ADHD Rates Soar in U.S. Kids: Study
Better diagnosis and screening may play a role in increase, researchers say
By Steven ReinbergHealthDay Reporter
WEDNESDAY, Nov. 10 (HealthDay News) -- The number of U.S. children with attention-deficit/hyperactivity disorder (ADHD) jumped nearly 22 percent in a recent four-year period, meaning nearly one in every 10 kids is now diagnosed with the disorder, U.S. health officials report.
"Based on our parent surveys, there has been an increase in parent-reported ADHD diagnosis among their children," said lead author Susanna Visser of the U.S Centers for Disease Control and Prevention.
"This increase was from 7.8 percent in 2003 to 9.5 percent in 2007," she said. "When we project that to the American population, that means that a million more children were diagnosed with ADHD in 2007 as compared to 2003. That's a substantial increase in four years."
About 5.4 million children have ADHD in the United States, according to their parents, and 2.7 million take medication for the condition, the CDC survey of 4- to 17-year-olds found.
"There are probably more children out there who have not received a diagnosis and we can't determine how many more children there are based on these data," added Visser, lead epidemiologist of the child development studies team at the CDC's National Center on Birth Defects and Developmental Disabilities.
ADHD, a neurobehavioral disorder, is characterized by levels of inattention and activity that are developmentally inappropriate. The condition can persist into adulthood.
Among older teens, the rate of ADHD soared 42 percent, the researchers found. This suggests that health care providers may be managing a larger and different population of children than they were four years ago.
"We don't know as well how to manage ADHD among older teens," Visser said. "Regardless of why we are seeing this, the end result is that health care providers are going to modify their care approach to consider the needs of older teens," she said.
The 53 percent increase in ADHD diagnosis since 2003 among Hispanics means providers are going to have to be sensitive to the needs of this group as well, Visser added.
Much of the increase may be driven by better screening programs and more awareness and diagnosis, Visser said.
The report is published in the Nov. 12 issue of the CDC's Morbidity and Mortality Weekly Report.
One expert isn't surprised by the numbers.
"I believe the findings are generally accurate and consistent with most research in detailing the rapid and rather disconcerting rise in the diagnosis of ADHD in U.S. children," said John D. Ranseen, an associate professor of psychiatry at the University of Kentucky College of Medicine.
The rapid rise in diagnosis, which is not necessarily equivalent to a rise in the actual condition, must be due in part to cultural factors -- a willingness to label certain symptoms as indicating ADHD, increased cultural acceptance of doing so and increased dissemination of information labeling ADHD as a "condition," he said.
Other, more vague, cultural factors may also play a role, Ranseen pointed out.
"For instance, increased stress to complete as much schooling as possible within a lousy economy," he noted.
"Another very uncomfortable issue is the role of pharmacological companies in all of this since it is very much in their interest to increase the diagnosis and treatment of this condition. The last thing they have any interest in seeing is a drop in the diagnosis and treatment," Ranseen said.
"One would hope that such findings might give the mental health field pause to wonder and worry about why we are seeing increases in virtually all psychiatric conditions -- autism, depression, ADHD, bipolar in children -- for instance, what does this say about our society?" Ranseen added.
But another ADHD expert, Dr. Jeffrey Brosco, professor of pediatrics at the University of Miami Miller School of Medicine, said parent-reported studies make it hard to ascertain true figures.
Whether the number of children with ADHD is actually increasing or whether the increase is a product of increased awareness isn't known, Brosco said.
"I don't know and I don't think anyone can really tell you based on this study," he said. "There is no doubt that over the last 30 to 40 years we have become much more sensitive to behavioral differences," Brosco said. "Whether there is truly a change -- whether kids in the 1970s are really different from kids in the '90s or the 2000s -- there's not any way to tell that."
Increasing Prevalence of Parent-Reported Attention-Deficit/Hyperactivity Disorder Among Children --- United States, 2003 and 2007
November 12, 2010 / 59(44);1439-1443
Attention-deficit/hyperactivity disorder (ADHD) is a neurobehavioral disorder that typically begins in childhood and often persists into adulthood. ADHD is characterized by developmentally inappropriate levels of inattention and hyperactivity resulting in functional impairment in academic, family, and social settings (1). ADHD is the most commonly diagnosed neurobehavioral disorder of childhood, with previous reports documenting increasing trends in prevalence during the past decade and increases in ADHD medication use (2,3). National estimates of the number of children reported by their parents to have ever been diagnosed with ADHD and the percentage of children with ADHD currently taking ADHD medications were published in 2005 using data from the 2003 National Survey of Children's Health (NSCH) (4,5). This report describes results from the second administration of NSCH in 2007 (6), which indicated that the percentage of children aged 4--17 years with a parent-reported ADHD diagnosis (ever) increased from 7.8% to 9.5% during 2003--2007, representing a 21.8% increase in 4 years. The findings in this report help to further characterize the substantial impact of ADHD on families.
