The number of children diagnosed with attention deficit hyperactivity disorder (ADHD) rose by 43 percent between 2003 and 2011. The percentage of children who have ADHD, however, is not thought to have changed, it’s simply that more are being diagnosed.
While the findings, published today in the Journal of Clinical Psychiatry, may be received as more unnecessary medicalization of childhood, experts welcomed it as good news.
“Part of the problem with ADHD is that there’s a lot of misinformation, so some people would look at that and say we’re just diagnosing too many kids,” said Dr. Mark Wolraich, chief of the developmental and behavioral pediatrics section at the University of Oklahoma Health Sciences Center and a spokesman for the American Academy of Pediatrics. “I see that some of it is encouraging in many kids who have been under-diagnosed in the past may now be getting diagnosed.”
It may be true that doctors have diagnosed ADHD too liberally. But because white boys, particularly those with insurance coverage, have been far more likely to be diagnosed, there are also likely some children with ADHD who lack access to a doctor to diagnose them.
Putting Treatment Within Reach
With a diagnosis comes access to stimulant medications. The drugs effectively manage ADHD symptoms, allowing young people to perform better in school, doctors and psychologists say.
The new research — done by Sean Cleary, PhD, MPH, an asspcoate professor of epidemiology and biostatistics at The George Washington University Sschool of Public Health and Health Services, and Mathematica Policy Research statistician Kevin Collins — suggests the gap in access may be shrinking. Rates of diagnosis among Hispanic youth rose 83 percent. Girls, who are less than half as likely to be diagnosed with ADHD, saw their rates go up by 55 percent.
The rates of diagnoses, which are based on the number of parents who reported that they had been told by a doctor that their child had ADHD, doesn’t explain why the trends have been different for different demographic groups.
“We could speculate that among females there may be a greater recognition of symptoms that in the past wouldn’t have been recognized,” Cleary said. “It is possible that female adolescents may have different forms of verbal aggression than male adolescents.”
The aggression includes teasing and name-calling.
“It’s not particularly surprising if you have teenagers,” he added.
It’s Not Just Little Kids
Rates of diagnosis went up more among adolescents than among younger children, according to the study. Psychologists once thought that kids grew out of ADHD, but more now believe that it usually persists.
“The researchers did show one of the explanations of the increased rates, which is that in the past most of the children were diagnosed at elementary age, and where you’re seeing the increases is more in adolescents,” said Wolraich, who was not involved in the study.
He offered one theory on why the United States could legitimately see more diagnoses even when ADHD is not becoming more common in absolute terms.
“There was a much higher dropout rate in ’50s and ’60s, but you could drop out of high school and still get a decent blue collar job. Now, even with a high school degree, options are limited,” Wolraich said. “So being able to function well in school has become a bigger priority and that’s contributing to why more kids are identified.”
Whatever the reason for the skyrocketing rates, they don’t worry experts as much as children who could benefit from treatment but aren’t given the chance.
“There may be an issue with over-diagnosis, but the greater concern is making sure that kids do get assessed,” Cleary said.