PBS/Frontline
Source: PBS/Frontline

6.4 million children in the United States—more than one in ten—received an ADHD diagnosis in 2011, with treatment by therapy, medication, or both. That represents an astonishing 42 percent rise from a decade earlier and builds on earlier reports that one out of every twenty-five school-age children was prescribed antidepressants that year.

The CDC announced the latest findings last week from its National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome. The response rate of the participants was strikingly low (10.9 percent, combining two surveys) and some of the data may in fact be under-reported, the authors of the study recognize, meaning that the overall figures and diagnostic picture are likely to be worse. National media are reporting the results widely, not least for the broader diagnostic patterns they suggest.

The study, led by Dr. Susanna N. Visser, underlines several clearly defined trends: children aren’t just being diagnosed with ADHD in far-greater numbers than even a few years ago; they also are being diagnosed at an earlier age, with half receiving a diagnosis at age 6 or below: 17.1 percent at age 6, 14.6 percent at age 5, and 16 percent at age 4 or younger.

Some commentators have been quick to call this good news, with the dramatic rise in diagnoses suggesting that physicians were getting better and more effective at detecting ADHD sooner. “In general, there’s more awareness of the diagnosis,” Dr. Michael F. Troy, Medical Director of Behavioral Health Services at Children's Hospitals and Clinics of Minnesota, told CBS News, “and once something’s accepted as a relatively common diagnosis, it becomes less stigmatized.” Or, it simply becomes easier to diagnose.

Others noted Dr. Visser’s observation that “one out of five children had a diagnosing provider who relied only on information collected from family members.” This goes against American Academy of Pediatrics (AAP) guidelines that information should be collected from multiple sources, such as teachers, coaches, and other adults involved in the child’s care. It indicates that one-in-five ADHD diagnoses in school-age children are heavily reliant on the way family members interpret that behavior.

Additionally, one out of every 10 children was diagnosed without the use of a behavior rating scale that is meant to be administered, raising further concerns about diagnostic accuracy.

Children under the age of six were more likely to receive an ADHD diagnosis from a psychologist, the survey determined; for those aged 6-13, a psychiatrist was more likely to make the diagnosis. In either case, the survey pointed to limitations to the current diagnostic process, especially for children younger than 6, since no official diagnostic process exists for that population and few diagnostic methods would prove accurate in children that young.

The survey follows reports that in some parts of the country—the South, for instance—23 percent of school-age boys have received an ADHD diagnosis. The CDC itself reported earlier this year that the number of U.S. children aged 2-3 currently medicated for ADHD exceeded 10,000.

christopherlane.org  Follow me on Twitter: @christophlane

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