Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-26T03:13:10.111Z Has data issue: false hasContentIssue false
  • English
  • Français

Prevalence of severe ADHD: an epidemiological study in the Italian regions of Tuscany and Latium

Published online by Cambridge University Press:  15 September 2014

R. Donfrancesco ,
A. Marano ,
D. Calderoni ,
D. Mugnaini ,
F. Thomas ,
M. Di Trani ,
M. Innocenzi  and
B. Vitiello
R. Donfrancesco*
Affiliation:
Sandro Pertini Hospital, Roma, Italy
A. Marano
Affiliation:
Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
D. Calderoni
Affiliation:
National Health System-ASL Roma B, Roma, Italy
D. Mugnaini
Affiliation:
Centre for Neuropsychological Assessment, Local Health Service of Florence, Florence, Italy
F. Thomas
Affiliation:
National Health System-ASL Roma B, Roma, Italy
M. Di Trani
Affiliation:
Department of Clinical and Dynamic Psychology, ‘Sapienza’ University, Rome, Italy
M. Innocenzi
Affiliation:
National Health System-ASL Roma B, Roma, Italy
B. Vitiello
Affiliation:
National Institute of Mental Health, Bethesda, Maryland, USA
*
Address for correspondence: Dr R. Donfrancesco, Ospedale Sandro Pertini, via dei Monti Tiburtini, 00157 Roma, Italy. (Email: renato.donfrancesco@yahoo.it)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background.

The rate with which attention deficit/hyperactivity disorder (ADHD) is diagnosed varies widely across countries, suggesting that cultural factors influence the clinical interpretation of child behaviour. This study estimated the point prevalence of severe ADHD among elementary and middle-school Italian children.

Method.

An epidemiological sample of 2016 children attending 2nd–8th grade in the Italian regions of Tuscany and Latium was selected based on census distribution of the school-age population. Teachers completed the Italian version of the ADHD Rating Scale for Teachers (SDAI). For children with at least six inattention symptoms and/or at least six hyperactivity/impulsivity symptoms rated ‘very often’ by the teachers, the parents completed the Italian ADHD Rating Scale for Parents (SDAG). Children with documented ADHD symptoms at both school and home received a complete psychiatric interview with the Kiddie Schedule for Affective Disorders and Schizophrenia-present and lifetime version (K-SADS-PL).

Results.

Of the 1887 assessed children, 4.45% (95% CI 3.58–5.51) met the ADHD cut-off on teacher ratings, 1.43% (0.96–2.12) had ADHD symptoms endorsed by both teacher and parent, and 1.32% (0.87–1.97) were further confirmed by the psychiatric evaluation. The male:female ratio was 7:1. The inattentive type accounted for about half of the ADHD cases.

Conclusions.

When applying stringent criteria for both severity and pervasiveness of symptoms, it is estimated that about 1.3% of the Italian elementary and middle-school children suffer from severe ADHD.

