title: Diagnostic overshadowing in a population of children with neurological disabilities: A cross sectional descriptive study on acquired ADHD.
abstract: OBJECTIVE
  Diagnostic overshadowing refers to the underdiagnosis of comorbid conditions in children with known neurological diagnoses. To demonstrate diagnostic overshadowing we determined the prevalence of attention deficit-hyperactivity disorders (ADHD) in a cohort of children with a wide range of neurological disabilities.
  
  
  METHODS
  The study cohort consisted of 685 children (mean age 10.3 years, SD: 3.1; 425 boys and 260 girls) who visited a tertiary outpatient multidisciplinary clinic for neurological learning disabilities. Patients with ADHD were identified by retrospective chart review using DSM-IV criteria.
  
  
  RESULTS
  The prevalence of ADHD in this cohort was 38.8% (266 children); of these children only 28.2% (75 children) were diagnosed with ADHD before referral.
  
  
  CONCLUSIONS
  ADHD is a common problem in children with neurological disabilities and may be underdiagnosed due to overshadowing of somatic, physical or syndromal features of the disability. In our heterogeneous population ADHD was overshadowed in 71.8% of the cases. This finding may have important implications for diagnosis and treatment of mental health needs in children with neurological disabilities.
authors.affiliation: Kempenhaeghe, Department of Neurological Learning Disabilities, P.O. Box 61, 5590 AB Heeze, The Netherlands; Kempenhaeghe Epilepsy Centre, Department of Behavioral Sciences, P.O. Box 61, 5590 AB Heeze, The Netherlands; Department of Neurology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. Electronic address: Hendriksenj@kempenhaeghe.nl.
authors.forename: J G M
authors.initials: JG
authors.lastname: Hendriksen
authors.affiliation: Kempenhaeghe, Department of Neurological Learning Disabilities, P.O. Box 61, 5590 AB Heeze, The Netherlands; Kempenhaeghe Epilepsy Centre, Department of Behavioral Sciences, P.O. Box 61, 5590 AB Heeze, The Netherlands; School of Mental Health and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands. Electronic address: Peijnenborghj@kempenhaeghe.nl.
authors.forename: J C A W
authors.initials: JC
authors.lastname: Peijnenborgh
authors.affiliation: Kempenhaeghe Epilepsy Centre, Department of Behavioral Sciences, P.O. Box 61, 5590 AB Heeze, The Netherlands; Department of Neurology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; School of Mental Health and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; Department of Electrical Engineering, University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands. Electronic address: Aldenkampb@kempenhaege.nl.
authors.forename: A P
authors.initials: AP
authors.lastname: Aldenkamp
authors.affiliation: Kempenhaeghe, Department of Neurological Learning Disabilities, P.O. Box 61, 5590 AB Heeze, The Netherlands; Department of Neurology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; School of Mental Health and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands. Electronic address: Jsh.vles@mumc.nl.
authors.forename: J S H
authors.initials: JS
authors.lastname: Vles
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications* / Q000175:diagnosis*; D002648:Child; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007859:Learning Disabilities / Q000150:complications*; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies
keywords: ADHD; Learning disabilities; Neurology; Neuropsychology