Advertisement
  1. Health

Study: Percentage of children with ADHD has nearly doubled in the last 20 years

A study released Friday found a steady increase in ADHD diagnoses among children -- from about 6 percent of children between 1997 and 1998 to more than 10 percent between 2015 and 2016. [iStockphoto.com]
Published Aug. 31, 2018

The number of children diagnosed with attention deficit hyperactivity disorder (ADHD) has reached more than 10 percent, a significant increase during the past 20 years, according to a study released Friday.

The rise was most pronounced in minority groups, suggesting that better access to health insurance and mental health treatment through the Affordable Care Act might have played some role in the increase. The rate of diagnosis during that time period doubled in girls, although it was still much lower than in boys.

MORE HEALTH COVERAGE: Four more cases of measles found in Pinellas County, bringing total to seven

But the researchers say they found no evidence confirming frequent complaints that the condition is overdiagnosed or misdiagnosed.

The U.S. has significantly more instances of ADHD than other developed countries, which researchers said has led some to think Americans are overdiagnosing children. Dr. Wei Bao, the lead author of the study, said in an interview that a review of studies around the world doesn't support that.

"I don't think overdiagnosis is the main issue," he said.

Nonetheless, those doubts persist. Dr. Stephen Hinshaw, who co-authored a 2014 book The ADHD Explosion: Myths, Medication, Money, and Today's Push for Performance, compared ADHD to depression. He said in an interview that neither condition has unequivocal biological markers, so it makes it hard to determine if a patient truly has the condition without lengthy psychological evaluations. Symptoms of ADHD can include inattention, fidgety behavior and impulsivity.

"It's probably not a true epidemic of ADHD," said Hinshaw, a professor of psychology at the University of California-Berkeley and a professor of psychiatry at UC-San Francisco. "It might be an epidemic of diagnosing it."

In interpreting their results, however, the study's authors tied the higher numbers to better understanding of the condition by doctors and the public, new standards for diagnosis and an increase in access to health insurance through the ACA.

Because of the ACA, "some low-income families have improved access to services and referrals," said Bao, an assistant professor of epidemiology at the University of Iowa College of Public Health.

The study, published in JAMA Pediatrics, used data from the National Health Interview Survey, an annual federal survey of about 35,000 households. It found a steady increase in diagnoses among children, from about 6 percent of children between 1997 and 1998 to more than 10 percent between 2015 and 2016.

Advances in medical technology also may have contributed to the increase, according to the research. Twenty years ago, preterm or low-weight babies had a harder time surviving. Those factors increase the risk of being diagnosed with ADHD.

The study also suggests that fewer stigmas about mental health care in minority communities may also lead to more people receiving an ADHD diagnosis.

In the late 1990s, 7.2 percent of non-Hispanic white children, 4.7 percent of non-Hispanic black children and 3.6 of Hispanic children were diagnosed with ADHD, according to the study.

By 2016, it was 12 percent of white kids, 12.8 percent of blacks and 6.1 percent of Hispanics.

Over the past several decades, Hinshaw said, there's been an expanded view of who can develop ADHD. It's no longer viewed as a disease that affects only white middle-class boys, as eating disorders are no longer seen as afflicting only white middle-class girls.

Still, he cautioned against overdiagnosing ADHD in communities where behavioral issues could be the result of social or environmental factors such as overcrowded classrooms.

The study found rates of ADHD among girls rose from 3 to more than 6 percent over the study period. It said that was partly a result of a change in how the condition is classified. For years, ADHD pertained to children who were hyperactive. But in recent years, the American Psychiatric Association added to its guide of mental health conditions that diagnosis should also include some children who are inattentive, Bao said. That raised the number of girls, he explained, because it seems they are more likely to be in that second subtype.

"If we compare these two, you can easily imagine people will easily recognize hyperactivity," he said.

That rang true for Ruth Hay, a 25-year-old student and cook from New York who now lives in Jerusalem. She was diagnosed with what was then called ADD the summer between second and third grade.

TO YOUR HEALTH: Keep track of trends and new developments that affect you. Visit the Times health page.

Hay said her hyperactive tendencies aren't as "loud" as some people's. She's less likely to bounce around a room than she is to bounce in her chair, she said.

Yet despite her early diagnosis, Hay said, no one ever told her about other symptoms. For example, she said, she suffers from executive dysfunction, which leaves her feeling unable to accomplish tasks, no matter how much she wanted to or tried.

"I grew up being called lazy in periods of time when I wasn't," Hay said. "If you look at a list of all the various ADHD symptoms, I have all of them to one degree or another, but the only ones ever discussed with me was you might be less focused and more fidgety."