The 2003 and 2007 NSCH were national, cross-sectional, random-digit--dialed landline telephone surveys used to estimate the prevalence of health and well-being indicators among children aged <18 years in the United States (5,6).* One child was selected randomly from each household to be the focus of the parent or guardian interview. Information about the design and response rates of the 2003 NSCH have been published (5). The design of the 2003 and 2007 surveys were similar. During April 2007--July 2008, a total of 91,642 interviews were completed for the 2007 NSCH (overall response rate = 46.7%; cooperation rate = 66.0%).† In 2007, data, including complete information on ADHD and sex, were obtained for 73,123 children aged 4--17 years. Data were weighted to account for unequal probabilities of selection of households and children, nonresponse, and households without landline telephones, and to reflect the demographic distribution of noninstitutionalized children in the United States.§
In both 2003 and 2007, parents were asked whether or not a doctor or other health-care provider had ever told them that their child had "attention deficit disorder or attention deficit hyperactive disorder, that is, ADD or ADHD." In 2007, parents who reported an ADHD diagnosis (ever) also were asked whether the child currently had ADHD and to describe its severity (mild, moderate, or severe). The question about medication use in the 2003 survey differed from that in the 2007 survey. Current medication treatment for ADHD was asked about children who ever had ADHD in 2003 and about children with current ADHD in 2007. Estimates of parent-reported ADHD (ever and current) among children aged 4--17 years, current medication use, and ADHD severity were calculated overall and by sociodemographic characteristics (Table 1) using 2007 data and NSCH survey weights. Rates of ADHD by sociodemographic characteristics using the 2003 survey data have been published (4) and were compared with 2007 data for the present analysis (Table 2). Estimated rates of children medicated for ADHD were calculated by dividing the weighted estimate of the number of children with current ADHD who were being medicated for the disorder by the total weighted estimate of the number of children aged 4--17 years. Prevalence ratios and 95% confidence intervals were calculated to compare ADHD prevalence (ever diagnosed, current ADHD diagnosis, and currently taking medications for ADHD) of sociodemographic subgroups to referent subgroups (Table 1), and across the two surveys (ever diagnosed; Tables 2 and 3).
Prevalence of ADHD diagnosis (ever) was compared between the two surveys using weighted logistic regression, predicting ADHD from survey year, while controlling for sociodemographics. Statistical interactions of survey year by sociodemographics were tested. The average annual percentage difference was calculated by dividing the 2003 to 2007 percentage difference by 4.¶
In 2007, the estimated prevalence of parent-reported ADHD (ever) among children aged 4--17 years was 9.5%, representing 5.4 million children (Table 1). Of those with a history of ADHD, 78% (4.1 million, or 7.2% of all children aged 4--17 years) were reported to currently have the condition. Of those with current ADHD, nearly half (46.7%) had mild ADHD, with the remainder having moderate (39.5%) or severe (13.8%) ADHD. ADHD (ever) was more than twice as common among boys as girls (13.2% versus 5.6%). High rates of ADHD (ever) were noted among multiracial children (14.2%) and children covered by Medicaid (13.6%).
Among children with current ADHD, 66.3% were taking medication for the disorder. In total, 4.8% of all children aged 4--17 years (2.7 million) were taking medication for ADHD. Among boys, the prevalence of medicated ADHD (current) was highest for boys 11--14 years. The rates of medicated ADHD (current) increased with age among girls. The proportion of children taking medication for ADHD increased with severity, from 56.4% among children with mild ADHD, to 71.6% among children with moderate ADHD and 85.9% among children with severe ADHD (p<0.0001). The national prevalence of ADHD (ever) increased significantly between the two surveys (from 7.8% to 9.5%; Table 2), even after adjustment for sociodemographics, equating to a 21.8% increase in 4 years, or an average annual increase of 5.5%. The national estimate of children aged 4--17 years with parent-reported ADHD (ever) increased from 4.4 million in 2003 to 5.4 million in 2007, an increase of approximately 1 million children. Compared with 2003, the 2007 rates were significantly higher for each subgroup, with three exceptions: among households with less than a high school education, "other" (not white or black) races, and those living in the western United States. The magnitude of increase was largest among older teens, multiracial and Hispanic children, and children with a primary language other than English. A significant interaction was identified for age and survey year, with the rate of ADHD diagnosis (ever) increasing more for those in the oldest age group (15--17 years). The national increase in ADHD (ever) was reflected in significant increases within 12 states (Table 3).
SN Visser, MS, RH Bitsko, PhD, ML Danielson, MSPH, R Perou, PhD, Div of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities; SJ Blumberg, PhD, Div of Health Interview Statistics, National Center for Health Statistics, CDC.
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