[Complete paper on CDC website PDF 2.9MB]
According to a new report released today by the Centers for Disease Control and Prevention (CDC), approximately 1.6 million elementary school-aged children have been diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD), a condition also known as Attention Deficit Disorder (ADD). In a national survey, the parents of 7 percent of children 6-11 years of age reported ever being told by a doctor or health professional that their child had ADHD.
The report, "Prevalence of Attention Deficit Disorder and Learning Disability," based on 1997-98 data from CDCs National Health Interview Survey, shows that about one-half of children diagnosed with ADHD have also been identified as having a learning disability.
"This report serves as a snapshot of a condition that has important consequences for the development of school-age children," said David Fleming M.D., Acting CDC Director. "However, much more needs to be learned about ADHD and about the spectrum of impairments associated with ADHD."
The report details many of the characteristics of children with ADHD, learning disability, and children with both conditions. Among children with a diagnosis of only ADHD, boys were nearly three times as likely as girls to have this diagnosis. White non-Hispanic children were more than twice as likely as Hispanic and black non-Hispanic children to report a diagnosis of ADHD.
In addition, access to health care plays an important role in the diagnosis and treatment of ADHD. Children with health insurance coverage were more often reported to have a diagnosis of ADHD than children without health insurance coverage.
The study shows that children with ADHD use more health care services than children without this diagnosis. Children with ADHD were more likely to have contact with a mental health professional and to have frequent health care visits.
"There has been concern in some circles that ADHD has been over-diagnosed among those with regular access to health care," said Fleming. "And there is equal concern that the problem may be under-diagnosed among those who have limited or no access to care. It’s clearly important to accurately identify children with ADHD and ensure that they have appropriate health care."
The report "Prevalence of Attention Deficit Disorder and Learning Disability" was prepared by CDCs National Center for Health Statistics and can be found at the CDC/NCHS Web site.
For Immediate Release Tuesday, May 21, 2002 Contact: NCHS Press Office (301) 458-4800 CDC Office of Media Relations (404) 639-3286 E-mail: paoquery@cdc.gov
Abstract
Objectives
This report presents national estimates of the prevalence of diagnosed Attention Deficit Disorder (ADD) and/or Learning Disability (LD) in U.S. children. Differences in the prevalence of these conditions are examined for children with selected sociodemographic characteristics. The occurrence of other health conditions and use of educational and health care services are contrasted for children with only ADD, those with only LD, those with both diagnoses, and those with neither diagnosis.
Methods
Estimates in this report are based on data from the National Health Interview Survey (NHIS), a national household survey of the civilian noninstitutionalized population of the United States. The analysis focuses on 8,647 children 6–11 years of age in the 1997 and 1998 NHIS.
Results
In 1997–98 over 2.6 million children 6–11 years of age were reported to have ever had a diagnosis of ADD or LD. A diagnosis of only ADD was reported for 3 percent of children, a diagnosis of only LD for 4 percent, and a diagnosis of both conditions for 4 percent. The prevalence of ADD with or without LD was greater for boys than for girls. Having health insurance was associated with a diagnosis of only ADD. Living in a low-income or mother-only family occurred more often among children with a diagnosis of LD.
Children with LD were nearly five times more likely to be in special education than children with a diagnosis of only ADD. Children with ADD, in contrast to children without this diagnosis, more often had contact with a mental health professional, used prescription medication regularly, and had frequent health care visits.
Keywords: children’s health, learning and behavioral disorders, health care utilization
Highlights
Prevalence
Other Health Conditions
Use of Special Education
Use of Health Care Services
Tables and References from:
Pastor PN, Reuben CA. Attention deficit disorder and learning disability: United States, 1997–98. National Center for Health Statistics. Vital Health Stat 10(206). 2002.
