sábado, 7 de diciembre de 2013

Key Findings: Trends in the Parent-Report of HCP Diagnosis and Medication Treatment for ADHD: US, 2003-2011|Features|NCBDDD|CDC

Key Findings: Trends in the Parent-Report of HCP Diagnosis and Medication Treatment for ADHD: US, 2003-2011|Features|NCBDDD|CDC

Did You Know?
December 6, 2013
  • A new CDC study found a 42% increase in the prevalence of attention-deficit/hyperactivity disorder (ADHD) in US children aged 4 to 17 years between 2003 and 2011, as reported by parents—estimates vary widely among states.
  • Children with ADHD are more likely to have problems in school, have strained family and peer relationships, and be injured than children without ADHD.
  • Knowing the symptoms of ADHD is essential so children can get the help they need and reach their full potential.
6.4 million children diagnosed with ADHD graphic

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Key Findings: Trends in the Parent-Report of Health Care Provider-Diagnosis and Medication Treatment for ADHD: United States, 2003—2011

A group of children running Researchers from the Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration have published a new study:  “Trends in the Parent-Report of Health Care Provider-Diagnosed and Medicated ADHD: United States, 2003—2011.” You can read the abstract here Adobe PDF fileExternal Web Site Icon 1 and listen to a podcast by the journal discussing the study and its findings here. Audio/Video fileExternal Web Site Icon See below for a summary of the findings from this article. Health care providers who care for children with attention-deficit/hyperactivity disorder (ADHD) and public health practitioners should be aware that an estimated two million more US children were reported by their parents to be diagnosed by a health care provider  with ADHD and a million more were reported to be taking medication for ADHD in 2011, compared to 2003. These health professionals should also be aware of the changing patterns of ADHD in the United States.

About attention-deficit/hyperactivity disorder and this study:

ADHD is a neurobehavioral disorder of childhood that often persists into adulthood. CDC uses national surveys that ask parents about their child’s health to monitor the number of children with ADHD and the treatment patterns for these children. The largest of these surveys is the National Survey of Children’s Health, which has been collected every four years since 2003. Previous results from the 2003 and 2007 surveys found that 7.8% and 9.5% of US children aged 4-17 years were reported by their parents to have ever been diagnosed with ADHD by a health care provider in 2003 and 2007, respectively. The current study looked at data from the third National Survey of Children’s Health, conducted in 2011-2012. The findings tell us more about ADHD diagnosis and treatment patterns, and reflect the substantial impact that ADHD has on families.

Important findings from this study include:

  • More than 1 in 10 (11%) US school-aged children had received an ADHD diagnosis by a health care provider by 2011, as reported by parents.
    • 6.4 million children reported by parents to have ever received a health care provider diagnosis of ADHD , including:
      • 1 in 5 high school boys
      • 1 in 11 high school girls

  • The percentage of US children 4-17 years of age with an ADHD diagnosis by a health care provider, as reported by parents, continues to increase.
    • A history of ADHD diagnosis by a health care provider increased by 42% between 2003 and 2011:
      • 7.8% had ever had a diagnosis in 2003
      • 9.5% had ever had a diagnosis in 2007
      • 11.0% had ever had a diagnosis in 2011
    • Average annual increase was approximately 5% per year 

  • The percentage of children 4-17 years of age taking medication for ADHD, as reported by parents, increased by 28% between 2007 and 2011.
    • Percentage of children taking medication for ADHD was:
      • 4.8% in 2007
      • 6.1% in 2011
    • Average annual increase was approximately 7%  per year

  • The average age of ADHD diagnosis was 7 years of age, but children reported by their parents as having more severe ADHD were diagnosed earlier. 
    • 8 years of age was the average age of diagnosis for children reported as having mild ADHD
    • 7 years of age was the average age of diagnosis for children reported as having moderate ADHD
    • 5 years of age was the average age of diagnosis for children reported as having severe ADHD

  • More US children were reported by their parents to be receiving ADHD treatment in 2011 compared to 2007, however treatment gaps may exist.
    • In 2011, as many as 17.5% of children with current ADHD were reported by their parents as not receiving either medication for ADHD or mental health counseling
    •  More than one-third of  children reported by their parents as not receiving treatment were also reported to have moderate or severe ADHD

