Trends in the Parent-Report of Health Care Provider-Diagnosed and Medicated Attention-Deficit/Hyperactivity Disorder: United States, 2003–2011
https://www.clinicalkey.es/#!/content/playContent/1-s2.0-S0890856713005947?returnurl=http:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0890856713005947%3Fshowall%3Dtrue&referrer=http:%2F%2Fwww.jaacap.com%2Farticle%2FS0890-8567%252813%252900594-7%2Fabstract
Abstract
Objective
Data from the 2003 and 2007 National Survey of Children’s Health (NSCH) reflect the increasing prevalence of parent-reported attention-deficit/hyperactivity disorder (ADHD) diagnosis and treatment by health care providers. This report updates these prevalence estimates for 2011 and describes temporal trends.
Data from the 2003 and 2007 National Survey of Children’s Health (NSCH) reflect the increasing prevalence of parent-reported attention-deficit/hyperactivity disorder (ADHD) diagnosis and treatment by health care providers. This report updates these prevalence estimates for 2011 and describes temporal trends.
Method
Weighted analyses were conducted with 2011 NSCH data to estimate prevalence of parent-reported ADHD diagnosis, current ADHD, current medication treatment, ADHD severity, and mean age of diagnosis for U.S. children/adolescents aged 4 to 17 years and among demographic subgroups. A history of ADHD diagnosis (2003–2011), as well as current ADHD and medication treatment prevalence (2007–2011), were compared using prevalence ratios and 95% confidence intervals.
Weighted analyses were conducted with 2011 NSCH data to estimate prevalence of parent-reported ADHD diagnosis, current ADHD, current medication treatment, ADHD severity, and mean age of diagnosis for U.S. children/adolescents aged 4 to 17 years and among demographic subgroups. A history of ADHD diagnosis (2003–2011), as well as current ADHD and medication treatment prevalence (2007–2011), were compared using prevalence ratios and 95% confidence intervals.
Results
In 2011, 11% of children/adolescents aged 4 to 17 years had ever received an ADHD diagnosis (6.4 million children). Among those with a history of ADHD diagnosis, 83% were reported as currently having ADHD (8.8%); 69% of children with current ADHD were taking medication for ADHD (6.1%, 3.5 million children). A parent-reported history of ADHD increased by 42% from 2003 to 2011. Prevalence of a history of ADHD, current ADHD, medicated ADHD, and moderate/severe ADHD increased significantly from 2007 estimates. Prevalence of medicated ADHD increased by 28% from 2007 to 2011.
In 2011, 11% of children/adolescents aged 4 to 17 years had ever received an ADHD diagnosis (6.4 million children). Among those with a history of ADHD diagnosis, 83% were reported as currently having ADHD (8.8%); 69% of children with current ADHD were taking medication for ADHD (6.1%, 3.5 million children). A parent-reported history of ADHD increased by 42% from 2003 to 2011. Prevalence of a history of ADHD, current ADHD, medicated ADHD, and moderate/severe ADHD increased significantly from 2007 estimates. Prevalence of medicated ADHD increased by 28% from 2007 to 2011.
Conclusions
Approximately 2 million more U.S. children/adolescents aged 4 to 17 years had been diagnosed with ADHD in 2011, compared to 2003. More than two-thirds of those with current ADHD were taking medication for treatment in 2011. This suggests an increasing burden of ADHD on the U.S. health care system. Efforts to further understand ADHD diagnostic and treatment patterns are warranted.
................................
This article is discussed in an editorial by Dr. John T. Walkup on page 14.
Clinical guidance is available at the end of this article.
An interview with the authors is available by podcast at www.jaacap.org or by scanning the QR code to the right.
Ms. Danielson served as the statistical expert for this research.
Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
The National Survey of Children’s Health is a module of the Centers for Disease Control and Prevention’s State and Local Area Integrated Telephone Survey and was sponsored by the Maternal and Child Health Bureau of the Health Resources and Services Administration.
Disclosure: Drs. Bitsko, Holbrook, Kogan, Ghandour, Perou, and Blumberg, and Ms. Visser and Ms. Danielson report no biomedical financial interests or potential conflicts of interest.
Published by Elsevier Inc.
...................................
Content section navigation
Approximately 2 million more U.S. children/adolescents aged 4 to 17 years had been diagnosed with ADHD in 2011, compared to 2003. More than two-thirds of those with current ADHD were taking medication for treatment in 2011. This suggests an increasing burden of ADHD on the U.S. health care system. Efforts to further understand ADHD diagnostic and treatment patterns are warranted.
................................
This article is discussed in an editorial by Dr. John T. Walkup on page 14.
Clinical guidance is available at the end of this article.
