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In 2013, nearly one in eight males ages three to 17 (12 percent) had been diagnosed with attention-deficit/hyperactivity disorder by a doctor or other health professional, according to parental report.

Importance

Children with attention-deficit/hyperactivity disorder (ADHD) have “difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity).” [1] Three types of ADHD are diagnosed among children: predominantly inattentive type (previously known simply as attention deficit disorder), predominantly hyperactive-impulsive type, or combined type.[2] Treatment for ADHD can include medication, behavioral therapy, emotional counseling, social skills training, or a combination.[3]

Approximately half of all children with ADHD have additional mental disorders, including learning disabilities, oppositional-defiant disorder, Tourette Syndrome, conduct disorder, anxiety, bipolar disorder, or depression.[4]

ADHD can negatively affect children’s lives, especially when the condition goes untreated. Children with ADHD may have a more difficult time making and maintaining friendships.[5] Adolescents with ADHD may be more likely than their non-affected peers to fall behind in their school work,[6] use alcohol and tobacco, have negative moods, and spend less time with their families.[7] Children and adolescents with ADHD are also much more likely than their peers to suffer injuries while walking, biking, or driving and to be admitted to the hospital for accidental poisoning.[8]

The effects of ADHD may be cumulative and can negatively influence adult functioning. One longitudinal study following children with ADHD into young adulthood found that, at age 20, young adults with ADHD were less likely to have completed high school and be enrolled in college, had more trouble maintaining friendships, and had lower job performance ratings than their peers without ADHD. They also had sexual intercourse at an earlier age, were more likely to be involved in a teen pregnancy, to be treated for a sexually transmitted infection, and to have less savings.[9] Another study followed adolescents with ADHD into their late thirties. It found poorer physical and mental health among this group, compared with their peers without ADHD in adolescence, as well as impaired work performance, and greater financial stress.[10]

The Environmental Protection Agency included ADHD as an emerging issue in its report, America’s Children and the Environment: Measures of Contaminants, Body Burdens, and Illnesses. Although it is unknown whether environmental contaminants contribute to ADHD, several of the symptomatic behaviors are similar to those shown by children exposed to lead and PCBs (polychlorinated biphenyls).[11]

Trends

76_fig1The percentage of children diagnosed with ADHD increased from 1997 (5.5 percent) to 2012 (9.5 percent), an increase of nearly 75 percent. The rate declined slightly in 2013, to 8.8 percent. (Figure 1)

Differences by Gender

In 2013, males were more than two times more likely than females to have been diagnosed with ADHD (12 and six percent, respectively). This disparity (of approximately six percentage points) has been consistent since 1997. (Figure 1)

Differences by Race and Hispanic Origin[12]

In 2013, white and black children were more likely than Hispanic children to have been diagnosed with ADHD: 11 and eight percent, respectively, compared with six percent of Hispanic children. (Appendix 1)

Differences by Age

76_fig2In part because there has been more time for identification, a higher proportion of older children have been diagnosed with ADHD. In 2013, two percent of children ages three to four had been diagnosed with ADHD, while nine percent of children ages five to eleven, and 11 percent of children ages 12 to 17 had been. (Figure 2) Since 1997, most of the increase in the rate of ADHD has been in children ages 12 to 17, amongst whom the rate went from seven to 11 percent, while among children ages five to seven it increased from six to nine percent. However, the most striking change has been among children ages three to four, among whom the rate has more than doubled since 1997, from 0.5 to 1.7 percent. (Appendix 1)

Differences by Type of Insurance Coverage

76_fig3In 2013, children with public health insurance were the most likely to have been diagnosed with ADHD (11 percent), followed by children with private insurance (eight percent). Children without insurance were the least likely to have been diagnosed with ADHD, at five percent. (Figure 3)

Differences by Poverty Status

Children below the federal poverty line are more likely to have been diagnosed with ADHD, compared with children at or above poverty (12 percent versus eight percent, in 2013). (Appendix 1) 

State and Local Estimates

State estimates of the number of children with ADHD (as reported by parents) are available for 2011/12 through the National Survey of Children’s Health at the Data Resource Center for Child & Adolescent Health.

International Estimates

Cross-national comparisons of the prevalence of ADHD are problematic, due to the sensitivity of estimates to the particular
measurement methodologies used, and the samples included. However, there is evidence that in many countries ADHD prevalence among children is within the same range as that found within the U.S.[13]

National Goals

Although there are currently no goals specific to ADHD, the federal government, through its Healthy People 2020 initiative, has set a national goal to increase treatment for childhood mental health problems. The goal is to increase the proportion of children with mental health problems who receive treatment from 68.9 percent in 2008 to 75.8 percent in 2020. Among children, ADHD is the most common mental health disorder, as the Healthy People 2020 initiative defines mental disorder.[14]

More information is available here.

