Why Are There So Many Subthreshold Diagnoses for Children?

An important task for child psychiatrists is providing appropriate interventions for “not otherwise specified” (NOS) diagnoses. To address this issue, investigators examined time trends in the proportion of NOS to full criteria (FC) psychiatric diagnoses among children and young adults (age range, 2–19) between 1999 and 2010 in two national surveys of office-based physician visits (N=16,295).

Over the study period, almost half of all diagnoses were FC attention-deficit/hyperactivity disorder (ADHD); <1% were ADHD NOS. The proportion of NOS diagnoses significantly increased over time for any mood, bipolar, and learning disorder; the largest increase in NOS diagnoses occurred with bipolar disorder (1999, 3.6%; 2010, 72.6%).