Facts About ADHD
ADHD is one of the most common neurobehavioraldisorders of childhood. It is usually first diagnosed in childhood and often lasts into adulthood. Children with ADHD have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), and in some cases, are overly active.
Signs and Symptoms
It is normal for children to have trouble focusing and behaving at one time or another. However, children with ADHD do not just grow out of these behaviors. The symptoms continue and can cause difficulty at school, at home, or with friends.
A child with ADHD might:
- have a hard time paying attention
- daydream a lot
- not seem to listen
- be easily distracted from schoolwork or play
- forget things
- be in constant motion or unable to stay seated
- squirm or fidget
- talk too much
- not be able to play quietly
- act and speak without thinking
- have trouble taking turns
- interrupt others
There are three different types of ADHD, depending on which symptoms are strongest in the individual:
- Predominantly Inattentive Type: It is hard for the individual to organize or finish a task, to pay attention to details, or to follow instructions or conversations. The person is easily distracted or forgets details of daily routines.
- Predominantly Hyperactive-Impulsive Type: The person fidgets and talks a lot. It is hard to sit still for long (e.g., for a meal or while doing homework). Smaller children may run, jump or climb constantly. The individual feels restless and has trouble with impulsivity. Someone who is impulsive may interrupt others a lot, grab things from people, or speak at inappropriate times. It is hard for the person to wait their turn or listen to directions. A person with impulsiveness may have more accidents and injuries than others.
- Combined Type: Symptoms of the above two types are equally present in the person.
Causes of ADHD
Scientists are studying cause(s) and risk factors in an effort to find better ways to manage and reduce the chances of a person having ADHD. The cause(s) and risk factors for ADHD are unknown, but current research shows that genetics plays an important role. Recent studies of twins link genes with ADHD.1
In addition to genetics, scientists are studying other possible causes and risk factors including:
- Brain injury
- Environmental exposures (e.g., lead)
- Alcohol and tobacco use during pregnancy
- Premature delivery
- Low birth weight
Did you Know?
While some individuals, including many professionals, still refer to the condition as “ADD” (attention deficit disorder), this term is no longer in widespread use. For those who may have been diagnosed with ADD, the corresponding diagnostic category, using current terminology, would most likely be “ADHD, Predominantly Inattentive Type”.
Research does not support the popularly held views that ADHD is caused by eating too much sugar, watching too much television, parenting, or social and environmental factors such as poverty or family chaos. Of course, many things, including these, might make symptoms worse, especially in certain people. But the evidence is not strong enough to conclude that they are the main causes of ADHD.
Deciding if a child has ADHD is a several step process. There is no single test to diagnose ADHD, and many other problems, like anxiety, depression, and certain types of learning disabilities, can have similar symptoms. One step of the process involves having a medical exam, including hearing and vision tests, to rule out other problems with symptoms like ADHD. Another part of the process may include a checklist for rating ADHD symptoms and taking a history of the child from parents, teachers, and sometimes, the child.
In most cases, ADHD is best treated with a combination of medication and behavior therapy. No single treatment is the answer for every child and good treatment plans will include close monitoring, follow-ups and any changes needed along the way.
If you or your doctor has concerns about ADHD, you can take your child to a specialist such as a child psychologist or developmental pediatrician, or you can contact your local early intervention agency (for children under 3) or public school (for children 3 and older).
The Centers for Disease Control and Prevention (CDC) sponsors theNational Resource Center, a program of CHADD – Children and Adults with Attention-Deficit/Hyperactivity Disorder. Their Web site has links to information for people with ADHD and their families. The National Resources Center operates a call center with trained staff to answer questions about ADHD. The number is 1-800-233-4050.
To find out who to speak to in your area, you can contact the National Dissemination Center for Children with Disabilities by logging on tohttp://www.nichcy.org/ or calling 1-800-695-0285.
In order to make sure your child reaches his or her full potential, it is very important to get help for ADHD as early as possible.
Symptoms and Diagnosis
Deciding if a child has ADHD is a several-step process. There is no single test to diagnose ADHD, and many other problems, like anxiety, depression, and certain types of learning disabilities, can have similar symptoms.