What Works to Make Progress on This Indicator

A federal-government-sponsored review of interventions for preschool-aged children at risk for ADHD found that interventions using parent behavior training had greater evidence of effectiveness than stimulant medication. [15]

For school-aged children, the American Academy of Pediatrics recommends the “primary care clinician . . . prescribe US Food and Drug Administration–approved medications for ADHD . . . and/or evidence-based parent and/or teacher-administered behavior therapy as treatment for ADHD, preferably both . . . “[16]

Note: Child Trends does not provide medical advice or diagnosis. Readers are urged to consult with a qualified health professional before embarking on any course of treatment

Related Indicators

Definition

For purposes of this indicator, children with attention-deficit/hyperactivity disorder (ADHD) are those who have been identified by a doctor or other health professional as having the disorder, as reported by a knowledgeable adult within the household, usually a parent.

Children with ADHD are characterized by having a “chronic level of inattention, impulsive hyperactivity, or both such that daily functioning is compromised.”[17] More information is available from the 2000 Diagnostic and Statistical Manual
for Mental Disorders (DSM-IV-TR), which gives criteria for diagnosing ADHD and
is available online.

Note: attention-deficit/hyperactivity disorder is the American Psychiatric Association’s current term used for children who may have previously been diagnosed as having either attention deficit disorder or attention-deficit/hyperactivity disorder.[18]

Data Source

Child Trends’ original analysis of National Health Interview Survey data.

Raw Data Source

National Health Interview Survey

www.cdc.gov/nchs/nhis.htm

Appendix – 1 Percentage of Children Ages 3 to 17 Reported to Have Ever Been Diagnosed by a School or Health Professional as Having ADHD: 1997-2013

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Total 5.5 5.9 5.6 6.6 6.4 7.2 6.4 7.4 6.6 7.4 7.3 8.0 8.6 8.4 8.4 9.5 8.8
Gender
Male 8.3 8.5 8.4 9.3 9.1 10.3 9.0 10.2 9.2 10.7 10.0 11.1 11.8 11.2 12.0 13.5 12.0
Female 2.6 3.2 2.7 3.8 3.5 4.0 3.6 4.5 3.8 4.0 4.3 4.8 5.3 5.5 4.7 5.4 5.5
Race/Hispanic Origin
Non-Hispanic white 6.5 7.0 6.7 8.0 7.4 8.3 7.5 8.7 7.4 8.6 8.4 9.8 10.0 9.9 10.0 9.4 10.7
Non-Hispanic black 4.3 4.9 4.3 5.0 5.7 7.8 6.0 8.1 7.1 7.5 7.9 8.4 10.6 10.7 8.6 5.7 8.4
Hispanic1 3.3 3.5 2.7 3.8 3.5 3.7 3.7 4.0 4.6 5.0 4.0 4.2 5.0 4.3 5.6 11.7 6.3
Non-Hispanic Other 2.4 2.2 3.8 2.1 3.7 1.8 3.1 2.6 2.4 2.4 4.7 3.5 2.3 2.8 3.8 5.1 3.0
Age group
Ages 3-4 0.5 0.7 0.6 1.0 0.8 1.0 0.7 1.9 0.7 0.6 2.0 2.0 1.5 1.7 1.8 1.7 1.7
Ages 5-11 5.9 6.1 5.3 6.5 6.3 6.8 6.3 6.5 6.1 7.4 5.9 7.3 7.6 7.6 7.5 9.5 8.6
Ages 12-17 6.8 7.5 7.7 8.6 8.3 9.6 8.3 10.3 8.9 9.7 10.5 11.1 12.2 11.6 11.9 12.1 11.4
Poverty status
Below federal poverty
level (FPL)
6.7 7.7 7.0 7.1 9.7 7.0 7.5 7.9 9.4 9.0 10.1 10.5 10.5 10.4 12.3 11.6
At or above FPL 6.0 5.8 7.3 6.5 7.2 6.8 7.7 6.7 7.7 7.6 8.3 8.2 7.4 8.1 9.2 8.1
100-199% of
FPL
10.7 8.5 7.0 9.6 8.5
Above 199% of FPL 7.2 7.0 8.6 9.0 8.0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Parental Education2
Some high school or less 4.9 5.7 5.8 4.2 6.4 6.2 6.1 5.3 4.9 6.6 6.0 7.0 8.7 6.8 7.2 7.3
High school graduate/ GED 6.6 5.8 6.9 6.8 9.1 5.0 7.7 7.2 8.6 8.4 8.8 9.7 9.6 7.4 11.0 9.6
Some college, no degree /AA degree 6.1 6.2 7.5 7.6 7.2 7.9 9.1 7.0 9.1 8.1 9.2 9.9 9.1 11.0 11.4 10.1
Bachelor’s degree or higher 5.3 4.5 5.9 5.3 5.6 5.4 5.6 5.5 5.8 5.5 6.4 6.6 6.4 6.8 7.5 7.5
Insurance coverage
Private insurance3 5.2 5.1 6.3 5.8 6.5 5.6 7.0 6.2 6.4 6.3 6.7 7.2 6.4 8.1 8.0 8.1
Public insurance4 9.9 8.5 9.0 9.7 10.5 9.3 9.5 8.5 10.4 9.5 12.1 11.8 12.1 10.1 12.1 10.8
Not insured 4.9 5.2 5.4 4.4 5.3 6.3 5.5 4.7 4.8 5.9 4.8 5.7 6.1 4.6 7.2 4.5
Usual source of health care5
No usual source 4.1 3.8 5.0 3.1 5.4 5.0 4.1 4.5 2.2 6.0 4.5 7.2 5.0 4.0 6.2 5.4
Usual source 6.1 5.8 6.8 6.6 7.3 6.4 7.6 6.7 7.8 7.4 8.3 8.7 8.6 8.6 9.7 9.0
Welfare/TANF 6
Received income from welfare/TANF 7.7 6.7 9.5 8.9 14.0 14.9 9.9 10.0 9.8 13.1 13.8 14.8 12.4 9.6 14.7 14.3
Did not receive income from welfare/TANF 5.8 5.6 6.4 6.1 6.8 5.9 7.3 6.4 7.3 7.0 7.7 8.3 8.2 8.4 9.2 8.6
Food Stamps/SNAP 6
Authorized to receive food stamps/SNAP 7.0 7.3 8.4 10.0 11.0 9.6 9.3 8.6 11.9 11.6 12.8 12.3 12.4 10.8 12.2 12.0
Not authorized to receive food stamps/SNAP 5.8 5.4 6.4 5.9 6.6 5.9 7.1 6.3 6.6 6.5 7.1 7.7 7.2 7.6 8.6 7.7
1Persons of Hispanic origin may be of any race.2Parental education reflects the education level of the most educated parent in the child’s household.3Children with both public and private insurance are placed in the private insurance category.4As defined here, public health insurance for children consists mostly of MEDICAID or other public assistance programs, including State plans. It does not include children with only Medicare or the Civilian Health and Medical Care Program of the Uniformed Services (CHAMPUS/CHAMP-VA/Tricare).5Excludes emergency rooms as a usual source of care.

