Risks Associated With Undiagnosed ADHD and/or Autism: A Mixed-Method Systematic Review
Commentary by Dr. Doron Almagor*: The paper “Risks Associated with Undiagnosed ADHD and/or Autism: A Mixed-Method Systematic Review” by French et al., 2023, investigates the challenges faced by individuals with undiagnosed ADHD and/or ASD. Their research aims to elucidate the challenges and repercussions faced by individuals living with undiagnosed ADHD and ASD. The primary findings revealed three major areas of concern: pronounced academic underachievement, heightened mental health complications, and a conspicuous increase in risky behaviours among the undiagnosed cohort. To arrive at these conclusions, the researchers conducted a systematic review, sourcing data databases such as PubMed, PsycINFO. Their approach was bifurcated into qualitative and quantitative analyses. Qualitative data offered a deeper understanding of personal experiences, feelings of isolation, and internal struggles of undiagnosed individuals. On the other hand, quantitative data provided measurable metrics on academic outcomes, mental health statistics, and engagement in potentially harmful behaviours. For clinicians and healthcare professionals, this study presents several actionable takeaways. The results accentuate the necessity of early diagnosis and the adoption of an interdisciplinary approach. Regular screenings, particularly tailored for high-risk demographics, are of paramount importance. Despite the rise in ASD/ADHD diagnoses and better awareness in recent years, many remain undiagnosed. Research consistently shows that early diagnosis and treatment can mitigate mental health risks associated with these conditions. The study underscores the profound impact of not diagnosing, particularly on mental health, substance use and markers of educational and social well-being.
ABSTRACT
Background: The two most prevalent neurodevelopmental disorders—Attention Deficit Hyperactivity Disorder (ADHD) and Autism (ASD)—(ASD/ADHD) strongly impact individuals’ functions. This is worsened when individuals are undiagnosed and risks such as increased imprisonments, depression or drug misuse are often observed. This systematic review synthesizes the risks associated with late/undiagnosed ASD/ADHD.
Methods: Four databases were searched (Medline, Scopus, PsychInfor, and Embase). Published studies exploring the impact of undiagnosed ASD/ADHD were included. Exclusion criteria included, lack of diagnosis status, studies not solely on ASD or ADHD, gray literature and studies not in English. The findings were summarize through a narrative synthesis.
Results: Seventeen studies were identified, 14 on ADHD and three on ASD. The narrative synthesis identified three main themes: (1) Health, (2) Offending behavior, and (3) Day-to-day impact. The risks highlighted a significant impact on mental wellbeing and social interactions, higher risks of substance abuse, accidents and offending behavior as well as lower levels of income and education. Discussion: The findings suggest that undiagnosed ASD/ADHD is linked to many risks and negative outcomes affecting individuals, their families, and the wider society. The restricted number of studies on ASD are a limitation to the generalization of these findings Implications for research and practice are discussed, highlighting the importance of screening and acknowledging the possibility of ASD/ADHD in many settings such as psychiatric and forensic.
* Doron Almagor MD, FRCPC, Chair of CADDRA’s Advisory Council member, is a Child, Adolescent, and Adult Psychiatrist and Director of the Possibilities Clinic, headquartered in Toronto.
Journal articles are selected based on their clinical relevance. The commentary reflects the reviewer’s own opinion and is not approved, or necessarily representative, of the opinion of the CADDRA Board.