The American Psychiatric Association’s Diagnostic and Statistical Manual-IV, Text Revision (DSM-IV-TR) is used by mental health professionals to help diagnose ADHD. This diagnostic standard helps ensure that people are appropriately diagnosed and treated for ADHD. Using the same standard across communities will help determine the prevalence and public health impact of ADHD.
The criteria are presented here in modified form in order to make them more accessible to the general public. They are listed here for information purposes and should be used only by trained health care providers to diagnose or treat ADHD.
DSM-IV Criteria for ADHD
I. Either A or B:
- Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is inappropriate for developmental level:
- Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
- Often has trouble keeping attention on tasks or play activities.
- Often does not seem to listen when spoken to directly.
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
- Often has trouble organizing activities.
- Often avoids, dislikes, or doesn’t want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
- Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
- Is often easily distracted.
- Is often forgetful in daily activities.
- Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:
- Often fidgets with hands or feet or squirms in seat when sitting still is expected.
- Often gets up from seat when remaining in seat is expected.
- Often excessively runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
- Often has trouble playing or doing leisure activities quietly.
- Is often “on the go” or often acts as if “driven by a motor”.
- Often talks excessively.
- Often blurts out answers before questions have been finished.
- Often has trouble waiting one’s turn.
- Often interrupts or intrudes on others (e.g., butts into conversations or games).
II. Some symptoms that cause impairment were present before age 7 years.
III. Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home).
IV. There must be clear evidence of clinically significant impairment in social, school, or work functioning.
V. The symptoms do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).
Based on these criteria, three types of ADHD are identified:
IA. ADHD, Combined Type: if both criteria IA and IB are met for the past 6 months
IB. ADHD, Predominantly Inattentive Type: if criterion IA is met but criterion IB is not met for the past six months
IC. ADHD, Predominantly Hyperactive-Impulsive Type: if Criterion IB is met but Criterion IA is not met for the past six months.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.
My Child Has Been Diagnosed with ADHD – Now What?
It is understandable for parents to have concerns when their child is diagnosed with ADHD, especially about treatments. It is important for parents to remember that while ADHD can’t be cured, it can be successfully managed. There are many treatment options, so parents and doctors should work closely with everyone involved in the child’s treatment — teachers, coaches, therapists, and other family members. Taking advantage of all the resources available will help you guide your child towards success. Remember, you are your child’s strongest advocate!
In most cases, ADHD is best treated with a combination of medication and behavior therapy. Good treatment plans will include close monitoring, follow-ups and any changes needed along the way.
Following are treatment options for ADHD:
- Behavioral intervention strategies
- Parent training
- ADHD and school
To go to the American Academy of Pediatrics (AAP) policy statement on the treatment of school-aged children with ADHD, visit the Recommendations page.
Medication can help a child with ADHD in their everyday life and may be a valuable part of a child’s treatment. Medication is one option that may help better control some of the behavior problems that have led to trouble in the past with family, friends and at school.
Several different types of medications may be used to treat ADHD:
- Stimulants are the best-known and most widely used treatments. Between 70-80 percent of children with ADHD respond positively to these medications.
- Nonstimulants were approved for treating ADHD in 2003. This medication seems to have fewer side effects than stimulants and can last up to 24 hours.
Medications can affect children differently, where one child may respond well to one medication, but not another. When determining the best treatment, the doctor might try different medications and doses, so it is important to work with your child’s doctor to find the medication that works best for your child.
For more information on treatments, please click one of the following links:
Research shows that behavioral therapy is an important part of treatment for children with ADHD. ADHD affects not only a child’s ability to pay attention or sit still at school, it also affects relationships with family and how well they do in their classes. Behavioral therapy is another treatment option that can help reduce these problems for children and should be started as soon as a diagnosis is made.
Following are examples that might help with your child’s behavioral therapy:
- Create a routine. Try to follow the same schedule every day, from wake-up time to bedtime.
- Get organized. Put schoolbags, clothing, and toys in the same place every day so your child will be less likely to lose them.
