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Children being carefully evaluated for ADHD, study says

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Increasing rates of attention deficit hyperactivity disorder among kids have led some parents and experts to wonder if the condition is overdiagnosed. A new report from the Centers for Disease Control and Prevention’s National Center for Health Statistics finds the vast majority of evaluations for ADHD adhere to best practice guidelines, suggesting kids are, by and large, being carefully diagnosed.

ADHD diagnoses have risen 5 percent per year since the late 1990s, while diagnoses involving medication have risen 7 percent since 2007, said Susanna Visser, lead author of the report and an epidemiologist at the CDC’s National Center on Birth Defects and Developmental Disabilities. Around 8.8 percent of kids ages 4-17 have a current ADHD diagnosis, while 11 percent of kids in that age range have ever been diagnosed.

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Given these rates, the authors sought to understand how diagnoses are made. Their findings were based on data from the largest US survey to date on the diagnosis and treatment of ADHD in children, which included a nationally representative sample of nearly 3,000 kids.

Parents were asked questions including what age their child was first diagnosed with ADHD, what type of health care provider made the diagnosis, and what methods or tools were used to evaluate their child. Consistent with guidelines from the American Academy of Pediatrics, behavioral rating scales or checklists were used in the vast majority of evaluations (around 90 percent of the kids), while reports from adults outside of the family, such as teachers or child care providers, were included 82 percent of the time. Reports from multiple sources are important because symptoms need to be present across different settings, such as home and school, to meet diagnostic criteria.

In addition, more than two-thirds (68 percent) of the children had received neuropsychological testing, while 30 percent had undergone neurological imaging or laboratory tests.

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The median age at diagnosis was 7, though around 1 in 3 children was diagnosed before they turned 6. While just over half of all kids were first diagnosed by a pediatrician or other primary care provider, children younger than 6 were more likely than older kids to have been diagnosed by a psychiatrist. Given the challenges involved in diagnosing ADHD in very young children, psychiatrists’ involvement in these cases is good news, Visser said.

“So many symptoms associated with ADHD — not being able to sit still for long periods, acting as if being driven by a motor, having a tough time attending to tasks — are in fact developmentally appropriate [for kids younger than 6],” she said. If these symptoms seem to pose a problem, “you really need a specialist [to conduct an evaluation].”

Behavioral therapy, including training for parents to help manage their children’s symptoms, is the first line of treatment for children younger than 6. Research shows this type of intervention is nearly as effective as medication, Visser added.

The report suggests there has been significant improvement in diagnosing ADHD in children, said Dr. Timothy Wilens, chief of the division of child and adolescent psychiatry at Massachusetts General Hospital and an expert on ADHD.

“[The findings] indicate thoughtfulness on the part of families and healthcare providers,” said Wilens, who was not involved in the research. “The majority of physicians are engaging in conversations with parents and gathering information from adults outside of the home. Practitioners are using checklists to better articulate symptoms and the severity of symptoms. Kids are often receiving additional testing to clarify co-occurring disorders or learning problems. Compared with two decades ago, we’re doing much better.”

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Still, the rising rates of ADHD warrant further investigation, Visser said.

“The findings about following best practices coupled with the increased rate of diagnosis suggest we should look at why we’re seeing these rates,” she said.


Ami Albernaz can be reached at ami.albernaz@gmail.com.