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Prevalence, Recognition, and Treatment of Attention-Deficit/Hyperactivity Disorder in a National Sample of US Children
Tanya E. Froehlich, MD;
Bruce P. Lanphear, MD, MPH;
Jeffery N. Epstein, PhD;
William J. Barbaresi, MD;
Slavica K. Katusic, MD;
Robert S. Kahn, MD, MPH
Arch Pediatr Adolesc Med. 2007;161(9):857-864.
Objective To determine the US national prevalence of attention-deficit/hyperactivity disorder (ADHD) and whether prevalence, recognition, and treatment vary by socioeconomic group.
Design Cross-sectional survey.
Setting Nationally representative sample of the US population from 2001 to 2004.
Participants Eight- to 15-year-old children (N = 3082) in the National Health and Nutrition Examination Survey.
Main Outcome Measures The Diagnostic Interview Schedule for Children (caregiver module) was used to ascertain the presence of ADHD in the past year based on Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV) criteria. Prior diagnosis of ADHD by a health professional and ADHD medication use were assessed by caregiver report.
Results Of the children, 8.7% met DSM-IV criteria for ADHD. The poorest children (lowest quintile) were more likely than the wealthiest (highest quintile) to fulfill criteria for ADHD (adjusted odds ratio [AOR], 2.3; 95% confidence interval [CI], 1.4-3.9). Among children meeting DSM-IV ADHD criteria, 47.9% had a prior diagnosis of ADHD and 32.0% were treated consistently with ADHD medications during the past year. Girls were less likely than boys to have their disorder identified (AOR, 0.3; 95% CI, 0.1-0.8), and the wealthiest children were more likely than the poorest to receive regular medication treatment (AOR, 3.4; 95% CI, 1.3-9.1).
Conclusions Of US children aged 8 to 15 years, 8.7%, an estimated 2.4 million, meet DSM-IV criteria for ADHD. Less than half of children meeting DSM-IV criteria report receiving either a diagnosis of ADHD or regular medication treatment. Poor children are most likely to meet criteria for ADHD yet are least likely to receive consistent pharmacotherapy.
Author Affiliations: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio (Drs Froehlich, Lanphear, Epstein, and Kahn); and Departments of Pediatric and Adolescent Medicine (Drs Barbaresi and Katusic) and Health Sciences Research (Dr Katusic), Mayo Clinic, Rochester, Minnesota.
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