- Avoid distractions. Turn off the TV, radio, and computer, especially when your child is doing homework.
- Limit choices. Offer a choice between two things (this outfit, meal, toy, etc., or that one) so that your child isn’t overwhelmed and overstimulated.
- Change your interactions with your child. Instead of long-winded explanations and cajoling, use clear, brief directions to remind your child of responsibilities.
- Use goals and rewards. Use a chart to list goals and track positive behaviors, then reward your child’s efforts. Be sure the goals are realistic—baby steps are important!
- Discipline effectively. Instead of yelling or spanking, use timeouts or removal of privileges as consequences for inappropriate behavior.
- Help your child discover a talent. All kids need to experience success to feel good about themselves. Finding out what your child does well — whether it’s sports, art, or music — can boost social skills and self-esteem.
Another important part of treatment for a child with ADHD is parent training. Children with ADHD may not respond to the usual parenting practices, so experts recommend parent education. This approach has been successful in educating parents on how to teach their kids about organization, develop problem-solving skills and cope with their ADHD symptoms.
Parent training can be conducted in groups or with individual families and are offered by therapists or in special classes. Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD) offers a unique educational program to help parents and individuals navigate the challenges of ADHD across the lifespan. Find more information about CHADD’s “Parent to Parent” program by visiting CHADD’s Web site.
Just like with parent training, it is important for teachers to have the needed skills to help children manage their ADHD. However, since the majority of children with ADHD are not enrolled in special education classes, their teachers will most likely be regular education teachers who might know very little about ADHD and could benefit from assistance and guidance.
Here are some tips to share with teachers for classroom success:
- Use a homework folder for parent-teacher communications
- Make assignments clear
- Give positive reinforcement
- Be sensitive to self-esteem issues
- Involve the school counselor or psychologist
What Every Parent Should Know….
As your child’s most important advocate, you should become familiar with your child’s medical, legal, and educational rights. Kids with ADHD might be eligible for special services or accommodations at school under the Individuals with Disabilities in Education Act (IDEA) and an anti-discrimination law known as Section 504. To learn more about Section 504, click here.
Attention-Deficit/Hyperactivity Disorder (ADHD) often occurs with other disorders (called comorbidities of ADHD). About half of children with ADHD referred to clinics have behavioral disorders as well as ADHD.
The combination of ADHD with other behavioral disorders often presents extra challenges to affected individuals, educators, and health care providers. Therefore, it is important for doctors to screen every child with ADHD for other disorders and problems.
ADHD can have many effects on a child’s development. It can make childhood friendships, or peer relationships, very difficult. These relationships contribute to children’s immediate happiness and may be very important to their long-term development.
Children with ADHD might have difficulty in their peer relationships, for example, being rejected by peers or not having close friends. In some cases, children with peer problems may also be at higher risk for anxiety, behavioral and mood disorders, substance abuse and delinquency as teenagers.
- Parents of children with a history of ADHD report almost 3 times as many peer problems as those without a history of ADHD (21.1% vs. 7.3%).1
- Parents report that children with a history of ADHD are almost 10 times as likely to have difficulties that interfere with friendships (20.6% vs. 2.0%).1
How does ADHD interfere with peer relationships?
Exactly how ADHD contributes to social problems is not fully understood. Several studies have found that children with predominantly inattentive ADHD may be perceived as shy or withdrawn by their peers. Research strongly indicates that aggressive behavior in children with symptoms of impulsivity/hyperactivity may play a significant role in peer rejection. In addition, other behavioral disorders often occur along with ADHD. Children with ADHD and other disorders appear to face greater impairments in their relationships with peers.
Having ADHD does not mean a person has to have poor peer relationships.
Not everyone with ADHD has difficulty getting along with others. For those who do, many things can be done to improve the person’s relationships. The earlier a child’s difficulties with peers are noticed, the more successful intervention may be. Although researchers have not provided definitive answers, some things parents might consider as they help their child build and strengthen peer relationships are:
- Recognize the importance of healthy peer relationships for children. These relationships can be just as important as grades to school success.
