Prevalence, Recognition, and Treatment of Attention-Deficit/Hyperactivity Disorder in a National Sample of US Children

Froehlich, Tanya E. MD
Lanphear, Bruce P. MD, MPH
Epstein, Jeffery N. PhD
Barbaresi, William J. MD
Katusic, Slavica K. MD
Kahn, Robert S. MD, MPH

Author Affiliations: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (Drs Froehlich, Lanphear, Epstein, and Kahn); and Departments of Pediatric and Adolescent Medicine (Drs Barbaresi and Katusic) and Health Sciences Research (Dr Katusic), Mayo Clinic, Rochester, Minnesota.

Correspondence: Tanya E. Froehlich, MD, Cincinnati Children's Hospital Medical Center, Mail Location 4002, 3333 Burnet Ave, Cincinnati, OH 45229 ([email protected]).

Accepted for Publication: April 5, 2007.

Author Contributions: Dr Froehlich had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Froehlich, Lanphear, and Kahn. Acquisition of data: Froehlich and Kahn. Analysis and interpretation of data: Froehlich, Lanphear, Epstein, Barbaresi, Katusic, and Kahn. Drafting of the manuscript: Froehlich, Lanphear, and Kahn. Critical revision of the manuscript for important intellectual content: Froehlich, Lanphear, Epstein, Barbaresi, Katusic, and Kahn. Statistical analysis: Froehlich and Kahn. Obtained funding: Froehlich, Lanphear, and Kahn. Administrative, technical, and material support: Froehlich and Kahn. Study supervision: Lanphear, Epstein, and Kahn.

Financial Disclosure: None reported.

Funding/Support: This study was supported by the Ambulatory Pediatrics Association Young Investigator Grant (Dr Froehlich), National Research Service Award grant 1T32PE10027 (Drs Froehlich and Lanphear), grant K23-HD40362-01 from the National Institutes of Health (Dr Kahn), and a Robert Wood Johnson Generalist Physician Faculty Scholars Award (Dr Kahn).

Role of the Sponsors: The funding organizations played no role in the design and conduct of the study, in the collection, management, analysis, and interpretation of the data, or in the preparation, review, or approval of the manuscript.

Independent Statistical Analysis: The NHANES data are collected by the National Center for Health Statistics (NCHS). All analyses, interpretations, and conclusions expressed in this manuscript are those of the authors and not the NCHS, which is responsible only for the initial data.

Additional Contributions: Debra J. Brody, MPH (Division of Health Examination Statistics [NHANES program], National Center for Health Statistics, Centers for Disease Control and Prevention), and Peggy Auinger, MS (Department of Pediatrics, University of Rochester School of Medicine), provided valuable assistance with accessing and analyzing the NHANES dataset. Ms Auinger was compensated for her assistance.

Archives of Pediatrics & Adolescent Medicine 161(9):p 857-864, September 2007.

Objective

To determine the US national prevalence of attention-deficit/hyperactivity disorder (ADHD) and whether prevalence, recognition, and treatment vary by socioeconomic group.

Design

Cross-sectional survey.

Setting

Nationally representative sample of the US population from 2001 to 2004.

Participants

Eight- to 15-year-old children (N = 3082) in the National Health and Nutrition Examination Survey.

Main Outcome Measures

The Diagnostic Interview Schedule for Children (caregiver module) was used to ascertain the presence of ADHD in the past year based on Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV) criteria. Prior diagnosis of ADHD by a health professional and ADHD medication use were assessed by caregiver report.

Results

Of the children, 8.7% met DSM-IV criteria for ADHD. The poorest children (lowest quintile) were more likely than the wealthiest (highest quintile) to fulfill criteria for ADHD (adjusted odds ratio [AOR], 2.3; 95% confidence interval [CI], 1.4–3.9). Among children meeting DSM-IV ADHD criteria, 47.9% had a prior diagnosis of ADHD and 32.0% were treated consistently with ADHD medications during the past year. Girls were less likely than boys to have their disorder identified (AOR, 0.3; 95% CI, 0.1–0.8), and the wealthiest children were more likely than the poorest to receive regular medication treatment (AOR, 3.4; 95% CI, 1.3–9.1).

Conclusions

Of US children aged 8 to 15 years, 8.7%, an estimated 2.4 million, meet DSM-IV criteria for ADHD. Less than half of children meeting DSM-IV criteria report receiving either a diagnosis of ADHD or regular medication treatment. Poor children are most likely to meet criteria for ADHD yet are least likely to receive consistent pharmacotherapy.