An interview with the authors is available by podcast at www.jaacap.org or by scanning the QR code to the right.
Ms. Danielson served as the statistical expert for this research.
Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
The National Survey of Children’s Health is a module of the Centers for Disease Control and Prevention’s State and Local Area Integrated Telephone Survey and was sponsored by the Maternal and Child Health Bureau of the Health Resources and Services Administration.
Disclosure: Drs. Bitsko, Holbrook, Kogan, Ghandour, Perou, and Blumberg, and Ms. Visser and Ms. Danielson report no biomedical financial interests or potential conflicts of interest.
Published by Elsevier Inc.
...................................
Journal of the American Academy of Child & Adolescent Psychiatry
Obtener derechos y contenido
ARTÍCULO
ARTÍCULO
Trends in the Parent-Report of Health Care Provider-Diagnosed and Medicated Attention-Deficit/Hyperactivity Disorder: United States, 2003–2011
Journal of the American Academy of Child & Adolescent Psychiatry, 2014-01-01, Volúmen 53, Número 1, Páginas 34-46.e2, Copyright © 2014
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder with childhood onset. Children with ADHD experience clinically significant functional impairment across settings (for example at home, in school, and with friends), resulting in higher rates of unintentional injury, emergency room visits, peer problems, and academic failure. Approximately one-third of children diagnosed with ADHD retain the diagnosis into adulthood, supporting the recognition of ADHD as a chronic health condition.
Best practices for diagnosing and treating ADHD exist and include conducting a clinical diagnostic evaluation, incorporating information from multiple respondents (e.g., parents, child, teachers, child care staff) and across multiple settings (e.g., home, school, child care), and evaluating the child for co-occurring conditions. ADHD medication has long been used to effectively treat ADHD symptoms of impulsivity, inattention, and hyperactivity and is the single-most effective treatment for reducing ADHD symptoms. High-quality behavioral interventions can also improve functional outcomes of selected children with ADHD , but may not be as broadly available across the U.S.
Characterizing the evolving epidemiology of ADHD diagnosis and treatment informs the public health impact of diagnosis and treatment within communities, allows tracking changes over time, informs service use and needs, and provides a context for interpreting the impact of health alerts extending from adverse event reporting systems. Population-based epidemiological estimates of ADHD can come from a variety of sources. Analyses of insurance claims data have documented steady increases in the prevalence of ambulatory visits for ADHD diagnoses between 2001 and 2010 ; however, studies based on claims data are not necessarily representative of the uninsured or underinsured. A recent, large-scale community-based study from 4 school districts across 2 states suggests that the prevalence among elementary-aged children is 9% to 11% ; a large, national direct assessment of children 13 to 17 years of age suggested that the lifetime prevalence of ADHD among adolescents was 8.7%. However, direct assessment of children in communities is resource intensive, and it is not an efficient method for monitoring prevalence over time. Large-scale surveys of parents that ask about clinician-diagnosed conditions provide an important cross-sectional picture of the impact of disorders, including ADHD, and can be repeated over time for surveillance purposes. Parent surveys can also be used to estimate both national and state-based prevalence of conditions.
Since 1996, parent reports of health care provider-diagnosed ADHD in childhood have been collected by nationally representative health surveys, beginning with the National Health Interview Survey (NHIS). The reports of a diagnosis by a health care provider is a proxy for underlying ADHD, asking parents “Has a doctor or other health care provider ever told you that your child had attention deficit disorder (ADD) or attention-deficit/hyperactivity disorder (ADHD)?” This report of an ADHD diagnosis was included in the 2003, 2007, and 2011 National Survey of Children’s Health (NSCH), which is a periodic parent survey of the physical and emotional health of US children, 0 to 17 years of age. Increases in parent-reported ADHD diagnosis and medication treatment have been documented using data from NHIS and NSCH; average annual increases in parent-reported ADHD diagnosis ranged from 3% to 6% per year since the late 1990s.
Based on data from the 2007 NSCH, an estimated 9.5% of children/adolescents 4 to 17 years of age had been diagnosed with ADHD; 78% of those children were characterized by their parents as having current ADHD, representing 7.2% (4.1 million) of school-aged children. The estimated prevalence increased by 22% from 2003 to 2007, with an average annual increase of 5.5% per year from 2003 to 2007. Increases in prevalence were greatest among groups with historically lower rates of ADHD: older teens, Hispanics, and children who spoke a primary language other than English. Two-thirds of those with current ADHD were taking medication in 2007. ADHD medication treatment increased with ADHD severity. Nearly 1 in 20 (4.8%) of U.S. children/adolescents 4 to 17 years of age (2.7 million individuals) were taking ADHD medication in 2007, which is consistent with a 2008 Medical Expenditure Panel Survey estimate of 5.1% among children 6 to 12 years of age.
