The Prevalence of Attention-Deficit/Hyperactivity Disorder: Its Diagnosis and Treatment in a Community Based Epidemologic Study
CDC’s National Center on Birth Defects and Developmental Disabilities (NCBDDD) funded one of the largest community-based, epidemiologic studies of ADHD in the United States to enhance our understanding of ADHD in children and to make the most informed decisions and recommendations about potential public health prevention and intervention strategies.
To that end, researchers from the CDC, the University of Oklahoma Health Sciences Center, and the University of South Carolina used data from the multisite Project to Learn about ADHD in Youth (PLAY) to examine the prevalence and treatment of ADHD in two communities. The results were published in the Journal of Attention Disorders1.
Main Study Findings
This article from the PLAY study presents information about the rates of ADHD and treatment for ADHD in two diverse communities in South Carolina and Oklahoma. Teachers from four school districts in the two states screened over 10,000 elementary school-aged children for ADHD. Ultimately, 855 families participated in an interview that used a single, rigorous DSM-IV-based case definition to identify children who met the study’s ADHD case definition at the time of the interview.
- ADHD prevalence rates were at the upper end of previous community-based estimates of ADHD. Based on the interviews, the percentage of children 5-13 years of age who met the study’s case definition was 8.7% in SC and 10.6% in OK.
- Many children taking ADHD medication did not meet the study’s case definition for ADHD. The total percentage of children taking ADHD medication was 10.1% in SC and 7.4% in OK. Of those children taking ADHD medication, only 39.5% (SC) and 28.3% (OK) met the case definition.
- Some children taking ADHD medication and not meeting study criteria were probably appropriately treated; some may have been inappropriately treated. The large portion of children taking ADHD medication who did not meet the ADHD case definition had more ADHD symptoms, on average, than the other comparison children. This suggests that: 1) many of these children may have been appropriately treated for ADHD, resulting in a decrease in symptoms so that their symptoms or level of impairment no longer met the study’s case definition, and 2) some children may have had insufficient symptoms or impairment and were inappropriately treated with medications.
These findings highlight the need for consistent application of ADHD criteria when assessing a child for ADHD. Parents and health care practitioners, together, should also revisit treatment plans regularly to make sure they are appropriate.
ADHD is the most common neurobehavioral disorder of childhood. It is usually first diagnosed in childhood and often lasts into adulthood. ADHD causes problems in how well children do in school, in their ability to make and keep friends, and in their ability to function in society.
A previous national survey of parents found that 7.2% of school-aged children in the U.S. (4.1 million children) had a current ADHD diagnosis in 2007, and rates have increased throughout the past decade2,3. Community-based studies, such as PLAY, are an important complement to analyses of parent-reported survey data, as they allow for the assessment of ADHD regardless of a child’s access to care.
The American Academy of Pediatrics provided clinical practice guidelines in 2011 that provide evidence-based recommendations for the diagnosis and treatment of children with ADHD4. In most cases, ADHD is best treated with a combination of medication and behavior therapy. No single treatment is the answer for every child and good treatment plans will include close monitoring, follow-up, and take into account any changes needed along the way.
ADHD and CDC’s Work
CDC conducts community-based studies to better understand the impact of ADHD and other mental and behavioral health conditions. The Project to Learn about ADHD in Youth (PLAY) study methods have been implemented in four community sites. Information from the PLAY study helps us better understand ADHD and other mental and behavioral disorders, as well as the needs of children and families living with these conditions.
CDC also supports the National Resource Center on ADHD, a program of Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), which is a Public Health Practice and Resource Center. Their web site has links to evidence-based information for people with ADHD and their families. The National Resource Center operates a call center with trained, bilingual staff to answer questions about ADHD. The number is 1-800-233-4050.
CDC monitors the prevalence of disruptive behavioral disorders and ADHD, in particular, through the use of national survey data. The estimates that result from these monitoring activities have been used to assess the impact of the disorder over time and have been used to inform investigations of adverse events among children medicated for ADHD.
- Wolraich, M. L., McKeown, R. E., Visser, S. N., Bard, D., Cuffe, S. P., Neas, B., Geryk, L. L., Doffing, M., Bottai, M., Abramowitz, A.J., Beck, L., Holbrook J. R., Danielson, M. (2012). The Prevalence of ADHD: Its Diagnosis and Treatment in Four School Districts Across Two States. Journal of Attention Disorders, 18 (7), 563-575. Read the article.
- Increasing Prevalence of Parent-Reported Attention-Deficit/Hyperactivity Disorder Among Children – United States, 2003 and 2007 Morbidity and Mortality Weekly Report (MMWR); November 12, 2010 / 59(44);1439-1443.
- Akinbami, L. J., X. Liu, et al. (2011). Attention deficit hyperactivity disorder among children aged 5–17 years in the United States, 1998–2009. NCHS data brief. 70.
- ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents; Subcommittee on Attention-Deficit/Hyperactivity Disorder , Steering Committee on Quality Improvement and Management; Pediatrics peds.2011-2654; published ahead of print October 16, 2011, doi:10.1542/peds.2011-2654.