title: Prevalence of the ADHD phenotype in 7- to 9-year-old children: effects of informant, gender and non-participation.
abstract: OBJECTIVE
  To estimate the prevalence of the ADHD phenotype based on parent and teacher reports in a general population sample of 7- to 9-year-old Norwegian children and evaluate the effect of parent attrition, gender and informant on the prevalence estimate.
  
  
  METHODS
  The population consisted of all children (N = 9,430) attending 2nd-4th grade in the City of Bergen, Norway. The 18 symptoms of ADHD corresponding to the SNAP-IV and DSM-IV were included in the Bergen Child Study questionnaire to teachers and parents. Teacher information was available for 9,137 children (97%) and information from both informants was available for the 6,237 children (66%) whose parents agreed to participate in the study.
  
  
  RESULTS
  The prevalence of the ADHD phenotype based on the combination of parent and teacher reports was 5.2% among participants. Teacher ratings of non-participants had a doubled rate of ADHD high scorers with an OR of 2.1 (95% CI, 1.9-2.4). The non-participant ADHD high scorers had more inattentive and fewer hyperactive/impulsive symptoms as compared to participating ADHD high scorers. Teachers reported high scores of hyperactivity/impulsivity and the combined symptom constellation much more frequently in boys than girls, while the difference between genders was less marked according to parent reports.
  
  
  CONCLUSIONS
  The ADHD phenotype was twice as prevalent among non-participants as among participants. Reported prevalences in population studies are therefore likely to be underestimates, if such attrition bias is not accounted for. Choice of informant, criteria for symptom count, definitions of subtypes and gender differences influence the prevalence estimates of the ADHD phenotype.
authors.affiliation: Centre for Child and Adolescent Mental Health, Unifob Health, Bergen, Norway. anne.ullebo@uni.no
authors.forename: Anne Karin
authors.initials: AK
authors.lastname: Ullebø
authors.forename: Maj-Britt
authors.initials: MB
authors.lastname: Posserud
authors.forename: Einar
authors.initials: E
authors.lastname: Heiervang
authors.forename: Carsten
authors.initials: C
authors.lastname: Obel
authors.forename: Christopher
authors.initials: C
authors.lastname: Gillberg
mesh_terms: D019958:Attention Deficit and Disruptive Behavior Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics; D002648:Child; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005178:Faculty; D005260:Female; D006801:Humans; D008297:Male; D015233:Models, Statistical; D009664:Norway / Q000453:epidemiology; D010290:Parents; D010641:Phenotype; D015995:Prevalence; D011581:Psychological Tests; D002666:Psychology, Child; D011594:Psychometrics; D017678:Sex Distribution; D058992:Social Participation / Q000523:psychology*; D011795:Surveys and Questionnaires