New Survey Reveals Disparities as Diagnoses Rise

The number of children who have ever had an ADHD diagnosis shows a slow increase, but the rise in numbers follows what ADHD experts expected to find, according to a recent National Health Interview Survey report.

ADHD diagnoses in children and teens, according to a survey of parents, are at an estimated 11.3% of children ages five to seventeen.

“This data is in line with other epidemiological research [which looks at the causes, occurrence, and populations affected by ADHD],” says L. Eugene Arnold, MD, MEd, CHADD’s resident expert. Dr. Arnold, professor emeritus of psychiatry and behavioral health at The Ohio State University, has been lead researcher on many ADHD studies.

Increase in numbers may be a result of the pandemic

The 2020-22 survey, conducted by the National Center for Health Statistics, shows that 14.5% of boys and 8% of girls received a diagnosis, for an average of 11.3% of children that have, at one time or another, been diagnosed with ADHD.

Prior to the COVID-19 pandemic, data in 2016 indicated that 9.8% of children have ever had an ADHD diagnosis. Looking back more than two decades ago, a 1997-98 analysis of multiple research studies found that 6.1% of children and teens ages four to seventeen were diagnosed with ADHD.

The increased percentage of diagnoses is not surprising, Dr. Arnold says. The NHIS survey was conducted during the pandemic, which may have also contributed to the rise in diagnoses. When parents began working from home as their children were attending school online, they got a firsthand look at their children’s academic and behavioral challenges. This led to many parents seeking an evaluation for their children for the first time.

“Those who would have been left undiagnosed clinically in the past started being diagnosed in 2020 as parents became more aware of their child’s problems,” he says.

More middle school students diagnosed

Not surprising to Dr. Arnold when he reviewed the survey, the number of ADHD diagnoses was lower in children ages five to eleven (8.6%) than in children and teens ages twelve to seventeen (14.3%). This trend was seen across races. These results show what commonly occurs with ADHD, says Dr. Arnold.

“The peak age of having an ADHD diagnosis occurs around middle school, roughly between ages eleven to fourteen,” he adds.

The spike in the number of children diagnosed during middle school happens because of the life changes a child faces during this time—puberty, greater academic responsibility, increased importance of social life. Changing classrooms, keeping track of assignments and tablets, and taking on greater responsibilities can make ADHD symptoms become more prominent or troublesome during the middle school years.

The survey also pointed out racial and demographic differences in diagnosis and highlighted the barriers some families contend with when it comes to evaluation and treatment.

White children were more likely to be diagnosed than children who are Black or Hispanic. Children with public or private health insurance were more likely to be diagnosed than children without health insurance, according to the survey.

Brandi Walker, PhD, a retired United States Army major, describes underdiagnosis in different populations as a serious issue. “Most kids get diagnosed at age seven, but an African American child may not get their diagnosis until nine,” she says. “So then, it’s a two-year loss of academic achievement, or they may be minimally achieving when they could have been achieving well beyond what they actually are getting because of the diagnosis.”

Dr. Walker is a clinical psychologist at Womack Army Medical Center at Fort Bragg, North Carolina, and co-coordinator of the CHADD of Prince George’s County, Maryland, chapter and CHADD’s Southern Regional Center.

Greater awareness, but there’s still work to do

Why then, if very real disparities exist, does it seem like the number of people diagnosed with ADHD is skyrocketing? The answer could be that there is more awareness today about ADHD and how it affects individuals with the diagnosis.

More information about ADHD is shared by the popular media and on social media platforms. The changes made in the diagnostic criteria have led to better identification at all stages of life.

Margaret Sibley, PhD, says all of this has helped to create a perception of a fast-growing number of people who have ADHD. She is a member of CHADD’s professional advisory board and an associate professor of psychiatry and behavioral sciences at the University of Washington School of Medicine and a clinical psychologist at Seattle Children’s Hospital.

Dr. Sibley believes the inclusion of ADHD under the Individuals with Disabilities Education Act (IDEA) in 1991 brought about more awareness of the condition. Direct-to-consumer changes in marketing laws have also played a role since prescription medications can be advertised on television.

“Big marketing campaigns for new ADHD medications in the early 2000s increased awareness of ADHD by patients, families, pediatricians, and other doctors,” Dr. Sibley says. “ADHD treatments were becoming easier for families to find.”

More concerning to Dr. Sibley are individuals who are still struggling with ADHD but haven’t been able to get a proper diagnosis. She worries that doctors often overlook ADHD in women and girls, older adults, minorities, and individuals who are successful, intelligent, or well-liked. This concern is backed up by the data from the NHIS survey.

Dr. Walker says there’s more work to do to help people who experience barriers to receiving a diagnosis.

“The issue of health disparities is very real,” says Dr. Walker. “We see it all the time, and just understanding, raising awareness that it does happen… is something that every person can do.”

Read on ADHD statistics and diagnosis rates:

Join the discussion: At what age was your child diagnosed for ADHD? What prompted the need for an evaluation?