  • The patterns in ADHD diagnosis and medication treatment showed increases in the percentages overall, however some new patterns emerged between 2007 and 2011.
    • The percentage of children reported by their parents to have a history of health care provider diagnosed ADHD increased for most demographic groups (for example, across racial groups, boys and girls) from 2003 to 2011; however,
    • Between 2007 and 2011, the percentage of children reported by their parents to have a history of a health care provider diagnosed ADHD:
      • Was similar among older teens
      • Decreased among multiracial children and children of other races when compared to black or white children

  • The number of US families impacted by ADHD continues to increase.
    • An estimated 2 million more children were reported by their parents to be diagnosed by a health care professional with ADHD in 2011, compared to 2003
      • By 2011, 6.4 million children were reported by their parents to be diagnosed by a health professional with ADHD compared to 4.4 million in 2003
    • An estimated 1 million more children were reported by their parents to be taking medication for ADHD in 2011, compared to 2003.
      • By 2011, 3.5 million children were reported by their parents to be taking medication for ADHD compared to 2.5 million in 2003

ADHD: CDC’s Activities

CDC monitors the number of children who have been diagnosed with ADHD through the use of national survey data. Including questions about ADHD on national or regional surveys helps us learn more about the number of children with ADHD, their use of ADHD treatments, and the impact of ADHD on children and their families.  CDC has previously used national survey data to document increasing estimates of the number of children with ADHD from 2003-2007.2 CDC has also used these data to estimate the percentage of children taking medication for ADHD, nationally and by state.3
CDC also conducts community-based studies to better understand the impact of ADHD. The Project to Learn about ADHD in Youth (PLAY) is a study being conducted over time in two communities: one school district in South Carolina and five school districts in Oklahoma.  Information from the PLAY study helps us better understand ADHD as well as the needs of children and families living with ADHD.
CDC supports the National Resource Center on ADHD, a program of Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), which is a Public Health Practice and Resource Center. Their web site (http://www.help4adhd.org/External Web Site Icon) has links to information based on the current best medical evidence about the care for people with ADHD and their families. The National Resource Center operates a call center with trained, bilingual staff to answer questions about ADHD. Their phone number is 1-800-233-4050.

More Information

To learn more about ADHD, please visit http://www.cdc.gov/adhd.


  1. Visser S, Danielson M, Bitsko R, et al. Trends in the Parent-Report of Health Care Provider-Diagnosis and Medication Treatment for ADHD disorder: United States, 2003–2011. J Am Acad Child Adolesc Psychiatry. 2013 Adobe PDF fileExternal Web Site Icon  [published online November 22] doi: 10.1016/j.jaac.2013.09.001.
  2. Centers for Disease Control and Prevention. Increasing Prevalence of Parent-Reported Attention-Deficit/Hyperactivity Disorder Among Children --- United States, 2003 and 2007. MMWR. 2010;59(44):1439-1443.
  3. Visser SN, Blumberg SJ, Danielson ML, Bitsko RH, Kogan MD. State-Based and Demographic Variation in Parent-Reported Medication Rates for Attention-Deficit/Hyperactivity Disorder, 2007-2008. Prev Chronic Dis. Jan 2013;10:E09.

State Profiles

Parent-Reported Diagnosis of ADHD by a Health Care Provider and Medication Treatment Among Children 4-17 Years: National Survey of Children’s Health – 2003 to 2011 – Data Profiles by State

Click on any state in the map to view that state’s profile for prevalence and changes over time.