Keywords

Attention deficit/hyperactivity disorderchildrenItalyprevalence
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 24 , Issue 6 , December 2015 , pp. 525 - 533
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Al-Yagon, M, Cavendish, W, Cornoldi, C, Fawcett, AJ, Grünke, M, Hung, LY, Jiménez, JE, Karande, S, van Kraayenoord, CE, Lucangeli, D, Margalit, M, Montague, M, Sholapurwala, R, Sideridis, G, Tressoldi, PE, Vio, C (2013). The proposed changes for DSM-5 for SLD and ADHD: international perspectives – Australia, Germany, Greece, India, Israel, Italy, Spain, Taiwan, United Kingdom, and United States. Journal of Learning Disabilities 46, 58–72.Google Scholar
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association: Washington, DC.Google Scholar
Arcieri, R, Germinario, EA, Bonati, M, Masi, G, Zuddas, A, Vella, S, Chiarotti, F, Panei, P, Italian Attention-Deficit/Hyperactivity Disorder Regional Reference Centers (2012). Cardiovascular measures in children and adolescents with attention-deficit/hyperactivity disorder who are new users of methylphenidate and atomoxetine. Journal of Child and Adolescent Psychopharmacology 22, 423–431.Google Scholar
Bianchini, R, Postorino, V, Grasso, R, Santoro, B, Migliore, S, Burlò, C, Tata, C, Mazzone, L (2013). Prevalence of ADHD in a sample of Italian students: a population-based study. Research in Developmental Disabilities 34, 2543–2550.CrossRefGoogle Scholar
Buitelaar, JK, Barton, J, Danckaerts, M, Friedrichs, E, Gillberg, C, Hazell, PL, Hellemans, H, Johnson, M, Kalverdijk, LJ, Masi, G, Michelson, D, Revol, O, Sebastian, JS, Zhang, S, Zuddas, A (2006). A comparison of North American versus non-North American ADHD study populations. European Child and Adolescent Psychiatry 15, 177–181.Google Scholar
Cornoldi, C, Gardinale, M, Masi, A, Petteno, L (1996). Impulsività e autocontrollo. Erickson: Trento, Italy.Google Scholar
Dalsgaard, S, Nielsen, HS, Simonsen, M (2013). Five-fold increase in national Prevalence Rates of attention-deficit/hyperactivity disorder medications for children and adolescents with autism spectrum disorder, attention-deficit/hyperactivity disorder, and other psychiatric disorders: a Danish register-based study. Journal of Child and Adolescent Psychopharmacology 23, 432–439.CrossRefGoogle ScholarPubMed
DuPaul, GJ, Power, TJ, Anastopoulos, AD, Reid, R, McGoey, KE, Ikeda, MJ (1997). Teacher ratings of Attention-Deficit/Hyperactivity Disorder symptoms: factor structure and normative data. Psychological Assessment 9, 436–444.CrossRefGoogle Scholar
Frauger, E, Pauly, V, Natali, F, Pradel, V, Reggio, P, Coudert, H, Thirion, X, Micallef, J (2011). Patterns of methylphenidate use and assessment of its abuse and diversion in two French administrative areas using a proxy of deviant behaviour determined from a reimbursement database: main trends from 2005 to 2008. CNS Drugs 25, 415–424.Google Scholar
Frigerio, A, Rucci, P, Goodman, R, Ammaniti, M, Carlet, O, Cavolina, P, De Girolamo, G, Lenti, C, Lucarelli, L, Mani, E, Martinuzzi, A, Micali, N, Milone, A, Morosini, P, Muratori, F, Nardocci, F, Pastore, V, Polidori, G, Tullini, A, Vanzin, L, Villa, L, Walder, M, Zuddas, A, Molteni, M (2009). Prevalence and correlates of mental disorders among adolescents in Italy: the PrISMA study. European Child & Adolescent Psychiatry 18, 217–226.CrossRefGoogle ScholarPubMed
Froehlich, TE, Lanphear, BP, Epstein, JN, Barbaresi, WJ, Katusic, SK, Kahn, RS (2007). Prevalence, recognition, and treatment of attention-deficit/hyperactivity disorder in a national sample of US children. Archives of Pediatric and Adolescent Medicine 161, 857–864.Google Scholar
Gallucci, F, Bird, HR, Berardi, C, Gallai, V, Pfanner, P, Weinberg, A (1993). Symptoms of attention-deficit hyperactivity disorder in an Italian school sample: findings of a pilot study. Journal of the American Academy of Child and Adolescent Psychiatry 32, 1051–1058.Google Scholar
Goodman, R, Ford, T, Simmons, H, Gatward, R, Meltzer, H (2000). Using the Strengths and Difficulties Questionnaire (SDQ) to screen for child psychiatric disorders in a community sample. British Journal of Psychiatry 177, 534–539.Google Scholar
Istituto Nazionale di Statistica (1995). 13° Censimento Generale della Popolazione e delle Abitazioni – 20 ottobre 1991. Istituto Nazionale di Statistica: Rome, Italy.Google Scholar
Italian Ministry of Public Education (2000). La Scuola Statale: Sintesi dei Dati. Rome, Italy.Google Scholar
Kaufman, J, Birmaher, B, Brent, D, Rao, U, Flynn, C, Moreci, P, Williamson, D, Ryan, N (1997). Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry 36, 980–988.CrossRefGoogle ScholarPubMed