Table A. Number of children 6–11 years of age by diagnosed Attention Deficit Disorder and/or Learning Disability, according to selected characteristics: United States, 1997–98
KEY A=All children1, B=NEITHER2, C=ADD/noLD3, D=LD/noADD4, E=BOTH5
(Number in 1,000s) Sample size . Characteristic A B C D E A B C D E . Total 24,160 21,527 784 1,010 839 8,601 7,697 270 345 289 Sex Boys 12,311 10,556 582 576 597 4,413 3,806 202 197 208 Girls 11,850 10,970 203 434 242 4,188 3,891 68 148 81 Age 6–8 years 12,195 11,171 281 409 333 4,358 3,993 106 146 113 9–11 years 11,966 10,355 503 601 506 4,243 3,704 164 199 176 Race/ethnicity6 White non-Hispanic 15,789 13,944 649 621 575 4,629 4,084 193 180 172 Black non-Hispanic 3,735 3,312 69 201 153 1,415 1,264 34 62 55 Hispanic 3,573 3,268 48 165 93 2,237 2,049 35 95 58 Birthweight Low (less than 2,500 grams) 1,529 1,254 65 134 75 608 509 21 45 33 Not low (2,500 grams or more) 21,171 18,975 680 819 697 7,452 6,697 233 285 237 Family structure7 Mother and father 17,497 15,848 525 609 514 5,808 5,282 168 198 160 Mother only 5,308 4,538 203 325 242 2,200 1,901 80 117 102 Family income $20,000 or more 18,133 16,334 606 661 532 6,128 5,535 202 222 169 Less than $20,000 5,021 4,288 143 302 287 2,069 1,791 59 105 114 Residence in MSA8 Central city, MSA 6,553 5,862 190 294 208 2,694 2,427 78 104 85 Not central city, MSA 12,676 11,324 442 493 418 4,334 3,880 139 173 142 Not MSA 4,931 4,341 153 223 214 1,573 1,390 53 68 62 Health insurance coverage Uninsured 3,121 2,847 58 142 75 1,283 1,177 27 50 29 Medicaid9 3,738 2,982 158 304 295 1,434 1,159 54 107 114 Private10 17,165 15,576 566 562 461 5,823 5,307 187 186 143 ADD is Attention Deficit Disorder. LD is Learning Disability. 1 Data do not include children with unknown responses to the questions on ADD and LD. 2 NEITHER includes children who have never had a diagonsis of either ADD or LD. 3 ADD/noLD includes children who have ever had a diagnosis of ADD and have never had a diagnosis of LD. 4 LD/noADD includes children who have ever had a diagnosis of LD and have never had a diagnosis of ADD. 5 BOTH includes children who have ever had a diagnosis of both ADD and LD. 6 Data are not shown for non-Hispanic children of other races due to small sample size. 7 Mother and father refer to biological, adoptive, step, and foster parents. Data are not shown for children in other family types due to small sample size. 8 MSA is metropolitan statistical area. 9 Medicaid includes children insured only by Medicaid. 10 Private includes children covered by private insurance, those with non-Medicaid public insurance, and those with both private and public insurance.
Table B. Percent of children 6–11 years of age with Attention Deficit Disorder and/or Learning Disability by sex, according to selected characteristics: United States, 1997–98