- Maintain on-going communication with people who play important roles in your child’s life (such as teachers, school counselors, after-school activity leaders, health care providers, etc.). Keep up-dated on your child’s social development in community and school settings.
- Involve your child in activities with his or her peers. Communicate with other parents, sports coaches and other involved adults about any progress or problems that may develop with your child.
- Peer programs can be helpful, particularly for older children and teenagers. Schools and communities often have such programs available. You may want to discuss the possibility of your child’s participation with program directors and your child’s care providers.
Children and adolescents with ADHD can have more frequent and severe injuries than peers without ADHD.
Research indicates that children with ADHD are significantly more likely to:
- Be injured as pedestrians or while riding a bicycle
- Receive head injuries
- Injure more than one part of the body
- Be hospitalized for accidental poisoning
- Be admitted to intensive care units or have an injury result in disability
Further research is needed to understand what role ADHD symptoms play in the risk of injuries and other disorders that may occur with ADHD. For example, a young child with ADHD may not look for oncoming traffic while riding a bicycle or crossing the street, or may engage in high-risk physical activity without thinking of the possible consequences. Teenagers with ADHD who drive may have more traffic violations and accidents and twice as likely to have their driver’s licenses suspended than drivers without ADHD.
Much of what is already known about injury prevention may be particularly useful for people with ADHD.
- Ensure bicycle helmet use. Remind children as often as necessary to watch for cars and to avoid unsafe activities.
- Supervise children when they are involved in high-risk activities or are in risky settings, such as when climbing or when in or around a swimming pool.
- Keep potentially harmful household products, tools, equipment and objects out of the reach of young children.
- Teens with ADHD may need to limit the amount of music listened to in the car while driving, drive without passengers and/or keep the number of passengers to a chosen few, plan trips well ahead of time, avoid alcohol and drug use and cellular phone usage.
- Parents may want to enroll their teens in driving safety courses before they get their driver’s license.
- For more injury prevention tips, visit CDC’s Injury Center.
Oppositional Defiant Disorder (ODD) is one of the most common disorders occurring with ADHD. ODD usually starts before age eight, but no later than early adolescence. Symptoms may occur most often with people the individual knows well, such as family members or a regular care provider. These behaviors are present beyond what are expected for the child’s age, and result in significant difficulties in school, at home, and/or with peers.
Examples of ODD behaviors include:
- Losing one’s temper a lot
- Arguing with adults or refusing to comply with adults’ rules or requests
- Often getting angry or being resentful or vindictive
- Deliberately annoying others; easily becoming annoyed with others
- Often blaming other people for one’s own mistakes or misbehavior
Recently released data from the 1997-98 National Health Interview Survey suggests roughly half of those youth 6-11 years old diagnosed with ADHD may also have a Learning Disorder (LD). The combination of attention problems caused by ADHD and LD can make it particularly hard for a child to succeed in school. Properly diagnosing each disorder is crucial. Appropriate and timely interventions to address ADHD and LD should follow diagnosis. The nature and course of treatment for ADHD and LD may be different, and different types of providers may be involved. Working with health care professionals to determine appropriate referrals and treatment is the best way to make informed decisions for an individual dealing with ADHD and a learning problem.
Conduct Disorder (CD) is a behavioral pattern characterized by aggression toward others and serious violations of rules, laws, and social norms. These behaviors often lead to delinquency or incarceration. Increased injuries and strained peer relationships are also common in this population. The symptoms of CD are apparent in several settings in the person’s life (e.g., at home, in the community and at school).
Although CD is less common than Oppositional Defiant Disorder, it is severe and highly disruptive to the person’s life and to others in his/her life. It is also very challenging to treat. A mental health professional should complete evaluations for CD where warranted, and a plan for intervention should be implemented as early as possible.
Attention-Deficit/Hyperactivity Disorder (ADHD) is a serious public health problem because of the large estimated prevalence1 of the disorder, significant impairment in the areas of school performance and socialization, the chronic nature of the disorder, the limited effectiveness of current interventions to attend to all the impairments associated with ADHD, and the inability to demonstrate that intervention provides substantial benefits for long-term outcomes.
