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ADHD diagnoses among children increasing in the US, ethnic disparities exist

Robin Wulffson MD's picture
ADHD, attention-deficit/hyperactivity disorder, increase, ethnic disparities

According to a new study, diagnoses of attention-deficit/hyperactivity disorder (ADHD) are on the upsurge in the United States; furthermore, Caucasian children are being diagnosed more frequently than other ethnicities. Researchers affiliated with Kaiser Permanente Southern California, Pasadena published their findings online on January 21 in the journal JAMA Pediatrics.

The objective of the study was to examine trends in ADHD by race/ethnicity, age, sex, and median household income. The investigators accessed medical records from the Kaiser Permanente Southern California (KPSC) health plan. Rates of ADHD diagnosis were derived by a method termed Poisson regression analyses after adjustments for potential confounders (factors that could skew the data; thus, decreasing validity).

The study group comprised 842,830 children; all received care at the KPSC from January 1, 2001, through December 31, 2010. The main outcome measures were the incidence of physician-diagnosed ADHD in children aged 5 to 11 years.

The researchers found that the rates of ADHD diagnosis were 2.5% in 2001 and 3.1% in 2010; this marked a relative increase of 24%. From 2001 to 2010, the rate increased among Caucasians 4.7%-5.6%, African Americans 2.6%- 4.1%, and Hispanics 1.7%-2.5%. Rates for Asian/Pacific Islander and other racial groups remained unchanged over time. The investigators noted that the increase in ADHD diagnosis among African Americans was largely driven by an increase in females. Boys were more likely to be diagnosed as having ADHD than girls; however, the results suggested that the sex gap for African Americans may be closing over time. Children living in high-income households were more likely to be diagnosed with ADHD..

The authors concluded that their findings suggest that the rate of ADHD diagnosis among children in the health plan notably has increased over time. They observed disproportionately high ADHD diagnosis rates among Caucasian children and notable increases among African American Girls.

ADHD is the most common neurobehavioral disorder in children, affecting an estimated 3-5% of school aged children. The condition affects school performance and interpersonal relationships. Imaging studies suggest that the brains of children with ADHD are different from those of other children. These children handle neurotransmitters (including dopamine, serotonin, and adrenalin) differently from their peers. ADHD is often genetic. Whatever the specific cause may be, it seems to be set in motion early in life as the brain is developing.

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Depression, sleep deprivation, learning disabilities, tic disorders, and behavior problems may be confused with, or appear along with, ADHD. Every child suspected of having ADHD deserves a careful evaluation to sort out exactly what is contributing to the behaviors causing concern.

To be diagnosed with ADHD, children should have at least six attention symptoms or six activity and impulsivity symptoms to a degree beyond what would be expected for children their age. The symptoms must be present for at least six months, observable in two or more settings, and not caused by another problem. The symptoms must be severe enough to cause significant difficulties. Some symptoms must be present before age seven.

Inattention symptoms:

  • Fails to give close attention to details or makes careless mistakes in schoolwork
  • Difficulty sustaining attention in tasks or play
  • Does not seem to listen when spoken to directly
  • Does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
  • Difficulty organizing tasks and activities
  • Avoids or dislikes tasks that require sustained mental effort (such as schoolwork)
  • Often loses toys, assignments, pencils, books, or tools needed for tasks or activities
  • Easily distracted
  • Often forgetful in daily activities

Hyperactivity symptoms:

  • Fidgets with hands or feet or squirms in seat
  • Leaves seat when remaining seated is expected
  • Runs about or climbs in inappropriate situations
  • Difficulty playing quietly
  • Often "on the go," acts as if "driven by a motor," talks excessively

Impulsivity symptoms:

  • Blurts out answers before questions have been completed
  • Difficulty awaiting turn
  • Interrupts or intrudes on others (butts into conversations or games)

Take home message:
This study notes that ADHD diagnoses are on the increase in the US. This could be due to an actual increase in the number of affected children, an increase in the number diagnosed, or a combination. In general more boys than girls are diagnosed with ADHD; thus, the increase among African American girls is an interesting finding. It appears that more research is needed to determine why the trends noted in this study are occurring.

Reference: JAMA Pediatrics