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How Common Is Attention-Deficit/Hyperactivity Disorder?
Incidence in a Population-Based Birth Cohort in Rochester, Minn
William J. Barbaresi, MD;
Slavica K. Katusic, MD;
Robert C. Colligan, PhD;
V. Shane Pankratz, PhD;
Amy L. Weaver, MS;
Kevin J. Weber, PhD;
David A. Mrazek, MD;
Steven J. Jacobsen, MD, PhD
Arch Pediatr Adolesc Med. 2002;156:217-224.
Context The frequency of occurrence of attention-deficit/hyperactivity disorder
(AD/HD) is in dispute. This uncertainty has contributed to the concern that
too many children in the United States are being treated with stimulant medication.
Objectives To determine the cumulative incidence of AD/HD in a population-based
birth cohort and to estimate the prevalence of pharmacologic treatment for
children who fulfill research criteria for AD/HD.
Design Population-based birth cohort study.
Setting and Subjects All children born between 1976 and 1982 in Rochester, Minn, who remained
in the community after age 5 years (N = 5718).
Main Outcome Measures Medical and school records were reviewed for clinical diagnoses of AD/HD
and supporting documentation (symptoms consistent with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition
criteria and positive results for AD/HD-related questionnaires). Research-identified
cases were defined as: (1) "definite" AD/HD (clinical diagnosis and at least
one type of supporting documentation); (2) "probable" AD/HD (clinical diagnosis
but no supporting documentation or no clinical diagnosis
but both types of supporting documentation); (3) "questionable" AD/HD (no
clinical diagnosis, but at least one type of supporting documentation); and
(4) "not AD/HD" (all other subjects). Information about pharmacologic treatment
for AD/HD was abstracted for all subjects.
Results The highest estimate of the cumulative incidence at age 19 years (with
95% confidence interval) of AD/HD (definite plus probable plus questionable
AD/HD) was 16.0% (14.7-17.3). The lowest estimate (definite AD/HD only) was
7.4% (6.5-8.4). Prevalence of treatment with stimulant medication was 86.5%
for definite AD/HD, 40.0% for probable AD/HD, 6.6% for questionable AD/HD,
and 0.2% for not AD/HD.
Conclusions These results provide insight into the apparent discrepancies in estimates
of the occurrence of AD/HD, with less stringent criteria resulting in higher
cumulative incidence. Children who met the most stringent criteria for AD/HD
were most likely to receive pharmacologic treatment.
From the Departments of Pediatric and Adolescent Medicine (Dr Barbaresi),
Health Sciences Research (Drs Katusic, Jacobsen, and Pankratz, and Ms Weaver),
and Psychiatry and Psychology (Drs Colligan and Mrazek), Mayo Clinic, Rochester,
Minn; and Olmsted Medical Center, Rochester (Dr Weber).
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