However, because of the evolution of the case definition and differences in how the case definition is operationalized, there is disagreement as to prevalence and precise characteristics of children with the disorder.
Due to the lack of a single, consistent, and standard research protocol for case identification, variable and disparate findings have been noted in the literature. Consequently, relatively little is known about the etiology of ADHD, although genetic factors are believed to be important contributors.
Project to Learn About ADHD in Youth (PLAY)
Because of increasing concern and awareness among health professionals and the public alike, CDC’s National Center on Birth Defects and Developmental Disabilities (NCBDDD) is funding a joint collaboration research project with the University of South Carolina and the University of Oklahoma Health Sciences Center to conduct population-based research on ADHD among school-aged children.
Recognizing that many uncertainties remain concerning prevalence, etiology and treatment patterns of ADHD, this research will shed light on:
- Short and long-term outcomes of children with ADHD
- The prevalence and treated prevalence of ADHD in children
- The existence of comorbid and secondary conditions in children with ADHD
- The types and rates of health risk behaviors in children with ADHD
- Current and previous treatment patterns of children with ADHD
The result of this collaboration will be one of the largest community-based, epidemiologic studies of ADHD in the United States.
These data will also provide information critical to understanding the magnitude of the disorder, the expression of ADHD in diverse population groups, the receipt and quality of community care, and factors associated with differential outcomes in children with the disorder.
Study findings will not only enhance our understanding of ADHD in children, but will also increase our ability to make the most informed decisions and recommendations concerning potential public health prevention and intervention strategies.
Public health issues in ADHD can be divided into three areas: the burden of ADHD in the population, epidemiologic research issues in ADHD, and concerns related to interventions for ADHD. These three topical areas were identified by CDC as crucial for examining ADHD, and necessary to address public health concerns and opportunities for action. Following are the key issues for each topic as well as the necessary actions to address these public health needs.
- Social and Economic Burden of ADHD through the Lifespan
- Epidemiologic Issues in ADHD
- Interventions for ADHD
Given the nature of the disorder, ADHD is believed to have a noticeable impact on social, economic, educational, and health care delivery systems. Additionally, it is reasonable to assume the condition affects those socially associated with an ADHD individual, including his/her family members, peers, and co-workers. However, the magnitude of the social and economic burden in these areas has not been systematically documented.
In general, small, clinic-based studies have shown that adults with ADHD consistently exhibit problems with interpersonal relationships, often have difficulty with employment, and frequently have comorbid or secondary conditions that further debilitate. Perhaps many of the disabilities and poorer outcomes associated with ADHD actually are more strongly associated with conditions that are highly comorbid with ADHD (such as Conduct Disorder) and result in significantly higher economic consequences to society. However, this hypothesis has not been tested.
In understanding the full nature of the disorder, it is imperative to understand the effect it has on the families of children with ADHD. These families may be more prone to conflict and increased levels of familial stress. The child with ADHD may also reduce the parents’ productive participation in activities outside the family (work and community life). Many parents of children with ADHD themselves have the disorder or considerable levels of the symptomatology. However, the impact this disorder has on the family unit and in adult life needs considerable research effort to clarify what aspects of family it impacts and in what ways.
In addition, there is little concrete knowledge of the degree to which interventions can or do improve the outcome of children with ADHD. Developing ways to improve outcomes must begin with consistent and standardized measures of the impact of the disorder. Such methodical surveying has not occurred. Development of standardized burden measures is critical to beginning this process.
Action to Address Public Health Needs
- Conduct analyses of ADHD public health burden in a way that estimates a broad array of costs outside of those exclusively associated with medical treatment. The burden should be studied from a broad perspective to include estimations of cost to society in a monetary sense as well as to individual-level indicators of well-being such as family functioning and social relationships.
- Develop a standardized way to measure burden associated with ADHD and promote its use across studies. This would enable cross-study comparisons such as meta-analysis to be undertaken. This standardized measure should account for medical/treatment costs, educational costs, family costs, and adult functioning variables.