KEY A=ADD/noLD1, B=LD/noADD2, C=BOTH3, Percent (standard error) All children Boys Girls . Characteristic A B C A B C A B C Total 3.3(0.23) 4.2(0.27) 3.5(0.23) 4.7(0.37) 4.7(0.39) 4.9(0.39) 1.7(0.26) 3.7(0.37) 2.0(0.28) Age 6–8 years 2.3(0.27) 3.4(0.31) 2.7(0.30) 3.3(0.47) 3.8(0.45) 4.0(0.50) 1.3(0.28) 2.9(0.43) 1.5(0.34) 9–11 years 4.2(0.40) 5.0(0.43) 4.2(0.37) 6.1(0.64) 5.6(0.60) 5.7(0.60) 2.2(0.44) 4.4(0.61) 2.6(0.43) Race/ethnicity4 White non-Hispanic 4.1(0.33) 3.9(0.33) 3.6(0.30) 6.0(0.53) 4.2(0.45) 5.0(0.50) 2.1(0.37) 3.7(0.46) 2.2(0.38) Black non-Hispanic 1.8(0.34) 5.4(0.84) 4.1(0.67) 2.7(0.62) 7.6(1.40) 6.5(1.14) * 3.2(0.83) * Hispanic 1.4(0.29) 4.6(0.71) 2.6(0.40) 1.8(0.39) 4.8(0.75) 3.1(0.61) * 4.5(1.22) 2.0(0.50) Birthweight Low (Less than 2,500 grams) 4.3(1.04) 8.8(1.37) 4.9(1.06) 6.9(1.95) 8.7(1.90) 6.5(1.56) * 8.8(1.99) * Not low (2,500 grams or more) 3.2(0.25) 3.9(0.29) 3.3(0.24) 4.7(0.40) 4.6(0.42) 4.6(0.42) 1.7(0.28) 3.1(0.36) 2.0(0.29) Family structure5 Mother and father 3.0(0.27) 3.5(0.28) 2.9(0.26) 4.4(0.45) 4.0(0.41) 3.8(0.42) 1.5(0.27) 3.0(0.36) 2.0(0.34) Mother only 3.8(0.55) 6.1(0.76) 4.6(0.55) 5.4(0.85) 6.6(0.94) 7.0(0.95) * 5.7(1.15) 2.0(0.52) Family income $20,000 or more 3.3(0.27) 3.7(0.27) 2.9(0.26) 4.8(0.45) 3.9(0.38) 4.2(0.43) 1.9(0.31) 3.4(0.39) 1.7(0.29) Less than $20,000 2.8(0.46) 6.0(0.82) 5.7(0.63) 4.3(0.78) 7.4(1.11) 7.3(0.97) * 4.5(1.10) 3.9(0.82) Health insurance coverage Uninsured 1.9(0.39) 4.6(0.91) 2.4(0.50) 2.9(0.72) 5.1(1.08) 3.6(0.81) * * * Medicaid6 4.2(0.72) 8.1(0.99) 7.9(0.88) 6.1(1.22) 9.2(1.40) 11.0(1.42)* 6.9(1.31) 4.4(1.04) Private7 3.3(0.28) 3.3(0.27) 2.7(0.26) 4.8(0.46) 3.6(0.39) 3.6(0.42) 1.8(0.31) 2.9(0.36) 1.7(0.30) Residence in MSA8 Central city, MSA 2.9(0.39) 4.5(0.56) 3.2(0.40) 4.1(0.68) 5.0(0.75) 4.7(0.70) 1.7(0.41) 4.0(0.86) 1.6(0.42) Not central city, MSA 3.5(0.36) 3.9(0.33) 3.3(0.33) 5.1(0.59) 4.5(0.49) 4.5(0.53) 1.9(0.40) 3.3(0.44) 2.1(0.40) Not MSA 3.1(0.44) 4.5(0.71) 4.3(0.59) 4.7(0.75) 4.8(0.99) 5.9(0.94) * 4.2(0.89) 2.5(0.70) ADD is Attention Deficit Disorder. LD is Learning Disability. * Figure does not meet standard of reliability or precision. 1 ADD/noLD includes children who have ever had a diagnosis of ADD and have never had a diagnosis of LD. 2 LD/noADD includes children who have ever had a diagnosis of LD and have never had a diagnosis of ADD. 3 BOTH includes children who have ever had a diagnosis of both ADD and LD. 4 Data are not shown for non-Hispanic children of other races due to small sample size. 5 Mother and father refer to biological, adoptive, step, and foster parents. Data are not shown for children in other family types due to small sample size. 6 Medicaid includes children insured only by Medicaid. 7 Private includes children covered by private insurance, those with non-Medicaid public insurance, and those with both private and public insurance. 8 MSA is metropolitan statistical area.
