Parent-Reported Attention-Deficit/Hyperactivity Disorder Diagnosis
JAMA Pediatrics has published a research letter by CDC authors, entitled “Convergent Validity of Parent-Reported Attention-Deficit/Hyperactivity Disorder Diagnosis: A Cross-Study Comparison” (1).
Main Finding from this Study
Parent-reported data have been used to monitor the number of children who have Attention-Deficit/ Hyperactivity Disorder (ADHD). However, there is limited evidence about how valid these reports are as an indicator of a medical diagnosis. This study compared the estimated percentage of children medically diagnosed with ADHD as reported by parents on a national survey to the percentage from a recent study that used administrative data from medical records of a large health plan in California. When the percentage of children was estimated using samples with similar characteristics, the parent-reported ADHD estimate was similar to the ADHD estimate calculated from health plan medical records. This suggests that the efficient method of monitoring diagnosed childhood ADHD through parent-report may be a valid method of monitoring diagnosed ADHD in the community. Gathering accurate data on ADHD is a CDC priority and work towards understanding these parent-reported data continues.
About this study
What was the goal of the study?
- In a previous study, researchers from California published findings from a study of more than 842,000 children using Kaiser Permanente Southern California health plan medical records from 2001 to 2010 to estimate the number of children with ADHD (2). They reported that 4.9% of children aged 5-11 years met their criteria for having ADHD. This estimate was compared to previous parent-reported estimates of ADHD diagnosis in the United States (3), stating that parent-reported estimates of ADHD diagnosis overestimate the true prevalence of ADHD.
- In the current study, CDC researchers limited data used in their previous study of parent-reported ADHD diagnosis in the United States to a sample that was similar to that of the California study and then compared estimates across the two studies. Specifically the sample was limited to children 5-11 years of age, living in California, who had health insurance.
What were the study results?
- On initial inspection, the percentage of children with ADHD from California-based health plan medical records (4.9%) was lower than previously published national (9.5%) and California-based (6.2%) estimates of parent-reported ADHD diagnosis.
- However, when the parent-reported data were limited to children with similar demographic characteristics (age, state of residence, and insurance status), CDC researchers found the parent-reported estimate (4.7%) similar to that of the California study (4.9%).
- This comparison study suggests that using parent report of ADHD diagnosis provides estimates of the percentage of children affected with ADHD similar to those from health plan medical records. Because the estimates are so similar, it is more likely that they are valid measures of the percentage of children with diagnosed ADHD in the community. This finding provides evidence for the value of using parent-reported ADHD for monitoring over time the national and state-based percentages of children affected by ADHD.
ADHD and CDC’s Work
CDC monitors the number of children who have been diagnosed with ADHD through the use of national survey data. Including questions about ADHD on national or regional surveys helps us learn more about the number of children with ADHD, their use of ADHD treatments, and the impact of ADHD on children and their families. CDC has previously used national survey data to document increasing estimates of the number of children with ADHD from 2003-2007 (3). CDC has also used these data to estimate the percentage of children taking medication for ADHD, nationally and by state (4).
CDC also conducts community-based studies to better understand the impact of ADHD. 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 as well as the needs of children and families living with ADHD.
CDC 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 (http://www.help4adhd.org/NRC.aspxexternal icon) has links to information based on the current best medical evidence about the care for people with ADHD and their families. The National Resource Center operates a call center with trained, bilingual staff to answer questions about ADHD. Their phone number is 1-800-233-4050.
To learn more about ADHD and CDC’s work in the area of ADHD, please visit https://www.cdc.gov/ncbddd/adhd
- Visser SN, Danielson ML, Bitsko RH, Perou R, Blumberg SJ. Convergent validity of parent-reported attention-deficit/hyperactivity disorder diagnosis: A cross-study comparisonexternal icon. JAMA Pediatr. 2013; 1-2. doi:10.1001/jamapediatrics.2013.2364
- Getahun D, Jacobsen SJ, Fassettet MJ, et al., Recent trends in childhood attention-deficit/hyperactivity disorder. JAMA Pediatr. 2013; 167 (3):282-288.
- Centers for Disease Control and Prevention. Increasing prevalence of parent-reported attention-deficit/hyperactivity disorder among children — United States, 2003 and 2007. MMWR Morb Mortal Wkly Rep. 2010;59:1439-1443.
- Visser SN, Blumberg SJ, Danielson ML, Bitsko RH, Kogan MD. State-based and demographic variation in parent-reported ADHD medication rates, 2007-2008. Prev Chron Dis. 2013;10:20073.