6 At least one family member receives benefit.

Source: Original analysis by Child Trends of National Health Interview Survey data 1997-2013.

Endnotes


[1]National Institutes of Mental Health. (2008). Attention deficit hyperactivity disorder (ADHD) (NIH Publication no. 08-3572). Available at: http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/complete-index.shtml.

[2]Ibid.

[3]Ibid.

[4]Ibid.

[5]Centers for Disease Control and Prevention. (2011). Attention-deficit/hyperactivity disorder: Other concerns and conditions [Electronic Version]. Retrieved July 2012 from http://www.cdc.gov/ncbddd/adhd/conditions.html

[6]U.S. Department of Education. (2003). Identifying and treating attention deficit hyperactivity disorder: A resource for school and home [Electronic Version] from http://www.ed.gov/teachers/needs/speced/adhd/adhd-resource-pt1.pdf.

[7]Whalen, C. K., Jamner, L. D., Henker, B., Delfino, R. J., & Lozano, J. M. (2002). The ADHD spectrum and everyday life: Experience sampling of adolescent moods, activities, smoking, and drinking. Child Development, 73(1), 209-227.

[8]Centers for Disease Control and Prevention. (2011). Attention-deficit/hyperactivity disorder: Other concerns and conditions [Electronic Version]. Retrieved July 2012 from http://www.cdc.gov/ncbddd/adhd/conditions.html

[9]Fischer, M. (2005). Hyperactive kids as adults: Adaptive outcomes. Paper presented at the American Psychological
Association Annual Conference.

[10]Brook, J. S., Brook, D. W., Zhang, C., Seltzer, N., & Finch, S. J. (2013).  Adolescent ADHD and adult physical and mental health, work performance, and financial stress. Pediatrics, 131(1), 5-13.

[11]Environmental Protection Agency. (2003). America’s children and the environment: Measures of contaminants, body burdens, and illnesses. Washington, DC: Author.

[12]Hispanics may be of any race. Estimates for whites and blacks in this report do not include Hispanics.

[13]Faraone, S. V., Sergeant, J., Gillberg, C., & Biederman, J. (2003). The worldwide prevalence of ADHD: Is it an American
condition? World Psychiatry, 2(2), 104–113.

[14]Department of Health and Human Services. (2012). 2020 leading health indicators: Mental health. Available at: http://healthypeople.gov/2020/LHI/mentalHealth.aspx?tab=overview

[15]Charach, A., Carson, P. C., Fox, S., Ali, M. U., Beckett, J., & Lim, C. G. (2012). Interventiions for preschool children at high risk for ADHD: A comparative effectiveness review. Pediatrics, 131(5), e1584-e1604.

[16]American Academy of Pediatrics, Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement and Management. (2011). ADHD: Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, 128(5), 1007-1022.

[17]Centers for Disease Control and Prevention. Attention-deficit/hyperactivity disorder — What is ADHD?   Retrieved December 15, 2009, from http://www.cdc.gov/ncbddd/factsheets/adhd_whatis.pdf

[18]Ibid.

Suggested Citation:

Child Trends. (2014). ADHD. Available at: https://www.childtrends.org/?indicators=ADHD

Last updated: August 2014