National Variation of ADHD Diagnostic Prevalence and Medication Use: Health Care Providers and Education Policies

Fulton, Brent D.; Scheffler, Richard M.; Hinshaw, Stephen P.; Levine, Peter; Stone, Susan; Brown, Timothy M.; Modrek, Sepideh

doi:10.1176/appi.ps.60.8.1075

Cited by 27 publications

(32 citation statements)

References 22 publications

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“…However, these data do allow for ecological analyses of changes in policies and demographic characteristics, as conducted by Fulton and colleagues. 33 …”

Section: Discussionmentioning

confidence: 99%

“…A number of contextual factors are known to influence the frequency with which childhood ADHD is diagnosed, including increased awareness efforts, educational policies, physician characteristics, cultural factors, and changes in public perception. 33–36 Other factors, such as increased confidence to treat ADHD among clinicians and increased exposure to etiologic factors (e.g., environmental contaminants) may also play a role. The magnitude of increases documented with these cross-sectional data warrant future efforts to more fully understand the factors impacting ADHD diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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Trends in the Parent-Report of Health Care Provider-Diagnosed and Medicated Attention-Deficit/Hyperactivity Disorder: United States, 2003–2011

Visser

Danielson

Bitsko

et al. 2014

Journal of the American Academy of Child & Adolescent Psych

1,046

822

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Objective Data from the 2003 and 2007 National Survey of Children’s Health (NSCH) reflect the increasing prevalence of parent-reported ADHD diagnosis and treatment by health care providers. This report updates these prevalence estimates for 2011 and describes temporal trends. Method Weighted analyses were conducted with 2011 NSCH data to estimate prevalence of a parent-reported ADHD diagnosis, current ADHD, current medication treatment, ADHD severity, and mean age of diagnosis for US children aged 4–17 years and among demographic subgroups. A history of ADHD diagnosis (2003—2011) as well as current ADHD and medication treatment prevalence (2007–2011) were compared using prevalence ratios and 95% confidence intervals. Results In 2011, 11% of children aged 4–17 years had ever received an ADHD diagnosis (6.4 million children). Among those with a history of ADHD diagnosis, 83% were reported as currently having ADHD (8.8%); 69% of children with current ADHD were taking medication for ADHD (6.1%, 3.5 million children). A parent-reported history of ADHD increased by 42% from 2003—2011. Prevalence of a history of ADHD, current ADHD, medicated ADHD and moderate/severe ADHD increased significantly from 2007 estimates. Prevalence of medicated ADHD increased by 28% from 2007—2011. Conclusions An estimated two million more US children aged 4–17 years had been diagnosed with ADHD in 2011, compared to 2003. More than two-thirds of those with current ADHD were taking medication for treatment in 2011. This suggests an increasing burden of ADHD in the US. Efforts to further understand ADHD diagnostic and treatment patterns are warranted.

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“…However, these data do allow for ecological analyses of changes in policies and demographic characteristics, as conducted by Fulton and colleagues. 33 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Trends in the Parent-Report of Health Care Provider-Diagnosed and Medicated Attention-Deficit/Hyperactivity Disorder: United States, 2003–2011

Visser

Danielson

Bitsko

et al. 2014

Journal of the American Academy of Child & Adolescent Psych

1,046

822

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“…A nationwide survey in 2003 by the Centers for Disease Control and Prevention (CDC) estimated that statewide rates of ADHD among children ranged from 5.0% to 11.1% and that treatment rates varied between 2.2% and 6.5% (9). Wide variation in pediatric treatment rates has been reported within single states (10-12), among states (9,13,14), among different regions of the United States (15,16), and among counties (17,18). The only study (14) of adult treatment rates, derived from a sample of insurance claims, estimated that .8% of adults used ADHD medications, but the extent and nature of geographic variation in adult treatment have not been examined.…”

mentioning

confidence: 99%

“…Studies of geographic variation in use of prescribed stimulants have found correlations with a number of contextual characteristics, including supply of physicians, average age of physicians, school characteristics, and characteristics of the county’s population, such as age and gender distributions, per capita income and employment rates, education levels, household structure, racial-ethnic composition, insurance coverage, lead exposure levels, and even proximity of child’s residence to airports or parks (11,15,17,18). Two studies of county-level variation nationwide exist but only measure amounts of stimulants distributed per county resident (18) or amounts per estimated numbers of ADHD-diagnosed children (17) and not prevalence of treated patients.…”

mentioning

confidence: 99%

Geographic Variation and Disparity in Stimulant Treatment of Adults and Children in the United States in 2008

