Skip directly to search Skip directly to A to Z list Skip directly to navigation Skip directly to page options Skip directly to site content

PLAY Study Findings (Project to Learn About ADHD in Youth)

PLAY Study Questions and Available Findings

Project to Learn About ADHD in Youth (PLAY)

The study was designed to follow children from elementary school through adolescence and investigate the short and long-term outcomes of children with ADHD. The study questions were to examine:

  • The prevalence and treated prevalence of ADHD in children
  • The existence of comorbid and secondary conditions in children with ADHD
  • The types and rates of health risk behaviors in children with ADHD
  • Current and previous treatment patterns of children with ADHD

The sample includes children from six school districts with diverse populations from varied geographical settings. Because the study population was drawn from a school based sample, it provides information on ADHD symptoms and diagnosis and children’s development over time.

This community sampling method made it possible to find children who are likely to have ADHD, but have not yet been diagnosed with the condition, to learn more about their development over time.

Currently, data are available from the baseline assessment, using information collected from the parents and from teachers when the children were in elementary school.

Prevalence and treated prevalence of ADHD in children

My Story

collage of a diverse group of people

Personal stories from people who are living with ADHD.


Parent and teacher information was used to identify children with symptoms and levels of impairment used in the diagnostic criteria for ADHD. To determine the prevalence of ADHD in this community sample, teachers screened 10,427 children in South Carolina and Oklahoma. Parent reports were collected on 855 children.

  • The number of children in the community sample who had enough symptoms to fit the ADHD diagnosis at the time of the baseline assessment was 8.7% in South Carolina and 10.6% in Oklahoma.
  • The number of parents in the community sample who reported that their children were taking ADHD medication was 10.1% South Carolina and 7.4% in Oklahoma.
  • Of those children taking ADHD medication only 39.5% (SC) and 28.3% (OK) met the case definition.

These finding show that ADHD estimates in this sample were at the upper end of the range of prevalence found in previous studies. There was a large portion of children taking ADHD medication who did not meet the ADHD diagnostic criteria. These children had more ADHD symptoms, on average, than the other comparison children. Many children meeting case criteria had not been previously identified and were not receiving medication treatment, suggesting that the condition remains underdiagnosed.

Read more about rates of ADHD here.

Mark L. Wolraich, Robert E. McKeown, Susanna N. Visser, David Bard, Steven Cuffe, Barbara Neas, Lorie L. Geryk, Melissa Doffing, Matteo Bottai, Ann J. Abramowitz, Laoma Beck, Joseph R. Holbrook, and Melissa Danielson (2014). The prevalence of ADHD: Its diagnosis and treatment in four school districts across two states. Journal of Attention Disorders, 18 (7), 563-575.

Current and previous treatment patterns of children with ADHD

At the baseline assessment, parent reported whether their elementary-age children took medication for ADHD. We examined the medication rate for all children with ADHD as well as the rates for the three subtypes of ADHD: children with predominantly hyperactive symptoms, children with predominantly inattentive symptoms, and children with a combination of hyperactive and inattentive symptoms.

Percentage of children with ADHD taking ADHD medication by ADHD subtype, ADHD(all) 43% medicated, Combined 49% medicated, Hyperactive 32% medicated, and Inattentive 42% Medicated

Susanna N. Visser, Steven P. Cuffe, Joseph R Holbrook, Robert E. McKeown, (2010). Patterns in ADHD Medication Use among an Epidemiological Cohort of Youth. Poster presented at AACAP, Toronto Canada.

Comorbid and secondary conditions in children with ADHD

At the baseline assessment, children were also assessed on symptoms and impairment that would be sufficient for a diagnosis of a clinical disorder other than ADHD. The findings show that the prevalence of disorders from all diagnostic groups was higher among children with ADHD than among those without ADHD:

  • 53.4% had at least one other disorder
  • 44.3% had oppositional defiant disorder
  • 13.5% had conduct disorder
  • 16.8% had an affective or anxiety disorder

Types and rates of health risk behaviors in children with ADHD

At the baseline assessment, parents were asked about risky behaviors, including behaviors that could cause injury and early signs of smoking. Parents reported the following health risk behaviors for their elementary-age children:

Percentage of Chidlren Engaging in Health Risk Behavior

Susanna N. Visser, Melissa Danielson, Steven P. Cuffe, Robert E. McKeown, Rebecca H. Bitsko, Angelika H. Claussen, David E. Bard, Mark Wolraich (2011). Health Risk Behaviors over Time among Youth with ADHD. Poster presented at AACAP, Toronto Canada.

Follow Up

Follow up studies are underway.