Table C. Percent of children 6–11 years of age with selected health conditions by diagnosed Attention Deficit Disorder and/or Learning Disability, according to sex: United States, 1997–98
Percent (standard error)5 Health conditions NEITHER1 ADD/noLD2 LD/noADD3 BOTH4 . All children Mental retardation/ODD6 1.3(0.16) * 30.7(2.97) 34.4(3.38) Hearing or vision problems7 3.0(0.23) * 12.2(2.22) 9.5(2.07) Allergies8 27.3(0.61) 31.7(3.63) 35.6(3.05) 39.3(3.27) Asthma9 12.1(0.44) 17.4(2.64) 16.5(2.46) 16.6(2.63) Other chronic health condition10 4.1(0.26) 4.6(1.23) 9.7(1.77) 12.5(2.42) Boys Mental retardation/ODD6 2.0(0.30) * 30.4(3.76) 34.5(3.98) Hearing or vision problems7 2.8(0.32) * 10.6(2.46) 7.6(2.24) Allergies8 28.4(0.89) 31.6(4.33) 36.8(3.76) 39.0(3.64) Asthma9 15.0(0.73) 18.7(3.06) 17.9(3.03) 19.7(3.32) Other chronic health condition10 4.1(0.36) * 8.8(2.04) 10.8(2.46) Girls Mental retardation/ODD6 0.6(0.14) * 31.2(4.80) 34.2(6.64) Hearing or vision problems7 3.2(0.33) * 14.3(3.85) * Allergies8 26.1(0.85) 31.9(6.63) 34.0(4.93) 39.8(6.84) Asthma9 9.2(0.55) * 14.6(4.02) * Other chronic health condition10 4.2(0.36) * 11.0(3.11) * ADD is Attention Deficit Disorder. LS is Learning Disability. * Figure does not meet standard of reliability or precision. 1 NEITHER includes children who have never had a diagnosis of either ADD or LD. 2 ADD/noLD includes children who have ever had a diagnosis of ADD and have never had a diagnosis of LD. 3 LD/noADD includes children who have ever had a diagnosis of LD and have never had a diagnosis of ADD. 4 BOTH includes children who have ever had a diagnosis of both ADD and LD. 5 Unknowns for the variables of interest are not included in denominators used for the calculation of percents and standard errors. 6 Parental report of diagnosed mental retardation or other developmental delay, autism, or Down syndrome. 7 Parental report of blindness, deafness, or serious difficulty seeing or hearing. 8 Parental report of a digestive allergy, skin allergy, hay fever, respiratory allergy, or frequent ear infections (three or more) during the past 12 months. 9 Parental report of ever having a diagnosis of asthma. 10 Parental report of diagnosed Cerebral Palsy, Muscular Dystrophy, Cystic Fibrosis, Sickle Cell Anemia, Diabetes, Arthritis, or heart disease; also a parental report of frequent diarrhea or colitis, anemia, or seizures during the past 12 months.
Table D. Percent of children 6–11 years of age using selected educational and health care services by diagnosed Attention Deficit Disorder and/or Learning Disability according to sex: United States, 1997–98
Percent (standard error)5 Educational and health care services NEITHER1 ADD/noLD2 LD/noADD3 BOTH4 . All children Enrolled in special education6 2.3(0.20) 11.7(2.20) 45.9(3.24) 64.7(3.18) Contacted a mental health professional7 3.4 (0.26) 33.9(3.43) 16.5(2.50) 51.1(3.72) Used prescription medication8 5.8 (0.30) 53.6(3.55) 13.8(2.12) 61.4(3.47) Contacted a medical specialist9 9.4 (0.41) 20.3(3.24) 17.0(2.37) 28.4(3.17) Contacted a therapist10 3.9 (0.27) * 26.2(3.02) 24.8(2.97) Had four or more health care visits11 22.6(0.60) 44.8(3.56) 34.3(3.13) 50.6(3.77) Boys Enrolled in special education6 2.9 (0.33) 11.8(2.49) 48.5(4.12) 63.3(3.83) Contacted a mental health professional7 3.9 (0.41) 35.2(3.92) 17.9(3.20) 53.3(4.23) Used prescription medication8 6.7 (0.46) 55.7(4.20) 16.1(2.87) 68.2(4.10) Contacted a medical specialist9 9.5 (0.57) 21.3(3.88) 17.5(3.25) 28.9(3.81) Contacted a therapist10 4.2 (0.39) * 27.2(3.67) 25.7(3.46) Had four or more health care visits11 22.4 (0.84) 44.5(4.01) 34.9(4.00) 52.8(4.27) Girls Enrolled in special education6 1.7(0.23) * 42.5(5.10) 68.0(6.45) Contacted a mental health professional7 2.9(0.33) 30.0(6.79) 14.7(3.93) 45.7(6.63) Used prescription medication8 5.0(0.39) 47.7(6.99) 10.7(3.11) 44.7(6.77) Contacted a medical specialist9 9.2 (0.55) * 16.3(3.76) 27.3(6.24) Contacted a therapist10 3.5 (0.38) * 24.8(4.81) 22.8(5.47) Had four or more health care visits11 22.8 (0.81) 45.9(7.39) 33.5(4.75) 45.3(6.83) ADD is Attention Deficit Disorder. LD is Learning Disability. * Figure does not meet standard of reliability or precision. 1 NEITHER includes children who have never had a diagnosis of either ADD or LD. 2 ADD/noLD includes children who have ever had a diagnosis of ADD and have never had a diagnosis of LD. 3 LD/noADD includes children who have ever had a diagnosis of LD and have never had a diagnosis of ADD. 4 BOTH includes children who have ever had a diagnosis of both ADD and LD. 5 Unknowns for the variables of interest are not included in denominators used for the calculation of percents and standard errors. 6 Receives special education services. 7 Saw or spoke to a mental health professional such as a psychiatrist, psychologist, psychiatric nurse, or clinical social worker during the past 12 months. 8 Has a condition for which prescription medication had been taken regularly for at least 3 months. 9 Saw or spoke to a medical specialist (other than a gynecologist, psychiatrist, or ophthamalogist) during the past 12 months. 10 Saw or spoke to a physical therapist, speech therapist, respiratory therapist, audiologist, or occupational therapist. 11 Four or more visits to a doctor or other health professional during the past 12 months; overnight hospitalizations, emergency room visits, home visits, or telephone calls are not included.
