September 6, 2018

A recent study1, published online in JAMA Network Open, found that the proportion of children in the United States diagnosed with attention deficit disorder (ADHD or ADD) rose dramatically from 6.1% in 1997 to 10.2% in 2016.

The researchers analyzed data from the nationwide, cross-sectional National Health Interview Survey conducted yearly from 1997 to 2016. This sample included 186,457 children (aged 4 to 17) diagnosed with ADHD by a physician, as reported through in-person interviews with a parent or guardian.

They found increases in total diagnoses across all groups, with significant prevalence differences by age, sex, race/ethnicity, family income, and geographic region as follows:

  • Sex: ADHD was diagnosed more among boys (≈ 14% prevalence in 2015-2016 vs. ≈ 9% prevalence in 1997-1998) than girls (≈3% prevalence in 2015-2016 vs. ≈ 3.1% prevalence in 1997-1998).
  • Race/Ethnicity: Non-Hispanic black children had the highest rate of diagnosis (12.8%) in 2016, followed by non-Hispanic white children (12%). Hispanic youths had the lowest rate of diagnosis (6.1%).
  • Family Income: Families at or below the poverty level had the highest prevalence of ADHD diagnoses (12.9% in 2016). As income increased, prevalence generally decreased.
  • Geographic Region: The Midwest had the highest prevalence of ADHD (12.2%) in 2016. The West had the lowest (7%).

The data does not explain what is responsible for the rising diagnoses, but study coauthor Dr. Wei Bao of the College of Public Health at the University of Iowa suggested three possibilities:

  1. Better understanding and recognition of ADHD symptoms among physicians
  2. Greater public awareness of the condition, which in turn increases the likelihood of pursuing a screening and accurate diagnosis
  3. Biological or environmental risk factors, like the increased survival rates among premature infants who are at higher risk of developing ADHD

Other experts attribute the rise to misdiagnosis, or misreporting of diagnosis by parents.

Regardless, the persistent upward trend demonstrates a need to understand preventable risk factors and further investigate treatment and educational supports for all affected.

1Guifeng Xu, MD; Lane Strathearn, MBSS, FRACP, PhD; Buyun Liu, MD, PhD; et al. “Twenty-Year Trends in Diagnosed Attention-Deficit/Hyperactivity Disorder Among US Children and Adolescents, 1997-2016.” JAMA Network Open. 2018;1(4):e181471. doi:10.1001

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