Recent Trends in Childhood Attention-Deficit/Hyperactivity Disorder

JAMA pediatrics 01/2013; 167(3):1-7. DOI: 10.1001/2013.jamapediatrics.401
Source: PubMed


OBJECTIVE To examine trends in attention-deficit/hyperactivity disorder (ADHD) by race/ethnicity, age, sex, and median household income. DESIGN An ecologic study of trends in the diagnosis of ADHD using the Kaiser Permanente Southern California (KPSC) health plan medical records. Rates of ADHD diagnosis were derived using Poisson regression analyses after adjustments for potential confounders. SETTING Kaiser Permanente Southern California, Pasadena. PARTICIPANTS All children who received care at the KPSC from January 1, 2001, through December 31, 2010 (n = 842 830). MAIN EXPOSURE Period of ADHD diagnosis (in years). MAIN OUTCOME MEASURES Incidence of physician-diagnosed ADHD in children aged 5 to 11 years. RESULTS Rates of ADHD diagnosis were 2.5% in 2001 and 3.1% in 2010, a relative increase of 24%. From 2001 to 2010, the rate increased among whites (4.7%-5.6%; relative risk [RR] = 1.3; 95% CI, 1.2-1.4), blacks (2.6%- 4.1%; RR = 1.7; 95% CI, 1.5-1.9), and Hispanics (1.7%-2.5%; RR = 1.6; 95% CI, 1.5-1.7). Rates for Asian/Pacific Islander and other racial groups remained unchanged over time. The increase in ADHD diagnosis among blacks was largely driven by an increase in females (RR = 1.9; 95% CI, 1.5-2.3). Although boys were more likely to be diagnosed as having ADHD than girls, results suggest the sex gap for blacks may be closing over time. Children living in high-income households were at increased risk of diagnosis. CONCLUSIONS The findings suggest that the rate of ADHD diagnosis among children in the health plan notably has increased over time. We observed disproportionately high ADHD diagnosis rates among white children and notable increases among black girls.

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    • "ADHD prevalence rates vary significantly between and within countries, and depend on the ascertainment method and criteria utilized. Of particular concern is the marked variability in diagnostic rates of ADHD in developed countries (Getahun et al., 2013). This may reflect increased awareness of teachers and parents to symptoms of ADHD in communities with a focus on education and adequate health care. "
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    ABSTRACT: Finding neurobiological markers for neurodevelopmental disorders, such as attention deficit and hyperactivity disorder (ADHD), is a major objective of clinicians and neuroscientists. We examined if functional Magnetic Resonance Imaging (fMRI) data from few distinct visuospatial working memory (VSWM) tasks enables accurately detecting cases with ADHD. We tested 20 boys with ADHD combined type and 20 typically developed (TD) boys in four VSWM tasks that differed in feedback availability (feedback, no-feedback) and reward size (large, small). We used a multimodal analysis based on brain activity in 16 regions of interest, significantly activated or deactivated in the four VSWM tasks (based on the entire participants' sample). Dimensionality of the data was reduced into 10 principal components that were used as the input variables to a logistic regression classifier. fMRI data from the four VSWM tasks enabled a classification accuracy of 92.5%, with high predicted ADHD probability values for most clinical cases, and low predicted ADHD probabilities for most TDs. This accuracy level was higher than those achieved by using the fMRI data of any single task, or the respective behavioral data. This indicates that task-based fMRI data acquired while participants perform a few distinct VSWM tasks enables improved detection of clinical cases.
    Clinical neuroimaging 09/2015; DOI:10.1016/j.nicl.2015.08.015 · 2.53 Impact Factor
    • "There has been a growing concern that child and adolescent mental health problems may be becoming more common, given sharp increases in rates of service use, diagnosis and treatment in many countries (Kessler et al., 2005; Kosidou et al., 2010; Sourander, Niemel€ a, Santalahti, Helenius, & Piha, 2008). For example, there has been a dramatic increase in diagnosis and treatment of ADHD over recent decades in the US (Getahun et al., 2013; Olfson, Gameroff, Marcus, & Jensen, 2003; Toh, 2006), the UK (Hsia & Maclennan, 2009; McCarthy et al., 2012), and other European countries (Atlad ottir et al., 2007; Getahun et al., 2013; Tick, Van Der Ende, & Verhulst, 2007). These increases might be explained by increased clinical recognition, changing diagnostic criteria and practice, changes in treatment availability and perceived efficacy, or by increases in the population prevalence of mental health symptoms and their functional impact (Collishaw, 2012). "
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    ABSTRACT: Background Child and adolescent mental health problems are common, associated with wide-ranging functional impairments, and show substantial continuities into adult life. It is therefore important to understand the extent to which the prevalence of mental health problems has changed over time, and to identify reasons behind any trends in mental health.Scope and MethodologyThis review evaluates evidence on whether the population prevalence of child and adolescent mental health problems has changed. The primary focus of the review is on epidemiological cross-cohort comparisons identified by a systematic search of the literature (using the Web of Knowledge database).FindingsClinical diagnosis and treatment of child and adolescent psychiatric disorders increased over recent decades. Epidemiological comparisons of unselected population cohorts using equivalent assessments of mental health have found little evidence of an increased rate of ADHD, but cross-cohort comparisons of rates of ASD are lacking at this time. Findings do suggest substantial secular change in emotional problems and antisocial behaviour in high-income countries, including periods of increase and decrease in symptom prevalence. Evidence from low- and middle-income countries is very limited. Possible explanations for trends in child and adolescent mental health are discussed. The review also addresses how cross-cohort comparisons can provide valuable complementary information on the aetiology of mental illness.
    Journal of Child Psychology and Psychiatry 12/2014; 56(3). DOI:10.1111/jcpp.12372 · 6.46 Impact Factor
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    • "Prevalence studies utilize data from crosssectional study designs, and estimates have been reported from a variety of epidemiologic data sources. National surveys include items on the parent report of health-care-provider-diagnosed ADHD (Akinbami et al., 2011; Visser et al., 2014), insurance claims have been mined to create estimates of diagnosed and treated (medicated) ADHD (Getahun et al., 2013), and community-based samples have used epidemiologic screening methods and direct diagnostic interviews to determine which children meet "
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    ABSTRACT: Objective: To examine ADHD symptom persistence and factors associated with elevated symptom counts in a diverse, longitudinal community-based sample. Method: Parents reported demographics and completed a diagnostic interview repeatedly over a 6-year period. At Time 1, 481 interviews were completed about children (5-13 years); all participants were invited to four annual follow-up interviews, and 379 (79%) completed at least one. Inattentive (IA) and hyperactive-impulsive (HI) symptom counts were modeled with logistic quantile regression, while accounting for study design complexities. Results: The prevalence of seven IA symptoms remained stable from early childhood through late adolescence. The prevalence of eight HI symptoms decreased by more than half over time. After demographic adjustment, the upper quartile of HI symptom counts decreased with age (p < .01). High HI symptom counts persisted more among those with high IA symptom counts (p = .05). Conclusion: This study further characterizes and provides insights into ADHD symptom trajectory through adolescence.
    Journal of Attention Disorders 07/2014; DOI:10.1177/1087054714539997 · 3.78 Impact Factor
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