Analysis of Survey Results

Parent-reported Cases of ADHD on the Rise, But Treatment Still Lags

January 08, 2014 02:39 pm Jessica Pupillo

A recent study on attention-deficit hyperactivity disorder(www.jaacap.com) (ADHD) demonstrated a 42 percent increase in parent-reported diagnoses of the disorder between 2003 and 2011. It's a trend that's in line with other ADHD prevalence studies and highlights a need for appropriate psychiatric care for children and adults with the disorder.

In 2011-2012, 11 percent of U.S. children ages 4-17 years -- about 6.4 million kids -- were reported by their parents to have received an ADHD diagnosis from a health care professional, according to data gleaned from the National Survey of Children's Health for that time period. Of those with a history of ADHD, 83 percent had a current ADHD diagnosis (8.8 percent of children overall), and 69 percent were reportedly taking medication for ADHD (6.1 percent of children overall). The percentage of children receiving medication for the disorder represented a 28 percent increase from 2007-2008, according to survey results published in the Journal of the American Academy of Child & Adolescent Psychiatry.

"We have seen consistent increases in ADHD diagnosis over the years," said Susanna Visser, M.S., lead author of the study and an epidemiologist for the CDC. Parent-reported diagnosis of ADHD parallels community-based studies of the disorder that involve evaluations of large groups of children, she said. Those studies show one in 10 elementary school children meet the diagnostic criteria for ADHD.

Story highlights
  • In 2011-2012, 11 percent of U.S. children ages 4-17 years were reported by their parents to have received a diagnosis of attention-deficit hyperactivity disorder (ADHD) at some point.
  • Of those with a history of ADHD, 83 percent had a current ADHD diagnosis, and 69 percent were reportedly taking medication for the disorder.
  • Behavior therapy is recommended by the American Academy of Pediatrics as a first-line treatment for preschool-aged children with ADHD, with the possible addition of medication as children age.

What's unknown is whether the actual prevalence of children with ADHD is increasing or whether more parents are willing to talk about ADHD because of reduced stigma, said Theodore Ganiats, M.D., professor of family and preventive medicine at the University of California, San Diego. Either way, he said, "There are still, according to parents, a large number of kids diagnosed with ADHD who are not on treatment."

It's a thought mirrored by a concurrently published editorial, "Beyond Rising Rates: Personalized Medicine and Public Health Approaches to the Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder,"(www.jaacap.com) which calls on primary care health professionals "to take on the challenge of high-quality psychiatric care." The writers also point out that treatment rates for ADHD remain lower than the rate of diagnosis, "suggesting a pattern of undertreatment of ADHD, not overtreatment, as commonly thought."

Many children are diagnosed with the disorder at a young age, the study found. About half of the children diagnosed with ADHD received their diagnosis by age 6, and, in the more severe cases, half are diagnosed by age 4.

"That presents a real opportunity to bring some fantastic behavior therapy to these children," Visser said. Behavior therapy is recommended by the American Academy of Pediatrics(18 page PDF) as a first-line treatment for preschool-aged children with ADHD.

As children age, adding medication to behavior therapy may be appropriate. Clinicians seem to have a greater comfort prescribing medication, and patients are demanding it more now than in the past, Visser observed.

However, deciding whether to prescribe stimulant medications is still a judgment call for physicians, said Ganiats. Not all cases of ADHD require medication, but it can significantly benefit those with ADHD and a predominance of core symptoms, he noted. "I don't think there is any question that the people who need it oftentimes get a lot better with medication."

Adults with ADHD also often do better with medication, said Ganiats, and changes to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders have loosened slightly the diagnostic criteria for adults, requiring they meet only five instead of six criteria. However, there are no "magical answers" when determining whether to treat the disease with medication, according to Ganiats. "You don't want to deny them the stimulant, and you don't want to give them the stimulant if they don't need it," he said.

"We need to ask the medical community to give us some more guidance on what we can do for this incredibly important problem," Ganiats said.

Additional Resources
CDC: Attention-Deficit /Hyperactivity Disorder (ADHD)(www.cdc.gov)

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5): Attention Deficit/Hyperactivity Disorder Fact Sheet(www.dsm5.org)

Children and Adults With Attention-Deficit/Hyperactivity Disorder: National Resource Center(www.chadd.org)


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