Twenty-Year Trends in Diagnosed Attention-Deficit/Hyperactivity Disorder Among US Children and Adolescents, 1997-2016

Guifeng Xu,Wei Bao,Buyun Liu,Binrang Yang,Lane Strathearn

doi:10.1001/jamanetworkopen.2018.1471

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is common in US children and adolescents. It is important to understand the most recent prevalence of ADHD and its long-term trends over the past decades. To estimate the prevalence of diagnosed ADHD and 20-year trends from 1997 to 2016 among US children and adolescents using nationally representative data. In this population-based, cross-sectional survey study (National Health Interview Survey), surveys were conducted annually from 1997 to 2016. A total of 186 457 children and adolescents aged 4 to 17 years from 1997 to 2016 were included in this analysis. Data were collected through in-person household interviews with a parent or guardian. The data analysis was performed in January 2018. Attention-deficit/hyperactivity disorder diagnosed by a physician or other health care professional. Among the included 186 457 children and adolescents (96 017 boys [51.5%], 51 350 Hispanic [27.5%], 91 374 non-Hispanic white [49.0%], 28 808 non-Hispanic black [15.5%], 14 925 non-Hispanic other race [8.0%]), 14 704 children and adolescents (7.9%; 10 536 boys [71.7%], 2497 Hispanic [17.0%], 9010 non-Hispanic white [61.3%], 2328 non-Hispanic black [15.8%], and 869 non-Hispanic other race [5.9%]) were reported to have ever been diagnosed with ADHD. The weighted prevalence of diagnosed ADHD was 10.2% (95% CI, 9.6%-10.8%) in 2015-2016. There were significant sex and racial/ethnic disparities in the prevalence of diagnosed ADHD. The prevalence was 14.0% (95% CI, 13.1%-15.0%) in boys and 6.3% (95% CI, 5.6%-7.0%) in girls, 6.1% (95% CI, 5.2%-7.0%) in Hispanic individuals, 12.0% (95% CI, 11.1%-12.9%) in non-Hispanic white individuals, and 12.8% (95% CI, 11.0%-14.5%) in non-Hispanic black individuals. Over the 20-year period, the estimated prevalence of diagnosed ADHD in US children and adolescents increased from 6.1% in 1997-1998 to 10.2% in 2015-2016 (P for trend <.001). All subgroups by age, sex, race/ethnicity, family income, and geographic regions showed a significant increase in the prevalence from 1997-1998 to 2015-2016. This study's findings suggest that among US children and adolescents, the estimated prevalence of diagnosed ADHD increased significantly between 1997-1998 and 2015-2016. This study suggests that additional research is needed to better understand the cause of this apparent rise in prevalence.

Highlights

Attention-deficit/hyperactivity disorder (ADHD) is a childhood-onset neuropsychiatric disorder characterized by persistent and impairing inattention, hyperactivity, and impulsivity.[1,2] The symptoms of ADHD often persist into adulthood
The weighted prevalence of diagnosed ADHD was 10.2% in 2015-2016
Over the 20-year period, the estimated prevalence of diagnosed ADHD in US children and adolescents increased from 6.1% in 1997-1998 to 10.2% in 2015-2016 (P for trend

Summary

Introduction

Attention-deficit/hyperactivity disorder (ADHD) is a childhood-onset neuropsychiatric disorder characterized by persistent and impairing inattention, hyperactivity, and impulsivity.[1,2] The symptoms of ADHD often persist into adulthood. The American Psychiatric Association states in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition that 5% of children have ADHD, based on previous worldwide estimates in earlier years.[5,6] The prevalence of ADHD varies across different countries, with a significantly higher prevalence in the United States than in European countries.[7] the prevalence of ADHD has changed over time. Several previous studies in the United States have shown an increase in ADHD prevalence over the past years.[8,9,10,11,12,13,14,15,16,17,18,19] For example, an analysis of the National Health Interview Survey (NHIS) reported a 33% increase in ADHD prevalence from 1997-1999 (5.7%) to 2006-2008 (7.6%) among children and adolescents aged 3 to 17 years.[8] the National Survey of Children’s Health showed a 42% increase between 2003 and 2011 in the prevalence of diagnosed ADHD among children and adolescents aged 4 to 17 years.[9]

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Conclusion