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Charting the Prevalence of ADHD
Attention deficit hyperactivity disorder (ADHD) is a brain disorder characterized by hyperactivity and inattention. According to a new Mayo Clinic study, children have at least a 7 1/2% chance of being diagnosed with ADHD some time between age 5 and high-school graduation.
"That's a large number of kids affected at some point during childhood," said Dr. William Barbaresi, developmental and behavioral pediatric specialist at the Mayo Clinic, who is lead author of the study published in Archives of Pediatrics and Adolescent Medicine. "ADHD is without question a very common condition that affects a large number of children and we have to deal with it in a systematic fashion in school and in the medical system. We can't ignore a problem that affects such a large number of kids."
The Mayo Clinic researchers studied computerized medical records of 8,548 children living in the Rochester area who were born between 1976 and 1982, combing medical and school records to determine which children met the most current diagnostic criteria for ADHD.
Current estimates suggest 3% to 5% of school-age children have ADHD at any given time. "That's an estimate based on a variety of sources of information," said Barbaresi, "but 3% to 5% is a conservative estimate, it's on the low side and it's reasonable to say a larger number is affected during childhood."
Another expert in ADHD who agrees the current 3% to 5% prevalence figure is too low is Dr. Joe Biederman, a child psychiatrist at Harvard Medical School and Massachusetts General Hospital. "The official figure of 3 (percent) to 5 percent is just an estimate, not a hard number," said Biederman, "this is a very common disorder, some studies have estimated 9 percent to 10 percent of children have ADHD. Not all of them may be on medications, but they're being attended to."
However, not all experts in the field think the current estimate is too conservative. Dr. Steven Kurtz with the Institute for the Study of ADHD and Related Disorders at the NYU Study Center pointed out that "given the startling data that 7 1/2% of school-age children will at some point be diagnosed with ADHD, you have to look at why the numbers are as high as they are. One needs to be extra careful about the criteria used in the new study. A child with ADHD has to be impaired in more than one setting and they didn't have data to show that."
Kurtz also noted some of the children’s symptoms listed in the medical charts could actually have been due to other disorders. “For instance,” he said, "other disorders that could account for symptoms of ADHD include posttraumatic stress disorder, which can make kids inattentive. Anxiety, depression and learning disorders can do the same thing. Parents should be concerned and understand the symptoms of ADHD. Getting a report from school is a good starting point, but children need to go to a physician for further evaluation." Current guidelines recommend at least two or three visits with a physician and behavior reports from parents and teachers before there can be an ADHD diagnosis.
Steven Hinshaw, child psychologist at University of California, Berkeley, feels the study is well done study and “in some ways not terribly surprising." Hinshaw continued, "prevalence data has varied widely from 1%- 2% to as high as 15% plus. The figure of 7 ˝% is higher than that stated by the surgeon general, but within the ballpark of other important population studies." He did, however caution that the study may not be representative of the entire U.S. population. "Rochester is white, fairly affluent middle America so we don't know if the figure would be higher or lower in inner cities or other regions of the country."
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