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Redesigned survey may help physicians better understand trends in diagnosis, treatment of ADHD

A newly redesigned national survey indicates that the estimated prevalence of ADHD diagnosis does not appear to have increased in the time since previous nationally representative estimates were published.

But, a significant proportion of U.S. children and adolescents aged 2 to 17 years — estimated at 6.1 million — have been diagnosed with the disorder, which justifies the continued monitoring of treatment received and outcomes of the population, according to the researchers.

“This information can help clinicians understand ongoing trends in the frequency of the diagnosis of ADHD in the community and the types of treatment received by children with ADHD,” Melissa L. Danielson, MSPH, a statistician at the CDC’s National Center on Birth Defects and Developmental Disabilities, and colleagues wrote. “Recognition of these trends is particularly important for clinical and school psychologists, as they can play an integral role in the diagnosis and treatment of children with ADHD, particularly for the administration of evidence-based behavioral treatments that have been shown to be effective in improving symptoms and outcomes for children with ADHD.”

The researchers aimed to estimate the national prevalence of parent-reported ADHD diagnosis and treatment among U.S. children aged 2 to 17 years using the 2016 National Survey of Children’s Health (NSCH).

The NSCH, a national, cross-sectional survey of parents regarding their children’s health, underwent a redesign prior to the 2016 data collection. The redesigned survey included indicators of lifetime receipt of an ADHD diagnosis by a health care provider, whether the child currently had ADHD, and whether the patient received medication and/or behavioral treatment for ADHD.

Weighted prevalence estimates were calculated overall and by demographic and clinical subgroups (n = 45,736). An estimated 6.1 million children in the U.S. aged 2 to 17 years had ever received an ADHD diagnosis, according to the survey in 2016.

Of those, 5.4 million currently had ADHD, which was 89.4% of children ever diagnosed with ADHD.

More than half (62%) of children with a current diagnosis of ADHD were receiving medication and less than half (46.7%) had received behavioral treatment within the past year. However, 23% had received neither treatment.

The parent-reported survey indicated that boys, adolescents aged 12 to 17 years, black children, non-Hispanic children, children living in households with English as the primary language, children in the lowest income bracket, children living in the Midwest or South, and children living in rural areas were more likely to have ever received an ADHD diagnosis and to currently have ADHD than their respective counterparts.

“The redesigned NSCH can be used to annually monitor diagnosis and treatment patterns for this highly prevalent and high-impact neurodevelopmental disorder,” the researchers wrote.

Danielson and colleagues did acknowledge that there some limitations to their analysis.

The first limitation is the data is reliant on parent-reported diagnosis and treatment of ADHD. That data has not been validated against medical records or clinical judgement and may be subject to recall bias, according to the researchers.

“However, previous work has shown that parent report of an ADHD diagnosis results in similar prevalence estimates to those attained through analysis of administrative claims data, suggesting convergent validity of estimated prevalence from both of these sources.”

Disclosures: The researchers report no relevant disclosures.