Background:
This nationwide population study by a Norwegian team aimed to evaluate the relationship between ADHD and various types of child welfare services contacts over a long-term period of up to 18 years among children and adolescents aged 5 to 18 years diagnosed with ADHD, in comparison to the general population within the same age group.
Norway has a single-payer national health insurance system that fully covers virtually the entirety of its population. In combination with a system of national population and health registers, this facilitates nationwide population studies, overcoming the limitations of relying on population sampling.
Study:
The study population included all 8,051 children and adolescents aged 5 to 18 who were diagnosed with ADHD for the first time in the Norwegian Patient Registry between 2009 and 2011.
The study also included a comparison sample of 75,184 children and adolescents aged 5–18 with no child welfare services contact during 2009–2011.
The interventions delivered by child welfare services in Norway are largely divided into two primary categories: supportive intervention and out-of-home placement.
Supportive interventions include improving parenting skills, promoting child development, providing supervision and control, facilitating cooperation with other services, assessments and treatments by other institutions, and offering housing support.
Norway uses foster homes or child welfare institutions as a last resort. When supportive interventions fail to meet the child’s needs, the child welfare services can temporarily place the child in these facilities. If parents disagree, the county social welfare board decides based on a municipal request.
The team adjusted for potential confounders: sex, age, parental socioeconomic status (father’s and mother’s education and income level), and marital status.
Results:
With these adjustments, children and adolescents diagnosed with ADHD were over six times more likely to have any contact with child welfare services than their general population peers. This was equally true for males and females.
Children and adolescents diagnosed with ADHD were also over six times more likely to receive supportive interventions from child welfare services. Again, there were no differences between males and females.
Finally, children and adolescents diagnosed with ADHD were roughly seven times more likely to have an out-of-home placement than their general population peers. For males this rose to eight times more likely.
Conclusion:
The team concluded, “This population-based study provides robust evidence of a higher rate and strong association between ADHD and contact with CWS [Child Welfare Service] compared to the general population in Norway.”
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