- Incorporate information on ADHD in efforts to study and prevent unintentional injuries, alcohol and drug abuse, sexual risk-taking, disability, and other health risk behaviors in which ADHD may play an important role.
- Include standardized measurements of burden in all public health research of ADHD. Future efforts to measure the impact of ADHD across a cohort should be a priority. Understanding if current interventions or future prevention strategies result in burden reduction will depend largely on consistent and accurate estimation of these burdens.
- Efforts must be made to estimate the prevalence and cost of this disorder in adult populations to understand the strict monetary costs as well as to better understand the areas of impairment for adults with ADHD.
- Conduct population-based ADHD research that includes information on comorbid conditions and the burden with which they are associated. Much of our current evidence regarding comorbid conditions comes from clinical studies rather than population-based studies.
- Explore mechanisms to append economic and social burden studies on other ongoing or completed studies in order to quantify the burden of ADHD.
- Foster collaborations across Federal agencies in order to include information on ADHD in data collection efforts.
- Establish a resource for both professionals and the public regarding what is known about the impact of ADHD.
Although investigation of ADHD has been quite extensive over the past 30 years, the scientific process has been significantly slowed by the lack of a single, consistent, and standard research protocol for case identification. Variable and disparate findings have been noted throughout the literature even on basic issues such as prevalence. As a consequence, speculation regarding possible increases in ADHD prevalence cannot currently be evaluated.
Additionally, we do not have demographic and descriptive statistics for children and adults with the disorder; therefore, there are disparities in identification, access to treatment, and reports of the manifestation of ADHD and its comorbidities. Risk factors for ADHD have not been thoroughly investigated although some clinical samples have identified possible factors that may contribute to ADHD. Some of these related factors are prenatal alcohol use, prenatal smoking, and low birth weight. Genetic predisposition or family history of ADHD has been noted consistently among clinical samples as a risk factor for the development of ADHD.
Unfortunately, many fundamental etiologic questions remain for ADHD. Identifying and understanding etiologic factors will enhance prevention efforts and treatment for both children and adults with ADHD.
Action to Address Public Health Needs
- Develop standard case identification protocols for use in research projects.
- Conduct etiologic studies of ADHD using population-based approaches to identify important risk factors and opportunities for prevention activities and research.
- Use observational epidemiologic methods to describe the impact of ADHD, its impact, and its intervention patterns at the population level.
- Utilize scientific findings to develop, design, and implement ADHD prevention efforts where possible.
- Identify current national or regional surveys where adding ADHD questions would provide particularly useful information regarding the magnitude of the disorder, the nature of common comorbidity and/or secondary conditions, as well as data on health risk behaviors and long-term outcomes for those with ADHD.
- Establish a Federal interagency workgroup to pool research expertise and resources in order to launch epidemiologic research efforts that address the public health research needs in ADHD. Such collaborations should be multi-disciplinary and include professionals in epidemiology, mental/physical health, risk behavior prevention, and health communication for example.
- Establish a resource for both professionals and the public regarding what is known about the epidemiology of ADHD.
ADHD is a chronic condition of high prevalence that requires long-term intervention. Because ADHD is an impairing condition and can have lifelong consequences, interventions designed to reduce negative outcomes and increase capacities should be carefully considered at the national level. One key public health concern is the safety of pharmacological interventions. A second key concern is the effectiveness of current interventions to reduce the impairment associated with ADHD thereby improving health and functioning for ADHD individuals over time. A third public health concern is access to appropriate interventions for individuals and families affected by the disorder.
There are several public health concerns relative to pharmacotherapy. Pharmacologic treatment is extremely prevalent. Assessing the health risks and benefits to young children, particularly preschoolers, is a high priority. Children who begin medication therapies very early and receive treatment on a long-term basis may have unknown risks associated with current treatments. Additionally, pharmacologic interventions often do not normalize behavior. Research, albeit limited, suggests that even with long-term treatment, children and adults with ADHD experience substantial problems in the school, home, workplace, and community settings. This raises questions about the effectiveness of pharmacologic interventions as a long-term approach.
