Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder: diagnostic coincidence analysis between Health Centers and Child and Adolescent Mental Health units
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Revista de Psiquiatría Infanto-Juvenil
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
DOI:
https://doi.org/10.31766/revpsij.v41n3a3Keywords:
Primary Care Physicians, pediatrics, child psychiatry, Attention Deficit Disorder with Hyperactivity, Autism Spectrum DisorderAbstract
Introduction: Due to the very high prevalence of mental pathology in early life (up to 20%), correct diagnosis and immediate treatment in early life is a global health priority. Objective: The aim of this study was to evaluate the degree of validity of the diagnoses of ADHD and ASD made in Primary Health Care Services (PHCS), comparing them with definitive diagnoses issued in the Child and Adolescent Mental Health Units (CAMHU). Methodology: 183 patients were included in this study, being referred from Primary Health Care (PHC) to Vecindario’s CAMHU, in Gran Canaria, Spain. Evaluation was retrospective and included the following variables: age, sex, perinatal history, adopted minor, family psychiatric history, referring physician's diagnosis of suspicion, definitive diagnosis in the CAMHU, subsequent follow-up and psychopharmacological treatment. To analyze the degree of quality of the referrals, we calculated the percentage of cases that matched the suspected diagnosis of the referring physicians (pediatricians or general practitioners (GP)) and the definitive confirmation diagnosis (issued by the child and adolescent psychiatrist). Results: 75.4% of the sample were males, with a mean age of 8.22 years, 7.7% had a perinatal history, and 17.5% had a family psychiatric history. 65.6% of them were referred with a suspected diagnosis of ADHD, 62.7% were confirmed and 26.27% were rejected. 31.7% were referred to the CAMHU with a suspected diagnosis of ASD. This entity was confirmed in 75.8% and rejected in 10.3%; 5.1% of them were finally diagnosed with ADHD. Only 2.7% were referred for a combined suspicion of ADHD and ASD, but 9.8% of children were finally diagnosed with both diagnoses (ADHD and ASD) concomitantly. Conclusion: The validity of the diagnostic suspicions made in the PHCS was very high: 62.7% for ADHD and 75.8% for ASD; obtaining notably higher percentages than in previous studies.
Downloads
References
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. https://doi.org/10.1111/jcpp.12381 DOI: https://doi.org/10.1111/jcpp.12381
Patel V, Flisher AJ, Hetrik S, McGorry P. Mental health of young people: a global public-health challenge. Lancet. 2007;369(9569): 1302-13. https://doi.org/10.1016/S0140-6736(07)60368-7 DOI: https://doi.org/10.1016/S0140-6736(07)60368-7
United Nation Children’s Fund. The state of the World’s children 2021: On my mind - promoting, protecting and caring for children’s mental health. New York: UNICEF; 2021.
Solmi M, Radua J, Olivola M, Croce E, Soardo L, Salazar de Pablo G, et al. Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Mol Psychiatry. 2022;27(1): 281-95. https://doi.org/10.1038/s41380-021-01161-7 DOI: https://doi.org/10.1038/s41380-021-01161-7
Klasen H, Crombag AC. What works where? A systematic review of child and adolescent mental health interventions for low and middle income countries. Soc Psychiatry Psychiatr Epidemiol. 2013;48(4): 595-611. https://doi.org/10.1007/s00127-012-0566-x DOI: https://doi.org/10.1007/s00127-012-0566-x
Froehlich TE, Lanphear BP, Epstein JN, Barbaresi WJ, Katusic SK, Kahn RS. Prevalence, recognition, and treatment of Attention-Deficit/Hyperactivity Disorder in a National sample of US children. Arch Pediatr Adolesc Med. 2007;161(9): 857-64. https://doi.org/10.1001/archpedi.161.9.857 DOI: https://doi.org/10.1001/archpedi.161.9.857
Canals J, Morales P, Roigé J, Voltas N, Herrnández C. Prevalence and Epidemiological Characteristics of ADHD in Pre-School and School Age Children in the Province of Tarragona, Spain. J Atten Disord. 2021;25(13): 1818-33. https://doi.org/10.1177/1087054720938866 DOI: https://doi.org/10.1177/1087054720938866
Kian N, Samieefar N, Rezaei N. Prenatal risk factors and genetic causes of ADHD in children. World J Pediatr. 2022;18(5): 308-19. https://doi.org/10.1007/s12519-022-00524-6 DOI: https://doi.org/10.1007/s12519-022-00524-6
