ADHD on the rise in the U.S.
Attention deficit hyperactivity disorder, known as ADHD, has nearly doubled over the last generation to include more than 10 percent of U.S. children, according to a recent study published in JAMA Network Open.
Between 1997-1998 and 2015-2016, the prevalence of the diagnosis increased across age, gender, race/ethnicity, income and geography, but is notably twice as high in girls and Hispanic children and has more than doubled for Black children.
The results contain several qualifiers, such as the findings “suggest” an “estimated” prevalence of 10 percent.
Several Texas Medical Center experts said the analysis confirmed the trends they have observed over the last two decades.
“It isn’t surprising that the number has gone up over time considering all of the factors involved,” said Adiaha I. A. Spinks-Franklin, M.D., MPH, a developmental-behavioral pediatrician at Texas Children’s Hospital and an assistant professor of developmental pediatrics at Baylor College of Medicine. “The results are very compelling. What the results show is what many of us in medicine have suspected for a long time—that the prevalence has gone up. We really didn’t have the hard-core national numbers to back that up. I wasn’t surprised when I read the study at all.”
She noted that the research was based on parent reports and not medical records.
ADHD is one of the most common mental disorders affecting children, according to the American Psychiatric Association, with symptoms including inattention, hyperactivity and impulsivity.
The recent analysis examined data for 186,457 children ages 4 to 17 from in-person household interviews where a child in each family was randomly selected and a parent was asked: “Has a doctor or health professional ever told you that [the sample child] had attention-deficit/hyperactivity disorder (ADHD) or attention-deficit disorder (ADD)?” Each parent in the 2016 survey also received an inquiry about whether the sample child currently had ADHD or ADD.
For Spinks-Franklin, the arc of the research tracks with her career; she was in medical school in 1997 and has been a pediatrician nearly 20 years.
“There are a whole lot of prenatal and perinatal factors that are related to the risk of having ADHD too, including genetics,” she said. “If a parent has ADHD, their likelihood of having a child with ADHD is very high. If a mother smokes or uses alcohol or drugs or has poor nutrition or was under significant stress during her pregnancy, it increases the risk of the child being diagnosed with ADHD.”
Criteria has broadened
Both Spinks-Franklin and Memorial Hermann Health System child psychiatrist Carlos Guerra, M.D., pointed out that the criteria the scientific community uses for diagnosing ADHD has broadened over the last two decades.
“It used to be a hard-and-fast rule that you must have been diagnosed or at least have had significant impairment before the age of 7. Well, that’s no longer the case,” Guerra said, adding that the baseline age was lifted to 12 under the DSM-5, the American Psychiatric Association’s “Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition,” published in 2013.
“You’re seeing an increase because you have better ability to diagnose, less stigma and maybe more access to medical care,” he said. “Many parents recognize that they have it, so they are willing to let their kids be diagnosed. And then you’re looking at the criteria change—and that’s made a lot of difference. Now you’re able to capture a bigger population.”
Guerra, a fast talker who serves as medical director for adolescent psychiatric services at Memorial Hermann Health System’s Prevention and Recovery Center, known as PaRC, also disclosed that he was diagnosed at age 31.
“I didn’t get diagnosed until I got out in the ‘real world’ when I left my residency and was in private practice. That’s when I started to see it affect my world,” he said. “If you can compensate and you’re smart enough, you can get missed for a long period of time … as long as you’re not hyper and not causing destruction in class. I wasn’t bouncing off the walls.”
The study was published online on August 31, 2018 as an open access article in the area of pediatrics. All five authors work for the University of Iowa at the Stead Family Children’s Hospital and/or the College of Public Health.