Data from the most recent NSCH allow updated estimates of parent-reported ADHD diagnosis and treatment, as well as inspection of trends in these estimates over time. Based on previous reports, average annual growth rates of 3% to 6% for parent-reported ADHD diagnosis and a commensurate increase in parent-reported ADHD medication treatment were expected.
Journal of the American Academy of Child & Adolescent Psychiatry, 2014-01-01, Volúmen 53, Número 1, Páginas 34-46.e2, Copyright © 2014
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder with childhood onset. Children with ADHD experience clinically significant functional impairment across settings (for example at home, in school, and with friends), resulting in higher rates of unintentional injury, emergency room visits, peer problems, and academic failure. Approximately one-third of children diagnosed with ADHD retain the diagnosis into adulthood, supporting the recognition of ADHD as a chronic health condition.
Best practices for diagnosing and treating ADHD exist and include conducting a clinical diagnostic evaluation, incorporating information from multiple respondents (e.g., parents, child, teachers, child care staff) and across multiple settings (e.g., home, school, child care), and evaluating the child for co-occurring conditions. ADHD medication has long been used to effectively treat ADHD symptoms of impulsivity, inattention, and hyperactivity and is the single-most effective treatment for reducing ADHD symptoms. High-quality behavioral interventions can also improve functional outcomes of selected children with ADHD , but may not be as broadly available across the U.S.
Characterizing the evolving epidemiology of ADHD diagnosis and treatment informs the public health impact of diagnosis and treatment within communities, allows tracking changes over time, informs service use and needs, and provides a context for interpreting the impact of health alerts extending from adverse event reporting systems. Population-based epidemiological estimates of ADHD can come from a variety of sources. Analyses of insurance claims data have documented steady increases in the prevalence of ambulatory visits for ADHD diagnoses between 2001 and 2010 ; however, studies based on claims data are not necessarily representative of the uninsured or underinsured. A recent, large-scale community-based study from 4 school districts across 2 states suggests that the prevalence among elementary-aged children is 9% to 11% ; a large, national direct assessment of children 13 to 17 years of age suggested that the lifetime prevalence of ADHD among adolescents was 8.7%. However, direct assessment of children in communities is resource intensive, and it is not an efficient method for monitoring prevalence over time. Large-scale surveys of parents that ask about clinician-diagnosed conditions provide an important cross-sectional picture of the impact of disorders, including ADHD, and can be repeated over time for surveillance purposes. Parent surveys can also be used to estimate both national and state-based prevalence of conditions.
Since 1996, parent reports of health care provider-diagnosed ADHD in childhood have been collected by nationally representative health surveys, beginning with the National Health Interview Survey (NHIS). The reports of a diagnosis by a health care provider is a proxy for underlying ADHD, asking parents “Has a doctor or other health care provider ever told you that your child had attention deficit disorder (ADD) or attention-deficit/hyperactivity disorder (ADHD)?” This report of an ADHD diagnosis was included in the 2003, 2007, and 2011 National Survey of Children’s Health (NSCH), which is a periodic parent survey of the physical and emotional health of US children, 0 to 17 years of age. Increases in parent-reported ADHD diagnosis and medication treatment have been documented using data from NHIS and NSCH; average annual increases in parent-reported ADHD diagnosis ranged from 3% to 6% per year since the late 1990s.
Based on data from the 2007 NSCH, an estimated 9.5% of children/adolescents 4 to 17 years of age had been diagnosed with ADHD; 78% of those children were characterized by their parents as having current ADHD, representing 7.2% (4.1 million) of school-aged children. The estimated prevalence increased by 22% from 2003 to 2007, with an average annual increase of 5.5% per year from 2003 to 2007. Increases in prevalence were greatest among groups with historically lower rates of ADHD: older teens, Hispanics, and children who spoke a primary language other than English. Two-thirds of those with current ADHD were taking medication in 2007. ADHD medication treatment increased with ADHD severity. Nearly 1 in 20 (4.8%) of U.S. children/adolescents 4 to 17 years of age (2.7 million individuals) were taking ADHD medication in 2007, which is consistent with a 2008 Medical Expenditure Panel Survey estimate of 5.1% among children 6 to 12 years of age.
Data from the most recent NSCH allow updated estimates of parent-reported ADHD diagnosis and treatment, as well as inspection of trends in these estimates over time. Based on previous reports, average annual growth rates of 3% to 6% for parent-reported ADHD diagnosis and a commensurate increase in parent-reported ADHD medication treatment were expected.
No hay comentarios:
Publicar un comentario