Parental psychosocial factors associated with parental reporting of their child's administrative ADHD diagnosis - results from the consortium project INTEGRATE-ADHD.

BACKGROUND: As one of the most commonly diagnosed psychiatric disorders in children and adolescents, reliable prevalence data on attention-deficit/hyperactivity disorder (ADHD) is highly relevant to health policy and health care planning. However, routine data and parental diagnosis reports from surveys - as important data sources on child ADHD - often differ. This study investigates whether parental psychosocial factors are associated with parental diagnosis reporting in German parents whose child is registered with an administrative ADHD diagnosis (ICD-10 F90.0-9) with their statutory health insurance. We expected more parental burden to be associated with a lower likelihood of a parental diagnosis report.

METHODS: Parents of 5,461 children and adolescents who presented with an administrative ADHD diagnosis in 2020 answered online questions about their child's ADHD diagnosis and various psychosocial characteristics, including parental strain, parental psychological problems, parental ADHD diagnosis, family cohesion and parental health literacy. Chi-square tests and unadjusted linear regressions were used to analyze group differences in parental psychosocial characteristics between parents who reported the ADHD diagnosis and those who did not. Binary logistic regressions were conducted to predict the parental report of their child's ADHD diagnosis in the survey.

RESULTS: Group comparisons revealed that parents who reported their child's ADHD diagnosis displayed significantly more parental strain, more psychological problems, higher rates of maternal and paternal ADHD, lower levels of family cohesion and lower health literacy than parents who did not report their child's ADHD diagnosis. The results were partly confirmed in multivariate analysis, where maternal (OR = 3.18) and paternal ADHD (OR = 2.94) turned out to be the strongest predictor of a parental diagnosis report.

CONCLUSIONS: Contrary to our expectations, parental psychosocial burden, in particular parental ADHD diagnosis, increased the likelihood of a parental report of their child's ADHD diagnosis, which may point to a greater sensitivity and awareness of affected parents towards their child's ADHD. The findings suggest that differences in the diagnosis prevalence of child ADHD between routine and survey data may vary as a function of parental psychosocial factors.