Map of the United States

U.S. States
Click on any state to view that state's profile.
  • U.S. States

Other Concerns & Conditions

Attention-Deficit/Hyperactivity Disorder (ADHD) often occurs with other disorders (called comorbidities of ADHD). About half of children with ADHD referred to clinics have behavioral disorders as well as ADHD.
The combination of ADHD with other behavioral disorders often presents extra challenges to affected individuals, educators, and health care providers. Therefore, it is important for doctors to screen every child with ADHD for other disorders and problems.
Star showing issues related to ADHD

Difficult Peer Relationships

Photo: Child being ridiculed by peersADHD can have many effects on a child's development. It can make childhood friendships, or peer relationships, very difficult. These relationships contribute to children's immediate happiness and may be very important to their long-term development.
Children with ADHD might have difficulty in their peer relationships, for example, being rejected by peers or not having close friends. In some cases, children with peer problems may also be at higher risk for anxiety, behavioral and mood disorders, substance abuse and delinquency as teenagers.
  • Parents of children with a history of ADHD report almost 3 times as many peer problems as those without a history of ADHD (21.1% vs. 7.3%).1
  • Parents report that children with a history of ADHD are almost 10 times as likely to have difficulties that interfere with friendships (20.6% vs. 2.0%).1
How does ADHD interfere with peer relationships?
Exactly how ADHD contributes to social problems is not fully understood. Several studies have found that children with predominantly inattentive ADHD may be perceived as shy or withdrawn by their peers. Research strongly indicates that aggressive behavior in children with symptoms of impulsivity/hyperactivity may play a significant role in peer rejection. In addition, other behavioral disorders often occur along with ADHD. Children with ADHD and other disorders appear to face greater impairments in their relationships with peers.
Having ADHD does not mean a person has to have poor peer relationships.
Not everyone with ADHD has difficulty getting along with others. For those who do, many things can be done to improve the person's relationships. The earlier a child's difficulties with peers are noticed, the more successful intervention may be. Although researchers have not provided definitive answers, some things parents might consider as they help their child build and strengthen peer relationships are:
  • Recognize the importance of healthy peer relationships for children. These relationships can be just as important as grades to school success.
  • Maintain on-going communication with people who play important roles in your child's life (such as teachers, school counselors, after-school activity leaders, health care providers, etc.). Keep up-dated on your child's social development in community and school settings.
  • Involve your child in activities with his or her peers. Communicate with other parents, sports coaches and other involved adults about any progress or problems that may develop with your child.
  • Peer programs can be helpful, particularly for older children and teenagers. Schools and communities often have such programs available. You may want to discuss the possibility of your child's participation with program directors and your child's care providers.

Risk of Injuries

Child on bikeChildren and adolescents with ADHD can have more frequent and severe injuries than peers without ADHD.
Research indicates that children with ADHD are significantly more likely to:
  • Be injured as pedestrians or while riding a bicycle
  • Receive head injuries
  • Injure more than one part of the body
  • Be hospitalized for accidental poisoning
  • Be admitted to intensive care units or have an injury result in disability

Further research is needed to understand what role ADHD symptoms play in the risk of injuries and other disorders that may occur with ADHD. For example, a young child with ADHD may not look for oncoming traffic while riding a bicycle or crossing the street, or may engage in high-risk physical activity without thinking of the possible consequences. Teenagers with ADHD who drive may have more traffic violations and accidents and twice as likely to have their driver’s licenses suspended than drivers without ADHD.

Much of what is already known about injury prevention may be particularly useful for people with ADHD.
  • Ensure bicycle helmet use. Remind children as often as necessary to watch for cars and to avoid unsafe activities.
  • Supervise children when they are involved in high-risk activities or are in risky settings, such as when climbing or when in or around a swimming pool.
  • Keep potentially harmful household products, tools, equipment and objects out of the reach of young children.
  • Teens with ADHD may need to limit the amount of music listened to in the car while driving, drive without passengers and/or keep the number of passengers to a chosen few, plan trips well ahead of time, avoid alcohol and drug use and cellular phone usage.
  • Parents may want to enroll their teens in driving safety courses before they get their driver’s license.
  • For more injury prevention tips, visit CDC’s Injury Center.

