ADHD in Children Estimated at 9%

A new study reports some attention getting numbers. The first is that about 9% of children in the United States have attention deficit hyperactivity disorder – ADHD. The second number is that only about 1/3 of them are getting medical treatment.

There have been a number of similar studies done through the years, but this study is considered important because it used the most modern diagnostic criteria for ADHD today, the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition.

The ADHD Information Library has written and maintained for years that about 5% of children in the US had ADHD, and that it has been both “over-diagnosed” and “under-diagnosed.”

Over-diagnosed in the sense that often the medical evaluations leading to a diagnosis don’t consider the differential diagnoses that need to be ruled out before diagnosing ADHD, such as fetal alcohol syndrome, head injuries, tourette’s syndrome, bipolar disorder, and more (see http://newideas.net/adhd/differential-diagnosis ).

Our concern is that this study may have fallen into the same trap. Simply reporting that 9% of children meet the DSM-IV criteria for ADHD is not the same as 9% of the kids having ADHD. Rather, many children who meet the criteria for ADHD actually have some other disorder.

And we have reported that ADHD is under-diagnosed in the sense that only about 1/3 of the kids who actually have ADHD ever get treatment. This study confirms that estimate.

"There is a perception that ADHD is overdiagnosed and overtreated," said lead researcher Dr. Tanya E. Froehlich, from Cincinnati Children's Medical Center. "But our study shows that for those who meet the criteria for ADHD, the opposite problem -- underdiagnosis and undertreatment -- seems to be occurring."

The researchers found that some 2.4 million children between the ages of 8 and 15 meet the medical definition of ADHD, but an estimated 1.2 million children haven't been diagnosed or treated, Froehlich said, adding that "girls were more likely to be undiagnosed."

The researchers studies the data on 3,082 children who participated in the National Health and Nutrition Examination Survey. Using interviews, the researchers were able to establish whether a child met the criteria for ADHD. They also used data from doctors and the numbers of ADHD medications being used to establish diagnosis and treatment patterns, according to the report.

The researchers found that of the 8.7 percent of children who met the criteria for ADHD, only 47.9 percent had been diagnosed with the condition and only 32 percent were treated consistently with medications.

Froehlich said more needs to be done to identify and treat children with ADHD. "It's not a trivial disorder," she said. "It can have an impact on the child and the family if it is not diagnosed and addressed. We need to redouble our efforts to help doctors spot the symptoms of ADHD and make an accurate diagnosis."

September 2007 issue of Archives of Pediatrics & Adolescent Medicine.