Overdiagnosis and Medication for Attention-Deficit Hyperactivity Disorder in Children with Cleft: Diagnostic Examination and Follow-Up

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Abstract
Objective: To examine the diagnosis of attention-deficit hyperactivity disorder (ADHD) in children with cleft to determine whether language-learning characteristics are taken into account when making this diagnosis. Design: Prospective examination of 177 consecutive patients. Objective behavioral ratings, cognitive assessments, and attention/impulsivity testing of 32 of the 177 children with nonsyndromic cleft lip and palate (CLP) who had previously been diagnosed as ADHD and were receiving medication were performed. the prospective 6- to 9-month follow-up examination was examined to determine the accuracy of prior and posttest diagnoses. Setting: University hospital-based cleft palate clinic. Main Outcome Measures: Pretest/posttest design to determine accuracy of DSM-IV psychiatric diagnosis. Results and Conclusions: The results show that the proportion of children originally diagnosed with ADHD (18%) was significantly higher than posttest diagnosis of ADHD (6% p < .001). Also, the frequency of pretest diagnosis of learning disorder (LD; 31%) was significantly different from posttest diagnosis (66% p < .01). The overdiagnosis of ADHD and underdiagnosis of LD in this sample of children with nonsyndromic unilateral cleft lip and palate appears to be due to lack of language-learning assessment.