Associated Factors of Attention-Deficit/Hyperactivity Disorder Diagnosis and Psychostimulant Use: A Nationwide Representative Study

Marco Antônio Arruda; Renato Arruda; Vicenzo Guidetti; Marcelo Eduardo Bigal; Jesus Landeira-Fernandez; Anna C Portugal; Luis Anunciação

doi:10.1016/j.pediatrneurol.2021.11.008

Associated Factors of Attention-Deficit/Hyperactivity Disorder Diagnosis and Psychostimulant Use: A Nationwide Representative Study

Pediatr Neurol. 2022 Mar:128:45-51. doi: 10.1016/j.pediatrneurol.2021.11.008. Epub 2021 Dec 15.

Authors

Marco Antônio Arruda¹, Renato Arruda², Vicenzo Guidetti³, Marcelo Eduardo Bigal⁴, Jesus Landeira-Fernandez⁵, Anna C Portugal⁶, Luis Anunciação⁷

Affiliations

¹ Glia Institute, Department of Child Neurology, Ribeirão Preto, São Paulo, Brazil.
² Department of Neuroscience and Behavioural Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
³ Department of Child and Adolescent Neurology, Psychiatry and Rehabilitation, Sapienza University of Rome, Rome, Italy.
⁴ Ventus Therapeutics, Montreal, Québec, Canada.
⁵ Pontifical Catholic University of Rio de Janeiro, Brazil.
⁶ Federal University of Rio de Janeiro, Brazil.
⁷ Pontifical Catholic University of Rio de Janeiro, Brazil; Marques de Sao Vicente, Gavea, Rio de Janeiro, Brazil. Electronic address: luisfca@puc-rio.br.

PMID: 35066370
DOI: 10.1016/j.pediatrneurol.2021.11.008

Abstract

Background: Connections between epidemiological findings and children's and adolescents' mental health policies have not been properly made in Brazil, and such nationwide studies are scarce. This epidemiological study (1) estimated the prevalence and predictors of parent-reported attention-deficit/hyperactivity disorder (ADHD) (ADHD-report), (2) estimated the probable diagnosis and risk of ADHD based on Diagnostic and Statistical Manual of Mental Disorders, 5th edition, criteria (ADHD-probable), and (3) estimated current psychostimulant use (ADHD-pst) in a representative nationwide sample of Brazilian school-aged children and adolescents.

Methods: Data were obtained from 7114 school-aged children (49.9% boys) from 87 cities in 18 Brazilian states. Parents and teachers were interviewed using psychometrically sound questionnaires. Data and codes are available.

Results: The prevalence of ADHD-report, ADHD-probable, and ADHD-pst were 7.1%, 3.9%, and 1.9%, respectively. The agreement was low between ADHD-probable and ADHD-report (22.6%) and between ADHD-report and ADHD-pst (15.6%). Logistic regression revealed that predictors of all three categories were male gender (odds ratio [OR] = 1.71, 2.32, and 1.96, respectively), divorced parents (OR = 1.47, 1.65, and 1.68, respectively), and below-expectation school performance (OR = 3.1, 13.74, and 3.95, respectively). Socioeconomic status was a significant predictor of ADHD-report, and participants from lower classes were less frequently diagnosed with ADHD than their peers from upper classes (OR = 0.57, 95% confidence interval = 0.37-0.88, P = 0.012).

Conclusions: The present findings provide an accurate description of ADHD in Brazil. We suggest disparities in agreement between report, risk, and psychostimulant use among children and adolescents and discrepancies between socioeconomic classes concerning the prevalence of an ADHD diagnosis.

Keywords: ADHD; Community prevalence; Diagnosis; Epidemiology; Psychostimulant.

MeSH terms

Adolescent
Attention Deficit Disorder with Hyperactivity / diagnosis*
Attention Deficit Disorder with Hyperactivity / drug therapy*
Attention Deficit Disorder with Hyperactivity / epidemiology
Brazil
Central Nervous System Stimulants / therapeutic use*
Child
Child, Preschool
Female
Humans
Male
Odds Ratio
Prevalence
Socioeconomic Factors
Surveys and Questionnaires

Substances

Central Nervous System Stimulants