The diagnosis of ADHD has been getting a lot of media attention lately over concerns about possible overdiagnosis and overtreatment. A recent study from the Centers for Disease Control’s (CDC) National Survey of Children’s Health has recently provided important national statistics regarding the prevalence of ADHD, as reported by parents, and the trends over time.
The data come from a random-digit-dialed telephone survey of parents that was performed in over 75,000 households using both land lines and mobile phones. Parents were asked about lifetime and current diagnosis of one of their children. The overall response rate was 23.0 percent which isn’t so great (but then, how many times have you agreed to do these phone surveys at 6 p.m. when you are trying to make your kids some dinner?).
Overall, the rate of ever having ADHD among 4 to 17 year olds nationally was 11 percent (15.1 percent for boys, 6.7 percent for girls), which represents about 6.4 million children. This rate reflects an increase of 42 percent from 2003 to 2011. Of those with current ADHD, 69 percent were taking medication for it resulting in an overall medication rate of 6.1 percent, an increase of 28 percent from 2007. Only about half of children with current ADHD were engaged in some kind of counseling or psychotherapy.
There was substantial variation in diagnosis rates and medication treatment between the states with several southern states, such as Arkansas (14.6 percent) and Kentucky (14.8 percent) among the highest. Overall, rates were highest in the southeast and midwest and lowest in the southwest. Some states did not show increases in ADHD diagnosis rates from 2007, like my own state of Vermont. Medication rates also varied widely between states from a low of 2.0 percent in Nevada to over five times that amount (10.4 percent) in Louisiana.
This paper comes soon after a very similar report looking at the number of children taking stimulant medication such at Ritalin. This study, which was a previous blog topic, found much lower percentages but used a very different methodology (analyses of actual prescriptions).
It is hard to say whether the increases in ADHD diagnosis represent an actual rise in the disorder versus a combination of increased detection and lower diagnostic threshold. This study cannot weigh in on that question, although the marked variability from state to state suggests a bit more of the latter. That said, these higher numbers come during a time when some known causes of ADHD, such as lead poisoning and maternal smoking during pregnancy, are decreasing.
It is also very important to remember that the study has no information regarding the accuracy or appropriateness of the diagnosis or treatment. Consequently, you can expect different people to use these numbers to make different conclusions. Some will focus on the number of diagnosed but not treated kids as a public health failure while others will complain that an ADHD rate of 11 percent just has to be too high. Figuring out if a diagnosis of ADHD is reasonable is a difficult proposition, and figuring out if a diagnosis of ADHD is correct in some cases may be impossible. More on that soon.
Visser et al., Trends in the Parent-Report of Health Care Provider-Diagnosed and Medicated Attention-Deficit/Hyperactivity Disorder: United States, 2003–2011. JAACAP 2014;53:34-46.
@copyright by David Rettew, MD
David Rettew is author of Child Temperament: New Thinking About the Boundary Between Traits and Illness and a child psychiatrist in the psychiatry and pediatrics departments at the University of Vermont College of Medicine.