Fewer Than Half of Children With ADHD Symptoms Get Help

What the survey found

8.6 percent of American children aged eight to fifteen met the criteria for ADHD in a single year, roughly one child in twelve. Among those children, 47.7 percent had spoken with anyone at a hospital, clinic or doctor’s office about the problem in the previous twelve months.

Those figures come from the National Health and Nutrition Examination Survey, the federal programme that examines a nationally representative sample of Americans inside mobile examination centres parked in counties across the country. Two survey cycles running from 2001 to 2004 included a mental health assessment of children, analysed by Kathleen Ries Merikangas and colleagues at the National Institute of Mental Health, the National Center for Health Statistics, Columbia University and Harvard, and published in the journal Pediatrics in 2010. The abstract reports 3,042 children aged eight to fifteen, recruited under a sampling design that deliberately oversampled low-income families, adolescents, Black children and Mexican American children.

Diagnoses came from selected modules of the Diagnostic Interview Schedule for Children, a fully scripted interview administered by trained lay interviewers rather than by clinicians. Children answered for themselves about anxiety, panic, depression and eating problems. The ADHD and conduct disorder modules went instead to the primary caretaker, by telephone, four to twenty-eight days after the child’s visit, which makes the national ADHD estimate a record of what parents reported.

Across the six disorders assessed, 13.1 percent of children met criteria for at least one in the past year. ADHD accounted for much of that total at 8.6 percent, divided between 4.3 percent with attention difficulties, 2.0 percent with hyperactivity and 2.2 percent with both. Mood disorders reached 3.7 percent, conduct disorder 2.1 percent, generalized anxiety or panic 0.7 percent and eating disorders 0.1 percent. ADHD was 2.1 times more common in boys, while mood disorders were twice as common in girls.

Raising the threshold changed the count very little. When the researchers required severe impairment rather than criteria alone, the ADHD rate moved from 8.6 percent to 7.8 percent, a reduction that did not reach statistical significance. Contact was almost as flat: among children who met the severe-impairment standard for ADHD, 48.5 percent had spoken with someone.

What it means for you and your child

The data are now more than twenty years old and rest on DSM-IV, the diagnostic manual in use at the time and since revised. Prevalence estimates have moved and criteria have been rewritten, so 8.6 percent belongs to the decade that produced it. What survives the interval is the relationship the survey recorded between the number of children who met criteria and the number who had been in any conversation about the problem.

The survey asked whether the child had seen or talked to someone at a hospital, clinic or office about that specific problem during the past year. One appointment counted, and a year of well-matched support counted the same. The survey, which distinguishes neither, records only that a conversation occurred.

Girls with a disorder were about half as likely as boys to have spoken with anyone, and children aged twelve to fifteen were nearly twice as likely as those aged eight to eleven. Family income, race, ethnicity and health insurance showed no significant association with contact at all.

The authors are direct that their rates understate the true picture. Only six disorders were assessed, and several of the most common in childhood, separation anxiety and phobic states among them, were left out entirely. Most diagnoses rested on a single informant where combined parent and child report is known to be more valid, and no clinician examined any child to confirm what the interview had recorded.

What remains is arithmetic of a plain kind. In a nationally representative sample of American children, more than half of those whose parents described a full ADHD presentation had not discussed the matter with anyone in a medical setting for a year, and requiring severe impairment barely moved that proportion. Whether those children needed care, or would have gained from it, lies beyond the reach of a survey taken at one point in time; what the survey documents is that nobody had yet seen them. Your child’s assessment placed them in the smaller group of children whom someone had already recognized.