Thapar A, Cooper M, Eyre O, Langley K. Practitioner review: what have we learnt about the causes of ADHD? J Child Psychol Psychiatry. 2013;54(1): 3-16. https://doi.org/10.1111/j.1469-7610.2012.02611.x DOI: https://doi.org/10.1111/j.1469-7610.2012.02611.x
Fernández D, Fernández AL, López S, Pelaz A, Fernández A. Trastorno por déficit de atención/hiperactividad y adopción. Rev Neurol. 2015;60(Supl 1): S103-7. https://doi.org/10.33588/rn.60S01.2014563 DOI: https://doi.org/10.33588/rn.60S01.2014563
Wing L, Potter D. The epidemiology of autistic spectrum disorders: is the prevalence rising? Mental Retardation Developmental Disabilities. Rese Rev. 2002;8(3): 151-61. https://doi.org/10.1002/mrdd.10029 DOI: https://doi.org/10.1002/mrdd.10029
Zeidan J, Fombonne E, Scorah J, Ibrahim A, Durkin MS, Saxena S, et al. Global prevalence of autism: A systematic review update. Autism Res. 2022;15(5): 778-90. https://doi.org/10.1002/aur.2696 DOI: https://doi.org/10.1002/aur.2696
Forbonne E. The epidemiology of child and adolescent psychiatry disorders: Recent developements and issues. Epidemiologia e Psychiatria Sociale. 1998;7(3): 161-6. https://doi.org/10.1017/s1121189x0000734x DOI: https://doi.org/10.1017/S1121189X0000734X
Alcantud, F, Alonso Y, Mata S. Prevalencia de los Trastornos del Espectro Autista: Revisión de datos. Siglo Cero. 2017;47(4): 7-26. https://doi.org/10.14201/scero2016474726 DOI: https://doi.org/10.14201/scero2016474726
Iles A. Autism Spectrum Disorders. Prim Care. 2021;48(3): 461-73. https://doi.org/10.1016/j.pop.2021.04.003 DOI: https://doi.org/10.1016/j.pop.2021.04.003
Mardomingo M, Parra E. Factores pre y perinatales en el autismo infantil precoz. Rev Española Neurología. 1991;6: 551-4.
Espinosa E, Mera P, Toledo D. Trastorno del espectro autista: caracterización clínica en pacientes de dos centros de referencia en Bogotá, Colombia. Rev Fac Med. 2018;26(1): 34-44. https://doi.org/10.18359/rmed.3990 DOI: https://doi.org/10.18359/rmed.3990
O'Roak BJ, State MW. Autism genetics: strategies, challenges, and opportunities. Autism Res. 2008;1(1): 4-17. https://doi.org/10.1002/aur.3 DOI: https://doi.org/10.1002/aur.3
Piven J, Palmer P, Landa R, Santangelo S, Jacobi D, Childress D. Personality and language characteristics in parents from multiple-incidence autism families. Am J Med Genet. 1997;74(4): 398-411. https://doi.org/10.1002/(SICI)1096-8628(19970725)74:4<398::AID-AJMG11>3.0.CO;2-D DOI: https://doi.org/10.1002/(SICI)1096-8628(19970725)74:4<398::AID-AJMG11>3.0.CO;2-D
Cummings JR, Lynch FL, Rust KC, Coleman KJ, Madden JM, Owen-Smith AA, et al. Health services utilization among children with and without autism spectrum disorders. J Autism Dev Disorders. 2016;46(3): 910-20. https://doi.org/10.1007/s10803-015-2634-z
Carmenate I, Salas Y. Perfil sociodemográfico de los trastornos del espectro autista en Sancti Spíritus. REMIJ. 2020; 21(1). https://remij.sld.cu/index.php/remij/article/view/275/471
Fortea M, Escandell M, Castro J. Estimación de la prevalencia de los trastornos del espectro autista en Canarias. Anales de Pediatría. 2013;79(6): 352-9. https://doi.org/10.1016/j.anpedi.2013.04.022 DOI: https://doi.org/10.1016/j.anpedi.2013.04.022
Myer L, Stein DJ, Jackson PB, Herman AA, Seedat S, Williams DR. Impact of common mental disorders during childhood and adolescence on secondary school completion. S Afr Med J. 2009;99(52): 354-6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3203644/
Chan V. Schizophrenia and psychosis: diagnosis, current research trends, and model treatment approaches with implications for transitional age youth. Child Adolesc Psychiatr Clin N Am. 2017;26(2): 341-66. https://doi.org/10.1016/j.chc.2016.12.014 DOI: https://doi.org/10.1016/j.chc.2016.12.014
Fatori D, Salum G, Itria A, Pan P, Alvarenga P, Rohde LA, et al. The economic impact of subthreshold and clinical childhood mental disorders. J Ment Health. 2018;27(6): 588-94. https://doi.org/10.1080/09638237.2018.1466041 DOI: https://doi.org/10.1080/09638237.2018.1466041
Biblioteca Virtual en Salud. Descriptores en Ciencias de la Salud. Organización Panamericana de la Salud. Organización Mundial de la Salud. https://decs.bvsalud.org/es/ths/resource/?id=59901
World Health Organization. Mental health policy and service guidance package: Child and adolescent mental health policies and plans. Geneva: WHO; 2015.