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Appendix II
Definition of Terms
Age¡ªchild¡¯s age in years at last birthday.
ADD¡ªfamily report of a diagnosis of Attention Deficit Disorder by a doctor or health professional.
ADD/noLD¡ªfamily report of a diagnosis of Attention Deficit Disorder without a diagnosis of Learning Disability.
BOTH¡ªfamily report of a diagnosis of Attention Deficit Disorder and Learning Disability. Contact with health care provider¡ª visit or conversation with a physician or other health professional about the child¡¯s health.
Developmental delay¡ªsignificant delay in one of several areas: physical development, cognitive (mental) development, social or emotional development, or adaptive development.
DSM¡ªDiagnostic and Statistical Manual of Mental Disorders, the standard manual for diagnosis of mental disorders in the United States.
DSM-III-R¡ªrevised third edition of the Diagnostic and Statistical Manual of Mental Disorders.
DSM-IV¡ªfourth edition of the Diagnostic and Statistical Manual of Mental Disorders.
Family structure¡ªparents(s) present in the household with the child. Mother and father refer to biological, adoptive, step, and foster parents.
Family income¡ªwages, salaries, government payments, child support/alimony, dividends, help from relatives, and other sources of family income during the calendar year prior to the interview. Each member of a family is classified by the total income of the family. Low family income is defined as an annual income of less than $20,000.
Health care visit¡ªvisits to a health care professional; not including overnight hospitalizations, emergency room visits, home visits, or telephone calls.
Health insurance coverage¡ª insurance coverage at the time of interview including the following categories: Medicaid and other related public insurance (e.g., most State-sponsored insurance coverage), private and other types of insurance (e.g., Medicare, military health insurance coverage, or another form of government-sponsored health insurance coverage), and uninsured. Children with only Indian Health Service coverage are considered uninsured. Children classified as having Medicaid coverage include children with only Medicaid coverage.
IDEA—Individuals with Disabilities Education Act, Federal legislation mandating free and appropriate public education for students with disabilities.
LD—family report of a diagnosis of Learning Disability by a representative from a school or a health professional.
LD/noADD—family report of a diagnosis of Learning Disability without a diagnosis of Attention Deficit Disorder.
MSA—metropolitan statistical area, a county or group of counties containing at least one city having a population of 50,000 or more plus adjacent counties that are metropolitan in character and economically and socially integrated with the central city.
Central city—largest city in an MSA.
Not central city—part of an MSA that is not the central city.
Not in MSA—all other places in the country.
NEITHER—family report of a diagnosis of neither Attention Deficit Disorder nor Learning Disability.
NHIS—National Health Interview Survey.
NHIS-CH—1988 Child Health Survey, a supplement to the National Health Interview Survey.
For answers to questions about this report or for a list of reports published in these series, contact:
Data Dissemination Branch
National Center for Health Statistics
Centers for Disease Control and Prevention
6525 Belcrest Road, Room 1064
Hyattsville, MD 20782-2003
(301) 458–4636
E-mail: nchsquery@cdc.gov
Internet: www.cdc.gov/nchs
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