the U.K.

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