Williams J, Klinepter K, Palmes G, Pulley A, Foy JM. Diagnosis and treatment of behavioural health disorders in pediatric practice. Pediatrics 2004;114(3): 601-6. https://doi.org/10.1542/peds.2004-0090 DOI: https://doi.org/10.1542/peds.2004-0090
Kelleher KJ, Campo JV, Gardner P. Management of pediatric mental disorders in primary care: where are we know and where are we going? Curr Opin Pediatr. 2006;18(6): 649-53. https://doi.org/10.1097/MOP.0b013e3280106a76 DOI: https://doi.org/10.1097/MOP.0b013e3280106a76
Closa H, Acosta FJ, García-Bello MA, Hernández JL. Validez diagnóstica y calidad de las derivaciones desde Atención Primaria a Unidades de Salud Mental en el Trastorno por déficit de Atención e hiperactividad. Rev Psiquiatría Infanto-Juvenil. 2011;28(3): 51-7. https://aepnya.eu/index.php/revistaaepnya/article/view/194
Landa N, Goñi A, García de Jalón E, López-Goñi JJ. Concordancia en el diagnóstico entre pediatría y salud mental. An Sst Sanit Navar. 2009;32(2): 161-8. https://doi.org/10.4321/S1137-66272009000300003 DOI: https://doi.org/10.4321/S1137-66272009000300003
Quinn PO. Treating adolescent girls and women with ADHD: gender-specific issues. J Clin Psychol. 2005;61(5): 579-87. https://doi.org /10.1002/jclp.20121 DOI: https://doi.org/10.1002/jclp.20121
Bitsko RH, Holbrook JR, O'Masta B, Maher B, Cerles A, Saadeh K, et al. Systematic Review and Meta-analysis of Prenatal, Birth, and Postnatal Factors Associated with Attention-Deficit/Hyperactivity Disorder in Children. Prev Sci. 2024 May;25(Suppl 2) :203-24. https://doi.org/10.1007/s11121-022-01359-3 DOI: https://doi.org/10.1007/s11121-022-01359-3
Rivas L, García P, Grandío B, Rozados C, Blanco MO, Martínez C. Trastorno por Déficit de Atención e Hiperactividad (TDAH) ¿Se mantiene el diagnóstico de sospecha realizado en Atención Primaria en la Unidad de Salud Mental Infanto-Juvenil? Rev Psiquiatría Infanto-Juvenil. 2017;34(1): 19-26. https://doi.org/10.31766/revpsij.v34n1a2 DOI: https://doi.org/10.31766/revpsij.v34n1a2
Cummings JR, Lynch FL, Rust KC, Coleman KJ, Madden JM, Owen-Smith AA, et al. Health services utilization among children with and without autism spectrum disorders. J Autism Dev Disorders. 2016;46(3): 910-20. https://doi.org/10.1007/s10803-015-2634-z DOI: https://doi.org/10.1007/s10803-015-2634-z
Zahner G, Pauls D. Epidemiological surveys of infantile autism. En: Cohen D, Donnellan A (eds.). Handbook of autism and pervasive developmental disorders. New York. Wiley. 1987; 199-210.
Mitroulaki S, Serdari A, Tripsianis G, Gundelfinger R, Arvaniti A, Vorvolakos T, et al. First Alarm and Time of Diagnosis in Autism Spectrum Disorders. Compr Child Adolesc Nurs. 2020;45(1): 75-91. https://doi.org/10.1080/24694193.2020.1834013 DOI: https://doi.org/10.1080/24694193.2020.1834013
Ruiz-Lázaro PM, Posada M, Hijano F. Trastornos del espectro autista. Detección precoz, herramientas de cribado. Rev Pediatr Aten Primaria. 2009;11(17): 381-97. https://doi.org/10.4321/S1139-76322009000700009 DOI: https://doi.org/10.4321/S1139-76322009000700009
Millá MG, Mulas F. Atención temprana y programas de intervención específica en el trastorno del espectro autista. Rev Neurol. 2009;48(2): 47-52. https://doi.org/10.33588/rn.48S02.2009020 DOI: https://doi.org/10.33588/rn.48S02.2009020
© 2021 AEPNyA Todos los derechos reservados
