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David Baxter

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9% of U.S. Kids Have ADHD
by By Steven Reinberg
Sep 4th 2007

Nearly 9 percent of American children have attention-deficit/hyperactivity disorder (ADHD), but only 32 percent of them are getting the medication they need.

That's the sobering conclusion of a landmark new study, the first of its kind based on what doctors consider the "gold standard" of diagnostic criteria -- the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition.

"There is a perception that ADHD is overdiagnosed and overtreated," said lead researcher Dr. Tanya E. Froehlich, a developmental-behavioral pediatrician at Cincinnati Children's Medical Center. "But our study shows that for those who meet the criteria for ADHD, the opposite problem -- underdiagnosis and undertreatment -- seems to be occurring."

The researchers found that some 2.4 million children between the ages of 8 and 15 meet the medical definition of ADHD, but an estimated 1.2 million children haven't been diagnosed or treated, Froehlich said, adding that "girls were more likely to be undiagnosed."

What's more, children from poor families, who have the highest rates of ADHD, were the least likely to have consistent treatment with medication, Froehlich noted. "In addition, children without health insurance were less likely to be diagnosed and treated," she said.

The findings were published in the September issue of Archives of Pediatrics & Adolescent Medicine.

ADHD is a condition that becomes apparent in some children in the preschool and early school years and is characterized by hyperactivity, inattention and impulsivity, according to the U.S. National Institute of Mental Health.

To arrive at their findings, Froehlich and her colleagues collected data on 3,082 children who participated in the National Health and Nutrition Examination Survey. Using interviews, the researchers were able to establish the presence of ADHD. They also used data from doctors and the numbers of ADHD medications being used to establish diagnosis and treatment patterns, according to the report.

The researchers found that of the 8.7 percent of children who met the criteria for ADHD, only 47.9 percent had been diagnosed with the condition and only 32 percent were treated consistently with medications.

Froehlich said medications can be quite effective, and people with ADHD can lead successful lives if they have been properly diagnosed and treated.

"There are many successful professionals who have ADHD," Froehlich said. "On the flip side, there can be a lot of negative consequences associated with the disorder, such as lower rates of school and career achievement and higher rates of substance abuse, incarceration, injuries and car accidents," she said.

Froehlich said more needs to be done to identify and treat children with ADHD. "It's not a trivial disorder," she said. "It can have an impact on the child and the family if it is not diagnosed and addressed. We need to redouble our efforts to help doctors spot the symptoms of ADHD and make an accurate diagnosis."

Dr. Jon A. Shaw, director of child and adolescent psychiatry at the University of Miami School of Medicine, agrees that ADHD is underdiagnosed and undertreated.

"The study is confirmatory of the general scientific literature," he said. "ADHD is a highly prevalent disorder, the most common psychiatric diagnosis in children, and that, in general, it is being underdiagnosed and undertreated in our community."

Shaw noted that those children most at risk receive the worst care. "It is clear once again that it is the poorest of our community who are deprived of the benefits of the most effective treatment -- psychopharmacology for this condition," he said.

The discovery that ADHD is more common among poorer people is probably related to other risk factors for the disorder, such as use of tobacco, low birth weight and lead exposure, Shaw said.

More information
For more on ADHD, visit the U.S. National Institute of Mental Health.
 

David Baxter

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Messages
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Study Finds Almost 9% of American Children Meet DSM-IV Criteria for ADHD

Study Finds Almost 9% of American Children Meet DSM-IV Criteria for ADHD
by Marlene Busko
September 20, 2007

A survey of a nationally representative sample of 8- to 15-year-old American children found that 8.7% met the Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSM-IV) criteria for attention deficit/hyperactivity disorder (ADHD). Among children meeting the criteria, only 47% had been diagnosed with ADHD and 32% were receiving consistent medication for it.

These key findings are from a study by Tanya E. Froehlich, MD, from the University of Cincinnati College of Medicine, in Ohio, and colleagues. The article appears in the September issue of the Archives of Pediatrics & Adolescent Medicine.

"The most important message is that we want physicians to be more aware of the symptoms of ADHD and to do a thorough diagnostic assessment," Dr. Froehlich told Medscape Psychiatry. She cautioned that although medications are very effective for most children who truly have ADHD, they are not effective for all children, and effective behavioral treatments exist. "We want children who are suffering from ADHD to be recognized, and we want families to know what the treatment options are, but not necessarily to go straight to medication," she said.

The group writes that despite concerns that the rate of ADHD is on the rise, the national prevalence of ADHD among American children is not clear and has been estimated at anywhere from 2% to 26%.

The researchers aimed to use a national sample with DSM-IV-based diagnostic criteria to estimate the prevalence of ADHD in American children and also to determine whether the prevalence, recognition, and treatment varied by socioeconomic group.

The study sample included the 3082 children, aged 8 to 15 years old, who participated in the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2004 and for whom DSM-IV ADHD diagnostic status was available.

Dr. Froehlich explained that to interview the caregivers, the researchers used a structured interview based on DSM-IV criteria for ADHD, which probed for 9 symptoms of inattention and 9 symptoms of hyperactivity.

To determine whether the child met the criteria for inattention, they asked the caregiver if their child had difficulty concentrating, avoided activities requiring long periods of attention, was very disorganized, omitted things that were necessary for schoolwork, had trouble finishing tasks, forgot what they were supposed to do, made mistakes that were careless in nature, did not listen when people were talking to them, or started things and did not finish them.

To determine whether the child met the criteria for hyperactivity/impulsiveness, they asked the caregiver if their child was overactive, seemed always on the go and driven by a motor, was fidgety or restless, left their seat when seating was expected, climbed and ran about when they were not supposed to, talked a lot and interrupted other people, made more noise than other children during an activity, butted in on what other people were doing, or had trouble waiting for their turn. The caregivers were asked if this behavior was seen at home and also at school.

The researchers found that 8.7% of the children (equivalent to 2.4 million children nationwide) met the criteria for having ADHD in the year prior to the survey. Hispanics were less likely than whites to meet the criteria, and boys were more likely than girls to meet the criteria, although girls with ADHD were less likely to have their disorder identified.

They authors note that 1 study limitation is that although the American Academy of Pediatrics recommends that both caregiver and teacher reports be used to diagnose ADHD, the current study used only a caregiver report of impairment at both home and school, which meets DSM-IV requirements. Lower overall rates of ADHD might be obtained when reports from both teachers and parents are available.

They summarize that that their study shows that first, DSM-IV?diagnosed ADHD is prevalent in American children, especially among poorer children, which needs to be further investigated. Second, less than half of the children who met the criteria for DSM-IV ADHD had their condition diagnosed or treated, "suggesting that some children with clinically significant inattention and hyperactivity may not be receiving optimal attention." Finally, poorer children were least likely to receive medication, which "warrants further investigation and possible intervention."

Arch Pediatr Adolesc Med. 2007;161:857-864. [Abstract]

Related Links
Large ADHD Study Finds Improvement Sustained at 3 Years in Most Children
New Study to Examine Potential Cardiovascular Risks of ADHD Drugs

Resource Centers
Attention Deficit/Hyperactivity Disorder ADHD Resource Center
Child and Adolescent Psychiatry Resource Center
 

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