Another intervention option to treat ADHD is behavior modification. It is clear that behavior modification therapies, for youth in particular, have been tested and shown beneficial for the treatment of behavioral disorders including ADHD. However, the majority of youth receiving psychological interventions for ADHD are probably receiving treatments that have not been shown to be effective, such as individual therapy and/or play therapy. The effectiveness of behavioral interventions must be further studied in the treatment of ADHD, to better understand their potential to normalize the behavior and functioning of those with the disorder, especially when combined with pharmacotherapy.
Access to interventions is a critical public health concern. ADHD affects a person’s ability to learn and be socialized to his/her potential; therefore access to diagnosis and intervention is a necessity. Common barriers to services include lack of insurance coverage for mental health problems, exclusion of behavior disorders, including ADHD, from mental health coverage, and under-identification or mis-identification. Community practice with respect to the diagnosis of ADHD fails to uniformly employ accepted methods for establishing cross-situational symptomatology, measurement of functional impairment, and diagnosis of comorbid conditions. Nationally, we must begin to look at a wide variety of intervention issues surrounding ADHD, including how current interventions impact individuals and systems over time, as well as problems with access to appropriate services.
Action to Address Public Health Needs
- Disseminate educational materials relating to the diagnosis of and intervention opportunities for ADHD. Recipients should include but would not be limited to primary care physicians, physician extenders (NP’s and PA’s), mental health professionals, and educators.
- Promote the necessity of careful case identification using standardized instruments and the employment of the most effective interventions in common practice by disseminating useful information to professionals and the public related evidence-based interventions for ADHD.
- Conduct population-based studies of ADHD intervention practices to examine such variables as age of initiation of treatment, type(s) of treatment, duration of treatment, and barriers to receipt of services.
- Establish a mechanism (possibly a registry) of treated individuals to monitor the health effects and potential benefits of long-term treatment for ADHD, particularly among pre-school age children. Additionally collect other related outcomes such as school attainment, interface with judicial system, work performance, and other pertinent variables.
- Collaborate with other organizations to educate and promote what is known about ADHD interventions, appropriate standards of practice, their effectiveness, and their safety.
- Establish a resource to the public for accurate and valid information about ADHD and evidence-based interventions.
* These CDC scientific articles are listed in order of date published
Increasing Prevalence of Parent-Reported Attention-Deficit/Hyperactivity Disorder Among Children – United States, 2003 and 2007
Morbidity and Mortality Weekly Report (MMWR); November 12, 2010 / 59(44);1439-1443
Diagnosed Attention Deficit Hyperactivity Disorder and Learning Disability: United States, 2004-2006
Vital and Health Statistics; July 2008; Series 10, Number 237
[Read article ]
Summary Health Statistics for U.S. Children: National Health Interview Survey, 2006
Vital and Health Statistics; September 2007; Series 10 Number 234, Appendix III, Table VI
[Read article ]
When you click
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National Estimates and Factors Associated With Medication Treatment for Childhood Attention-Deficit/Hyperactivity Disorder
Pediatrics; Vol. 119 Supplement February 2007, pp. S99-S106
Susanna N. Visser, MS, Catherine A. Lesesne, PhD, MPH and Ruth Perou, PhD
Mental Health in the United States: Prevalence of Diagnosis and Medication Treatment for Attention-Deficit/Hyperactivity Disorder — United States, 2003
Morbidity and Mortality Weekly Report; September 2, 2005; 54(34); 842-847
Attention-Deficit/Hyperactivity Disorder in School-Aged Children: Association with Maternal Mental Health and use of Health Care Resources
Pediatrics; 2003; 111:S1232-1237
Lesesne CA, Visser SN, White CP
The Epidemiology of Attention-Deficit/Hyperactivity Disorder (ADHD): A Public Health View
Mental Retardation Developmental Disability Research Review; 2002; 8:162-170
Rowland AS, Lesesne CA, Abramowitz AJ
To search a database of articles that have been published by CDC authors within the National Center on Birth Defects and Developmental Disabilities from 1990 to present, click here.