McDonald¹,

Jalbert²

2013

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Objective This study estimated the prevalence of stimulant treatment among both adults and children at national, state, and county levels during 2008 and explored explanations for wide variations in treatment prevalence. Methods Records of 24.1 million stimulant prescriptions dispensed to insured and uninsured patients were obtained from approximately 76% of U.S. retail pharmacies. Data were weighted to estimate treatment prevalence on March 15, 2008, for all U.S. states and counties. Regression models were used to estimate the associations among the counties’ treatment rates and the characteristics of the counties and their resident populations. Results An estimated 2.5% of children ≤17 years of age (3.5% of males and 1.5% of females) and .6% of persons >17 years of age were being treated with stimulants in March 2008. Treatment prevalence among states varied widely, and variation among counties was even wider. Two-thirds of the variation among counties in treatment prevalence was associated with supply of physicians, socioeconomic composition of the population, and, among children, funding for special education. Rates of children and adults in treatment were highly correlated. Conclusions Wide variations in treatment prevalence signal disparities between established clinical practice guidelines and actual practice, especially for primary care, where most patients prescribed stimulants are managed. Better education and training for physicians may improve identification and treatment, thereby reducing disparities in care for attention-deficit hyperactivity disorder and other disabling conditions.

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“…There is also substantial state-based variability in rates of medicated ADHD, from 2% in Nevada to 10% in Kentucky and Louisiana (Susanna N. Visser et al, 2014). State variation in prevalence has been partially explained by state demographics (race and public insurance coverage) and the characteristics of the state’s physicians; higher state proportions of younger physicians (<45 years) are associated with higher state-based rates of diagnosed and medicated ADHD (Fulton et al, 2009). Ecological analyses suggest that school policies, practices, and accountability laws may contribute to state-based variation in ADHD rates.…”

Section: Introductionmentioning

confidence: 99%

Student-Perceived School Climate Is Associated With ADHD Medication Treatment Among Adolescents in Medicaid

et al. 2015

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Objective Evaluate the relationship between school climate and ADHD medication treatment among adolescents in Medicaid in Georgia (GA). Methods School climate and Medicaid claims data were aggregated for 159 GA counties. County-level school climate percentile and medicated ADHD prevalence were calculated. T-tests and regression evaluated the relationship between school climate, medicated ADHD, and demographics, weighted by county population. Poorer 2008 school climate (<25th percentile) was regressed on 2011 medicated ADHD prevalence, controlling for potential confounders. Results The prevalence of medicated ADHD was 7.8% among Medicaid-enrolled GA adolescents. The average county-level prevalence of medicated ADHD was 10.0% (SD=2.9%). Poorer school climate was associated with lower rates of medicated ADHD (p<0.0001) and with demographics accounted for 50% of the county variation in medicated ADHD. Conclusions School climate is associated with medicated ADHD among adolescents in Medicaid. Additional research may reveal whether high medicated ADHD may reflect a lack of access to non-pharmacological therapies.

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National Variation of ADHD Diagnostic Prevalence and Medication Use: Health Care Providers and Education Policies

Cited by 27 publications

References 22 publications

Trends in the Parent-Report of Health Care Provider-Diagnosed and Medicated Attention-Deficit/Hyperactivity Disorder: United States, 2003–2011

Trends in the Parent-Report of Health Care Provider-Diagnosed and Medicated Attention-Deficit/Hyperactivity Disorder: United States, 2003–2011

Geographic Variation and Disparity in Stimulant Treatment of Adults and Children in the United States in 2008

Student-Perceived School Climate Is Associated With ADHD Medication Treatment Among Adolescents in Medicaid

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