Use of healthcare services before diagnosis of attention-deficit/hyperactivity disorder: a population-based matched case-control study

Prasad, Vibhore; Rezel-Potts, Emma; White, Patrick; Downs, Johnny; Boddy, Nicholas; Sayal, Kapil; Sonuga-Barke, Edmund

Abstract

Objective: To compare use of healthcare services and reasons for attendance by children and young people (CYP) with attention-deficit/hyperactivity disorder (ADHD) versus non-ADHD controls. Design: Population-based matched case-control study. Setting: English primary care electronic health records with linked hospital records from the Clinical Practice Research Datalink, 1998-2015. Participants: 8127 CYP with an ADHD diagnosis aged 4-17 years at the time of diagnosis and 40 136 non-ADHD controls matched by age, sex and general practitioner (GP) practice. Main outcome measures: Medical diagnoses, prescriptions, hospital admissions and hospital procedures in the 2 years before diagnosis (or the index date for controls). Results: CYP with ADHD attended healthcare services twice as often as controls (rate ratios: GP: 2.0, 95% CI=2.0, 2.1; hospital 1.8, 95% CI=1.8, 1.9). CYP with ADHD attended their GP, received prescriptions and were admitted to hospital for a wide range of reasons. The strongest association for GP attendances, comparing CYP with versus without ADHD, was for 'mental and behavioural disorders' (OR=25.2, 95% CI=23.3, 27.2). Common reasons for GP attendance included eye, ear, nose, throat, oral (OR=1.5, 95% CI=1.4, 1.5) and conditions such as asthma (OR=1.3, 95% CI=1.3, 1.4) or eczema (OR=1.2, 95% CI=1.0, 1.3). Conclusions: Two years before diagnosis, CYP with ADHD attended healthcare services twice as often as CYP without. CYP with ADHD had increased rates of physical conditions, such as asthma and eczema. These contacts may be an opportunity for earlier recognition and diagnosis of ADHD.

Citation

Prasad, V., Rezel-Potts, E., White, P., Downs, J., Boddy, N., Sayal, K., & Sonuga-Barke, E. (2024). Use of healthcare services before diagnosis of attention-deficit/hyperactivity disorder: a population-based matched case-control study. Archives of Disease in Childhood, 109, Article 46-51. https://doi.org/10.1136/archdischild-2023-325637

• Journal Article Type: Article
• Acceptance Date: Sep 19, 2023
• Online Publication Date: Oct 30, 2023
• Publication Date: 2024-01
• Deposit Date: Oct 12, 2023
• Publicly Available Date: Oct 30, 2023
• Journal: Archives of Disease in Childhood
• Print ISSN: 0003-9888
• Electronic ISSN: 1468-2044
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 109
• Article Number: 46-51
• DOI: https://doi.org/10.1136/archdischild-2023-325637
• Keywords: epidemiology, adolescent health, child health, child psychiatry, primary health care
• Public URL: https://nottingham-repository.worktribe.com/output/25810021
• Publisher URL: https://adc.bmj.com/content/early/2023/10/22/archdischild-2023-325637