Culture, criteria and clinicians – dissecting discrepancies in the prevalence of attention deficit hyperactivity disorder

Consideration of social factors is key to understanding and assessing under- and over-treatment of attention deficit hyperactivity disorder (ADHD), as they play a large role in presentation, diagnosis and management strategy. The lower prevalence of ADHD in Ireland, as compared to other countries, is an example of the varied rates of the disease around the world. Is this because, here in Ireland, the symptoms of ADHD are viewed as a behavioural problem? Variable diagnostic rates are in part unavoidable, as ADHD diagnoses are made based on behaviour alone. The use of different diagnostic criteria may result in a lower diagnostic ‘bar’, which manifests as a generally higher prevalence of ADHD as more are likely to fit its less rigid diagnostic criteria. Similarly, prescribing patterns, and thus treatment protocols, for children with ADHD vary greatly. This article discusses these issues and how they fit into the Irish context.