ADHD cases have increased considerably in the USA
By 2022, about 1 in 9 children had been diagnosed with attention-deficit/hyperactivity disorder at some point in their lives, according to one study. study published Wednesday. Approximately 6.5 million children ages 3 to 17 had ADHD that year — up from 5.4 million in 2016.
The study’s lead author, Melissa Danielson, a statistician at the Centers for Disease Control and Prevention, said there are two main reasons for this trend. First, doctors, parents, teachers and children are becoming more aware of the symptoms of ADHD, making it easier to identify cases. Second, because there are more treatments available today, doctors have more reason to test and diagnose children.
“There are more providers who are comfortable making these diagnoses and treating ADHD, which may allow children to be helped by different medications, behavioral therapy, or school services. So, as there are more opportunities for these children to be helped, I think there is more incentive to get these types of diagnoses,” she said.
As the study results suggest more children are being screened, she added, “it could be a positive finding.”
A third factor in the trend, Danielson said, may have been the Covid-19 pandemic, which could have worsened ADHD symptoms or allowed parents to watch their children more closely.
Estimates from their study, published in the Journal of Clinical Child & Adolescent Psychology, were based on more than 45,000 responses to the 2022 National Survey of Children’s Health.
Mental health professionals who diagnose and treat ADHD said the data is consistent with their experiences.
“This is something we see every day. We are seeing more and more families and patients wondering if they have ADHD,” said Dr. Willough Jenkins, a psychiatrist at Rady Children’s Hospital-San Diego who was not involved in the study.
In particular, Jenkins said, doctors have gotten better at recognizing the disorder in girls and older children.
“It used to be thought that ADHD was only a disease of hyperactive boys,” she said. “In the last 15, 10 years, this has really changed a lot. And even in the last five years, we have seen a lot of improvements in diagnosis.”
ADHD is one of the most commonly diagnosed neurodevelopmental disorders in children and adolescents. The cases were increasing for several decades as awareness increased. The disorder is often characterized by difficulty concentrating, sitting still, or exercising self-control.
Danielson said younger children with ADHD tend to be more hyperactive or impulsive, while in adolescence the disorder tends to shift more toward inattention — behaviors like daydreaming, hyperconcentration or difficulty completing tasks.
Other mental health experts agree that the pandemic has likely accelerated ADHD diagnoses.
Thomas Power, director of the ADHD Management Center at Children’s Hospital of Philadelphia, said the stress of remote learning, social isolation, family health scares and disruption to routines may have worsened children’s symptoms, making them more visible.
“Particularly for children who had mild attention difficulties, learning in this type of context would be much more challenging and could be enough to trigger attention deficit disorder,” he said.
As parents have spent more time at home, they may also have noticed difficulties in their children, said Yamalis Diaz, a child and adolescent psychologist at the Center for Child Studies at NYU Langone.
“This provided parents with an extended period of observation of their children trying to concentrate and accomplish academic work,” Diaz said. “Parents are now watching, ‘Oh my God, my kid interrupts me 50 times a day just to do a chore.’”
But Jenkins said there may have been an uptick in misdiagnoses during the pandemic because rates of depression and anxiety have increased during that time and symptoms can overlap.
“People may not realize that anxiety and depression can be a reason you can’t pay attention,” she said.
Discussions about ADHD on social media have also increased during the pandemic, according to one 2022 Study. Danielson said this may have led some older children to self-diagnose.
“As kids and teens spend more time on social media and learn more about ADHD, they may see it in themselves a little more,” Danielson said.
Excessive screen time, however, has demonstrated increase the risk of ADHDaccording to some previous research — so it could be another, albeit minor, reason for the trend, Power said.
“There’s certainly been a lot of attention recently about the downside of kids’ heavy involvement in social media and video games, so I think those could be contributing factors,” he said.
Jenkins highlighted another important contributor to ADHD rates: changes in the American Psychiatric Association’s diagnostic guidelines.
Until 2013, doctors would not diagnose a child with both autism and ADHD, due to concerns that autism-related attention problems would be confused with ADHD. A child also needed to have symptoms of ADHD before age 7 to be diagnosed. But over the past decade, an updated diagnostic manual has stated that children can be diagnosed with ADHD if they have autism, as well as if their symptoms appear before age 12.
Diaz said expanding criteria likely helped more children access treatment.
“The reason for diagnosis is not simply to label children,” she said. “It’s really about identifying where there might be some challenges that we can actually rectify and course correct.”
Doctors often recommend behavioral therapy for younger children with ADHD, while older children may receive a combination of behavioral therapy and medication.
But according to the new study, 30% of children with ADHD in 2022 did not receive behavioral therapy or medication, compared to 23% in 2016.
Danielson said some children receive behavioral therapy at school, so virtual learning during the pandemic may have impeded access. The Food and Drug Administration also reported a shortage of ADHD medications starting in 2022 — a problem that continues to some extent today, although some of the shortages have recently been resolved, the FDA said.
Some drugmakers attributed the shortage, in part, to high demand due to the rise in ADHD diagnoses.
Diaz said it can still be difficult to find appointments with doctors who treat ADHD.
“Even in places where treatment options are saturated, like New York City, there are waiting lists everywhere,” she said. “It’s possible that parents wanted or tried and simply couldn’t access good treatment.”
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