Oppositional Defiant Disorder

Oppositional Defiant Disorder (ODD) is one of the most common disorders occurring with ADHD. ODD usually starts before age eight, but no later than early adolescence. Symptoms may occur most often with people the individual knows well, such as family members or a regular care provider. These behaviors are present beyond what are expected for the child’s age, and result in significant difficulties in school, at home, and/or with peers.
Examples of ODD behaviors include:
  • Losing one’s temper a lot
  • Arguing with adults or refusing to comply with adults’ rules or requests
  • Often getting angry or being resentful or vindictive
  • Deliberately annoying others; easily becoming annoyed with others
  • Often blaming other people for one’s own mistakes or misbehavior

Learning Disorder

Teacher working with studentRecently released data from the 1997-98 National Health Interview Survey suggests roughly half of those youth 6-11 years old diagnosed with ADHD may also have a Learning Disorder (LD). The combination of attention problems caused by ADHD and LD can make it particularly hard for a child to succeed in school. Properly diagnosing each disorder is crucial. Appropriate and timely interventions to address ADHD and LD should follow diagnosis. The nature and course of treatment for ADHD and LD may be different, and different types of providers may be involved. Working with health care professionals to determine appropriate referrals and treatment is the best way to make informed decisions for an individual dealing with ADHD and a learning problem.

Conduct Disorder

Conduct Disorder (CD) is a behavioral pattern characterized by aggression toward others and serious violations of rules, laws, and social norms. These behaviors often lead to delinquency or incarceration. Increased injuries and strained peer relationships are also common in this population. The symptoms of CD are apparent in several settings in the person’s life (e.g., at home, in the community and at school).
Although CD is less common than Oppositional Defiant Disorder, it is severe and highly disruptive to the person’s life and to others in his/her life. It is also very challenging to treat. A mental health professional should complete evaluations for CD where warranted, and a plan for intervention should be implemented as early as possible.


1Strine TW, Lesesne CA, Okoro CA, McGuire LC, Chapman DP, Balluz LS, Mokdad AH. Emotional and behavioral difficulties and impairments in everyday functioning among children with a history of attention-deficit/hyperactivity disorder. Prev Chronic Dis. 2006 Apr;3(2):A52. Epub 2006 Mar 15.

Symptoms and Diagnosis

Deciding if a child has ADHD is a several-step process. There is no single test to diagnose ADHD, and many other problems, like anxiety, depression, and certain types of learning disabilities, can have similar symptoms.
The American Psychiatric Association's Diagnostic and Statistical Manual, Fifth edition (DSM-5)1, is used by mental health professionals to help diagnose ADHD. It was released in May 2013 and replaces the previous version, the text revision of the fourth edition (DSM-IV-TR). This diagnostic standard helps ensure that people are appropriately diagnosed and treated for ADHD. Using the same standard across communities will help determine how many children have ADHD, and how public health is impacted by this condition.
There were some changes in the DSM-5 for the diagnosis of ADHD: symptoms can now occur by age 12 rather than by age 6; several symptoms now need to be present in more than one setting rather than just some impairment in more than one setting; new descriptions were added to show what symptoms might look like at older ages; and for adults and adolescents age 17 or older, only 5 symptoms are needed instead of the 6 needed for younger children.
Group of children

Here are the criteria in shortened form. Please note that they are presented just for your information.  Only trained health care providers can diagnose or treat ADHD.
DSM-5 Criteria for ADHD
People with ADHD show a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development:
  1. Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:
    • Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
    • Often has trouble holding attention on tasks or play activities.
    • Often does not seem to listen when spoken to directly.
    • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
    • Often has trouble organizing tasks and activities.
    • Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
    • Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
    • Is often easily distracted
    • Is often forgetful in daily activities.
  2. Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:
    • Often fidgets with or taps hands or feet, or squirms in seat.
    • Often leaves seat in situations when remaining seated is expected.
    • Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
    • Often unable to play or take part in leisure activities quietly.
    • Is often "on the go" acting as if "driven by a motor".
    • Often talks excessively.
    • Often blurts out an answer before a question has been completed.
    • Often has trouble waiting his/her turn.
    • Often interrupts or intrudes on others (e.g., butts into conversations or games)
In addition, the following conditions must be met:
  • Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
  • Several symptoms are present in two or more setting, (e.g., at home, school or work; with friends or relatives; in other activities).
  • There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
  • The symptoms do not happen only during the course of schizophrenia or another psychotic disorder. The symptoms are not better explained by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).
Based on the types of symptoms, three kinds (presentations) of ADHD can occur:
Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months
Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months
Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity but not inattention were present for the past six months.
Because symptoms can change over time, the presentation may change over time as well.


American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.

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