Girls showed a sharp rise in ADHD diagnosis during eight-year study period.
By 2011, roughly 12% of U.S. children and adolescents had been diagnosed with Attention Deficit/Hyperactivity Disorder (ADHD), a prevalence that represents a 43% increase since 2003. The analysis, based on parent reports from a large national survey, estimates about 5.8 million U.S. children ages 5 to 17 carry an ADHD diagnosis. The study was led by Sean D. Cleary, PhD, MPH, an associate professor of epidemiology and biostatistics at the Milken Institute School of Public Health, George Washington University.
One of the most notable findings was a substantial rise in diagnoses among girls. Parent-reported prevalence for girls climbed from 4.3% in 2003 to 7.3% in 2011 — a 55% increase over eight years. Historically, boys have been diagnosed with ADHD more often than girls, making this shift especially significant for clinicians, educators, and families.
The report, published online in The Journal of Clinical Psychiatry, used data from the National Survey of Children’s Health collected in 2003, 2007 and 2011. That nationally representative, cross-sectional survey asks parents whether a health professional has ever told them their child has ADHD. Cleary and co-author Kevin P. Collins of Mathematica Policy Research examined trends in parent-reported ADHD and the influence of sociodemographic factors across racial and ethnic groups.
The study revealed sharp increases in several subgroups. Adolescents showed a 52% rise in parent-reported ADHD since 2003. Hispanic children experienced the largest relative change among racial/ethnic groups, with an 83% increase in reported diagnosis over the eight-year period. Overall, ADHD prevalence remained highest among white non-Hispanic children, but the upward trends were evident across all racial and ethnic groups examined.
Cleary cautions that this research was not designed to determine why diagnoses have increased. The rise could reflect a true increase in ADHD prevalence, greater awareness and screening, changes in diagnostic practices, or potential over-diagnosis in some settings. He calls for further research to identify the drivers of these trends and to examine the factors contributing to differences by gender, age and racial/ethnic group.
The investigators adjusted their analyses for a range of sociodemographic variables previously linked to ADHD diagnosis, including age, sex, poverty level, primary household language, insurance status, parental marital status and neighborhood safety. These factors were found to influence reported ADHD differently across racial and ethnic groups, suggesting that economic, family and neighborhood contexts matter when interpreting prevalence patterns.
The increase in diagnoses has practical implications because ADHD is commonly treated with stimulant medications such as methylphenidate (Ritalin) and amphetamine formulations. These medications can improve attention and reduce impulsivity for many children and adults with ADHD, but they have raised concerns about possible over-prescription. Cleary emphasizes that parents who notice persistent difficulties with attention, impulsivity or behavior should consult their child’s healthcare provider to pursue an appropriate evaluation rather than assume medication is automatically required.
Children with ADHD may struggle to maintain attention in classroom or home settings, act impulsively, make careless mistakes, or forget tasks and instructions. Without recognition and support, these symptoms can contribute to academic, social and family challenges. Early identification, comprehensive assessment and individualized interventions can reduce impairment and improve long-term outcomes.
Funding: This study was supported by the NIH/National Institute of Mental Health.
Source: JKathy Fackelmann – George Washington University
Image Source: The image is adapted from the GWU press release
Original Research: Abstract for “Racial and Ethnic Disparities in Parent-Reported Diagnosis of ADHD” by Kevin P. Collins and Sean D. Cleary in Journal of Clinical Psychiatry. Published online December 8, 2015. doi:10.4088/JCP.14m09364
Abstract
Racial and Ethnic Disparities in Parent-Reported Diagnosis of ADHD
Background: Attention-deficit/hyperactivity disorder (ADHD) is the most commonly diagnosed behavioral health condition among children in the United States. While overall ADHD prevalence has risen, few studies have looked closely at differences across racial and ethnic groups.
Objective: To analyze trends in parent-reported ADHD prevalence from 2003 to 2011 across racial and ethnic groups, and to assess how sociodemographic factors may explain observed differences.
Method: The analysis used pooled data from three waves of the National Survey of Children’s Health (2003, 2007, 2011), covering 190,408 children ages 5–17. Race/ethnicity categories included white non-Hispanic, black non-Hispanic, Hispanic, and other non-Hispanic. Other variables included gender, age, poverty status, household primary language, insurance coverage, parental marital status, and neighborhood safety. Researchers compared sociodemographic characteristics and year-to-year trends for children with parent-reported ADHD using χ2 tests and fitted adjusted logistic regression models, stratified by race/ethnicity. The outcome variable was parental report that a doctor or health professional had diagnosed the child with ADHD.
Results: From 2003 to 2011, parent-reported ADHD prevalence rose 43% overall (P < .001). Increases were especially pronounced among children aged 10–14 (47%, P < .001) and adolescents 15–17 (52%, P < .001). Although prevalence was highest among white children, all racial/ethnic groups showed rising trends, with Hispanic youth showing an 83% increase (P < .001). Females experienced a larger relative increase (55%, P < .001) than males (40%).
Conclusions: Economic conditions, family structure, primary household language and neighborhood safety were associated with differences in parent-reported ADHD across racial and ethnic groups. While the study identified new insights into how sociodemographic factors relate to reported ADHD diagnoses, additional research is needed to clarify the causes of the observed disparities and the drivers of rising prevalence.
“Racial and Ethnic Disparities in Parent-Reported Diagnosis of ADHD” by Kevin P. Collins and Sean D. Cleary in Journal of Clinical Psychiatry. Published online December 8, 2015. doi:10.4088/JCP.14m09364