Marzocchi, GM, Cornoldi, C (2000). Una scala di facile uso per la rilevazione dei comportamenti problematici dei bambini con Deficit di Attenzione e Iperattività . Psicologia Clinica dello Sviluppo 4, 43–63.Google Scholar
Moffitt, TE, Melchior, M (2007). Why does the worldwide prevalence of childhood attention deficit hyperactivity disorder matter? American Journal of Psychiatry 164, 856–858.Google Scholar
Mugnaini, D, Masi, G, Brovedani, P, Chelazzi, C, Matas, M, Romagnoli, C, Zuddas, A (2006). Teacher reports of ADHD symptoms in Italian children at the end of first grade. European Psychiatry 21, 419–426.Google Scholar
National Institute for Health and Clinical Excellence (2013). Attention deficit hyperactivity disorder. Diagnosis and management of ADHD in children, young people, and adults. Issued September 2008; last modified: March 2013. NICE clinical guideline 72. Retrieved 17 July 2014 from http://www.nice.org.uk/guidance/CG72 Google Scholar
Polanczyk, G, de Lima, MS, Horta, BL, Biederman, J, Rohde, LA (2007). The worldwide prevalence of ADHD: a systematic review and metaregression analysis. American Journal of Psychiatry 164, 942–948.Google Scholar
Polanczyk, GV, Willcutt, EG, Salum, GA, Kieling, C, Rohde, LA (2014). ADHD prevalence estimates across three decades: an updated systematic review and meta-regression analysis International Journal of Epidemiology 43, 434–442.Google Scholar
Rohde, LA, Szobot, C, Polanczyk, G, Schmitz, M, Martins, S, Tramontina, S (2005). Attention-deficit/hyperactivity disorder in a diverse culture: do research and clinical findings support the notion of a cultural construct for the disorder? Biological Psychiatry 57, 1436–1441.Google Scholar
Rowland, AS, Skipper, BJ, Umbach, DM, Rabiner, DL, Campbell, RA, Naftel, AJ, Sandler, DP (2013). The Prevalence of ADHD in a Population-Based Sample. Journal of Attention Disorders. [Epub ahead of print].Google Scholar
Santosh, PJ, Taylor, E, Swanson, J, Wigal, T, Chuang, S, Davies, M, Greenhill, L, Newcorn, J, Arnold, LE, Jensen, P, Vitiello, B, Elliott, G, Hinshaw, SP, Hechtman, L, Abikoff, H, Pelham, WE, Hoza, B, Molina, B, Wells, K, Epstein, J, Posner, M (2005). Refining the diagnoses of inattention and overactivity syndromes: a reanalysis of the Multimodal Treatment study of attention deficit hyperactivity disorder (ADHD) based on ICD-10 criteria for hyperkinetic disorder. Clinical Neuroscience Research 5, 307–314.CrossRefGoogle Scholar
Shaffer, D, Gould, MS, Brasic, J, Ambrosini, P, Fisher, P, Bird, H, Aluwahlia, S (1983). A children's global assessment scale (CGAS). Archives General Psychiatry 40, 1228–1231.Google Scholar
Shaw, P, Malek, M, Watson, B, Sharp, W, Evans, A, Greenstein, D (2012). Development of cortical surface area and gyrification in attention-deficit/hyperactivity disorder. Biological Psychiatry 72, 191–197.Google Scholar
Singh, I (2008). Beyond polemics: science and ethics of ADHD. Nature Review Neuroscience 9, 957–964.Google Scholar
Skounti, M, Philalithis, A, Galanakis, E (2007). Variations in prevalence of attention deficit hyperactivity disorder worldwide. European Journal of Pediatrics 166, 117–123.Google Scholar
Swanson, JM, Sergeant, JA, Taylor, E, Sonuga-Barke, EJ, Jensen, PS, Cantwell, DP (1998). Attention-deficit hyperactivity disorder and hyperkinetic disorder. Lancet 351, 429–433.Google Scholar
Taylor, E, Sonuga-Barke, E (2008). Disorders of attention and activity. In Rutter's Child and Adolescent Psychiatry, 5th edn (ed. Rutter, M. et al. ), pp. 521–542. Blackwell Publishing: Oxford, UK.Google Scholar
Taylor, E, Döpfner, M, Sergeant, J, Asherson, P, Banaschewski, T, Buitelaar, J, Coghill, D, Danckaerts, M, Rothenberger, A, Sonuga-Barke, E, Steinhausen, HC, Zuddas, A (2004). European clinical guidelines for hyperkinetic disorder – first upgrade. European Child and Adolescent Psychiatry 13(Suppl. 1), I7–I30.Google Scholar
Thomas, R, Mitchell, GK, Batstra, L (2014). Attention-deficit/hyperactivity disorder: are we helping or harming? Brisitsh Medical Journal 347, f6172.Google Scholar
Visser, SN, Danielson, ML, Bitsko, RH, Holbrook, JR, Kogan, MD, Ghandour, RM, Perou, R, Blumberg, SJ (2014). Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003–2011. Journal of the American Academy of Child and Adolescent Psychiatry 53, 34–46.Google Scholar
Vitiello, B (2008). An international perspective on pediatric psychopharmacology. International Review of Psychiatry 20, 121–126.Google Scholar
Zuvekas, SH, Vitiello, B (2012). Stimulant medication use among US children: a twelve-year perspective. American Journal of Psychiatry 169, 160–166.Google Scholar