Study Finds Almost 9% of American Children Meet DSM-IV Criteria for ADHD

Marlene Busko

September 20, 2007

September 20, 2007 -- A survey of a nationally representative sample of 8- to 15-year-old American children found that 8.7% met the Diagnostic and Statistical Manual of Mental Disorders, 4th ed ( DSM-IV) criteria for attention deficit/hyperactivity disorder (ADHD). Among children meeting the criteria, only 47% had been diagnosed with ADHD and 32% were receiving consistent medication for it.

These key findings are from a study by Tanya E. Froehlich, MD, from the University of Cincinnati College of Medicine, in Ohio, and colleagues. The article appears in the September issue of the Archives of Pediatrics & Adolescent Medicine.

"The most important message is that we want physicians to be more aware of the symptoms of ADHD and to do a thorough diagnostic assessment," Dr. Froehlich told Medscape Psychiatry. She cautioned that although medications are very effective for most children who truly have ADHD, they are not effective for all children, and effective behavioral treatments exist. "We want children who are suffering from ADHD to be recognized, and we want families to know what the treatment options are, but not necessarily to go straight to medication," she said.

The group writes that despite concerns that the rate of ADHD is on the rise, the national prevalence of ADHD among American children is not clear and has been estimated at anywhere from 2% to 26%.

The researchers aimed to use a national sample with DSM-IV-based diagnostic criteria to estimate the prevalence of ADHD in American children and also to determine whether the prevalence, recognition, and treatment varied by socioeconomic group.

The study sample included the 3082 children, aged 8 to 15 years old, who participated in the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2004 and for whom DSM-IV ADHD diagnostic status was available.

Dr. Froehlich explained that to interview the caregivers, the researchers used a structured interview based on DSM-IV criteria for ADHD, which probed for 9 symptoms of inattention and 9 symptoms of hyperactivity.

To determine whether the child met the criteria for inattention, they asked the caregiver if their child had difficulty concentrating, avoided activities requiring long periods of attention, was very disorganized, omitted things that were necessary for schoolwork, had trouble finishing tasks, forgot what they were supposed to do, made mistakes that were careless in nature, did not listen when people were talking to them, or started things and did not finish them.

To determine whether the child met the criteria for hyperactivity/impulsiveness, they asked the caregiver if their child was overactive, seemed always on the go and driven by a motor, was fidgety or restless, left their seat when seating was expected, climbed and ran about when they were not supposed to, talked a lot and interrupted other people, made more noise than other children during an activity, butted in on what other people were doing, or had trouble waiting for their turn. The caregivers were asked if this behavior was seen at home and also at school.

The researchers found that 8.7% of the children (equivalent to 2.4 million children nationwide) met the criteria for having ADHD in the year prior to the survey. Hispanics were less likely than whites to meet the criteria, and boys were more likely than girls to meet the criteria, although girls with ADHD were less likely to have their disorder identified.

They authors note that 1 study limitation is that although the American Academy of Pediatrics recommends that both caregiver and teacher reports be used to diagnose ADHD, the current study used only a caregiver report of impairment at both home and school, which meets DSM-IV requirements. Lower overall rates of ADHD might be obtained when reports from both teachers and parents are available.

They summarize that that their study shows that first, DSM-IV-diagnosed ADHD is prevalent in American children, especially among poorer children, which needs to be further investigated. Second, less than half of the children who met the criteria for DSM-IV ADHD had their condition diagnosed or treated, "suggesting that some children with clinically significant inattention and hyperactivity may not be receiving optimal attention." Finally, poorer children were least likely to receive medication, which "warrants further investigation and possible intervention."

Arch Pediatr Adolesc Med. 2007;161:857-864. Abstract

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