A recent study conducted by the Centers for Disease Control and Prevention found a dramatic increase in the prevalence of childhood ADHD as reported by parents between the years 2003 and 2007. ADHD is one of the most common behavior disorders in children. Children with ADHD have trouble paying attention, controlling impulsive behaviors and display overly active behavior.
There are actually three variations of ADHD according to the American Psychiatric Associations Diagnostic and Statistical Manual, ADHD Predominantly Inattentive, ADHD Primarily Hyperactive, and ADHD Combined (Both inattentive and hyperactive.)
According to the CDC's new findings 10% of the population of children between the ages, 4 and 17 would qualify for a diagnosis of ADHD, that's over 5 million children.
The report also found:
- Approximately 10% or 5.4 million children 4-17 years of age have ever been diagnosed with ADHD, as of 2007.
- The percentage of children with a parent-reported ADHD diagnosis increased by 22% between 2003 and 2007.
- Rates of ADHD diagnosis increased an average of 3% per year from 1997 to 2006 and an average of 5.5% per year from 2003 to 2007.
- Boys (13.2%) were more likely than girls (5.6%) to have ever been diagnosed with ADHD.
- Rates of ADHD diagnosis increased at a greater rate among older teens as compared to younger children.
- The highest rates of parent-reported ADHD diagnosis were noted among children covered by Medicaid and multiracial children.
- Prevalence of parent-reported ADHD diagnosis varied substantially by state, from a low of 5.6% in Nevadato a high of 15.6% in North Carolina.
There has also been a dramatic increase in the use of prescription medications to treat ADHD, these being the stimulant medications; Ritalin, Adderall, and Dexedrine.
So what is going on? Is there truly an ADHD epidemic or are we just getting better at diagnosing and treating this disorder?
According to Dr. Allen Frances, DSM task force member and professor emeritus at Duke, the answer is still not clear. However, Dr. Frances believes that there are a combination of things that have led this 22% increase in reported cases of Childhood ADHD.
"I can think of at least 12 different, probably interacting factors that may have contributed (in greater or lesser degrees) to the huge jump in ADD rates. These are not listed in any presumed order of priority because I am simply not sure how much weight to give to each." Allen Frances, M.D
1. Rates are now higher because our better diagnostic tools and increased awareness allow us to properly identify previously missed cases of true ADD, and/or
2. The changes introduced by the DSM-IV criteria made ADD diagnosis loose by lowering the definitional thresholds, and/or
3. Kids previously diagnosed with Conduct Disorder are now often given an ADD label, and/or
4. Massive direct-to-the-consumer drug company advertising to patients, parents, and teachers has succeeded in elevating ADD to fad status. Drug companies also used thought leader influence on and aggressive marketing to psychiatrists, pediatricians, primary care physicians, and other mental health workers to spread the gospel of ADD, and/or
5. The increase in ADD symptoms results from environmental factors—like kids now being bombarded by an information overload driven by the internet or by drug use or by food additives or environmental toxins, and/or
6. The increased rate of ADD symptoms may be partly due prenatal problems like increased rates of premature birth and maternal drug use, and/or
7. ADD is over diagnosed because of increased perfectionism among parents and teachers who expect more self control from kids than is feasible given their developmental stage, and/or
8. We have less tolerance for what should be expectable and acceptable individual difference in activity levels and inability to focus and control impulses, and/or
9. There has been a decrease in tolerance for ADD symptoms because parents are often single, stressed, and overworked and teachers are confronting large and unruly classes, and/or
10. Enormous publicity generated by the media, the internet, and consumer advocacy groups has increased the visibility, popularity, and acceptability of ADD, and/or
11. Schools require a diagnosis of ADD as a precondition for providing special educational services, and/or
12. Epidemiological studies have relied on an inherently flawed methodology that results in inflated reported prevalence.
Despite the limitations inherent to this kind of research, these findings still raise important questions about whether ADHD is truly increasing or whether there are changes in clinical practice and clinical assessment in this country.
Clearly further work is needed to more precisely identify the results in this CDC report. However, this report does add to a growing body of evidence on the importance of continued ADHD research. A better understanding of how ADHD is diagnosed and how it is treated could affect the well-being of millions of children in the United States.
There is a comprehensive screening tool for ADHD, on the WEBMD site Follow this link to assess your child’s risk for having ADHD.
Source material: APA 2000, Psychiatric Times, CDC.gov, webmd.com, psychology today
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