"I don't know how my brain would be if I didn't have it," she added. "I don't know if I'd still be me, but all it has been for me is a disability."

__________

KHN's coverage of children's health care issues is supported in part by the Heising-Simons Foundation.

ALSO IN THIS SECTION

  1. Imam Askia Muhammad Aquil says religious leaders must be empathetic to the needs of families members of those who die by suicide. SCOTT KEELER  |  Tampa Bay Times
    Attitudes have evolved with understanding about mental illness
  2. FILE  - In this Aug. 28, 2019, file photo, a man exhales while smoking an e-cigarette in Portland, Maine. Walmart says it will stop selling electronic cigarettes at its namesake stores and Sam's Clubs following a string of illnesses and deaths related to vaping.  The nation's largest retailer said Friday, Sept. 20 that it will complete its exit from e-cigarettes after selling through current inventory. It cited growing federal, state and local regulatory complexity regarding vaping products. ROBERT F. BUKATY  |  AP
    The nation’s largest retailer said Friday that it will complete its exit from e-cigarettes after selling through current inventory.
  3. Erik Maltais took an unconventional path to becoming CEO of Immertec, a virtual reality company aimed at training physicians remotely. He dropped out of school as a teenager, served in Iraq in the Marine Corps and eventually found his way to Tampa. OCTAVIO JONES   |   TIMES  |  Times
    Software from Immertec can bring physicians into an operating room thousands of miles away.
  4. Homeowner Cheryl Murdoch, 59, explains the workings of the Philips Smart Mirror in her bathroom. Murdoch and her husband live in the Epperson neighborhood in Wesley Chapel, home of the Crystal Lagoon, where some residents are piloting new health technologies inside their homes. SCOTT KEELER  |   Times
    In Pasco’s Crystal Lagoon community, AdventHealth and Metro Development Group are testing in-home technology aimed at keeping people away from the hospital.
  5. Dr. Paul McRae was the first black chief of staff at Bayfront Medical Center in St. Petersburg. Dr. McRae died on September 13, 2019. He was photographed here in the Tampa Bay Times photo studio for the 2008 Dr. Carter G Woodson Museum's "Legends Honorees" gala. BOYZELL HOSEY  |  BOYZELL HOSEY  |  Times
    ‘His extraordinary example paved the way for so many others.’
  6. Michael Jenkins spent seven days at North Tampa Behavioral Health last July. Since then, he says his three children have been afraid he’ll leave and not come home. JOHN PENDYGRAFT   |   Times
    The patients have no choice, and the hospital is making millions.
  7. Samantha Perez takes a call for someone in need of counseling at the Crisis Center of Tampa Bay earlier this year. The center handles calls dealing with suicide, sexual assault, homelessness and other traumatic situations. They also do outreach and counseling, and operate Transcare, an ambulance service. JONES, OCTAVIO  |  Tampa Bay Times
    Florida’s mental health care system saves lives.
  8. The Florida Department of Health in Hillsborough County identified a positive case of hepatitis A in a food service worker at Hamburger Mary's in Ybor City on Oct. 22, 2018. [JOSH FIALLO | Times] JOSH FIALLO | TIMES  |  JOSH FIALLO | Times
    Slightly more than 200,000 people have been vaccinated this year — a huge jump from the 49,324 people vaccinated in all of 2018.
  9. FILE - In this Feb. 20, 2014, file photo, a patron exhales vapor from an e-cigarette at a store in New York. Under the Trump administration, former FDA commissioner Scott Gottlieb kicked off his tenure in 2017 with the goal of making cigarettes less addictive by drastically cutting nicotine levels. He also rebooted the agency’s effort to ban menthol flavoring in cigarettes. But those efforts have been largely eclipsed by the need to respond to an unexpected explosion in e-cigarette use by teens. AP
    Hundreds of people nationwide have come down with lung illness related to vaping.
  10. This May 2018, photo provided by Joseph Jenkins shows his son, Jay, in the emergency room of the Lexington Medical Center in Lexington, S.C. Jay Jenkins suffered acute respiratory failure and drifted into a coma, according to his medical records, after he says he vaped a product labeled as a smokable form of the cannabis extract CBD. Lab testing commissioned as part of an Associated Press investigation into CBD vapes showed the cartridge that Jenkins says he puffed contained a synthetic marijuana compound blamed for at least 11 deaths in Europe. JOSEPH JENKINS  |  AP
    The vapor that Jenkins inhaled didn’t relax him. After two puffs, he ended up in a coma.
Advertisement
Advertisement
Advertisement