[Table, Variability in Prevalence, Clinical Identification, and Treatment of ADHD in Children]. - Comparative Effectiveness Review Summary Guides for Clinicians

Factor	Conclusions
Location	Cultural differences influence how ADHD is understood and treated in different countries. After accounting for differences in research methodologies between countries, the underlying prevalence does not appear to vary much among countries. Rates of diagnosis vary considerably due to cultural context, access to local health care services, and providers available in the area. There are significant regional variations in clinical identification across the United States. Rates of treatment vary considerably due to location and access to health care providers—internationally, regionally, and even within the same community.
Service Provider	Providers vary in their level of expertise in diagnosing ADHD.
Informant	Rates of diagnosis vary considerably due to cultural context. Some ethnicities are more likely to seek help or accept the diagnosis than others. The sociocultural experience of the parent or teacher informant may influence the interpretation and reporting of behaviors, willingness and persistence in seeking professional help, and/or acceptance of treatment modalities.
Time Period	Since being identified as a clinical entity in 1902, the prevalence of identified ADHD cases has increased. This is partially due to increased knowledge about ADHD. It is also partially due to changes in the definition of who can identify a child as having ADHD (parents and teachers are becoming informants), changes in screening tests, and changes in diagnostic categories and classification systems over time. The use of MPH and other drug treatments for ADHD has increased steadily since the early 1980s. As an indicator of trends in treatment, the International Narcotics Control Board reported that medical use of MPH in the United States increased 77 percent from 2004 to 2008.
SES	Some studies found that children of lower SES have a higher prevalence of ADHD. Children of lower SES are identified as having ADHD more often than children of higher SES; however, the latter are more likely to be receiving treatment. Lower SES and minority ethnicity are associated with shorter duration of medication use. Insurance status may influence access to specialist providers in the United States.
Sex	Most studies found the prevalence of ADHD is greater in boys than in girls. There are few comparative data examining rates of treatment by sex in children diagnosed with ADHD.
Age	Children ages 5 to 10 years appear to have the highest prevalence of ADHD. Elementary school children are identified as having ADHD more frequently than older children. Medication treatment prevalence is higher for elementary school children than for adolescents or adults.

Factor

Conclusions

Location

Cultural differences influence how ADHD is understood and treated in different countries.
After accounting for differences in research methodologies between countries, the underlying prevalence does not appear to vary much among countries.
Rates of diagnosis vary considerably due to cultural context, access to local health care services, and providers available in the area.
There are significant regional variations in clinical identification across the United States.
Rates of treatment vary considerably due to location and access to health care providers—internationally, regionally, and even within the same community.

Service Provider

Providers vary in their level of expertise in diagnosing ADHD.

Informant

Rates of diagnosis vary considerably due to cultural context. Some ethnicities are more likely to seek help or accept the diagnosis than others.
The sociocultural experience of the parent or teacher informant may influence the interpretation and reporting of behaviors, willingness and persistence in seeking professional help, and/or acceptance of treatment modalities.

Time Period

Since being identified as a clinical entity in 1902, the prevalence of identified ADHD cases has increased.
- This is partially due to increased knowledge about ADHD. It is also partially due to changes in the definition of who can identify a child as having ADHD (parents and teachers are becoming informants), changes in screening tests, and changes in diagnostic categories and classification systems over time.
The use of MPH and other drug treatments for ADHD has increased steadily since the early 1980s.
As an indicator of trends in treatment, the International Narcotics Control Board reported that medical use of MPH in the United States increased 77 percent from 2004 to 2008.

SES

Some studies found that children of lower SES have a higher prevalence of ADHD.
Children of lower SES are identified as having ADHD more often than children of higher SES; however, the latter are more likely to be receiving treatment.
Lower SES and minority ethnicity are associated with shorter duration of medication use.
Insurance status may influence access to specialist providers in the United States.

Sex

Most studies found the prevalence of ADHD is greater in boys than in girls.
There are few comparative data examining rates of treatment by sex in children diagnosed with ADHD.

Age

Children ages 5 to 10 years appear to have the highest prevalence of ADHD.
Elementary school children are identified as having ADHD more frequently than older children.
Medication treatment prevalence is higher for elementary school children than for adolescents or adults.

From: Attention Deficit Hyperactivity Disorder in Children and Adolescents

Cover of Comparative Effectiveness Review Summary Guides for Clinicians

Comparative Effectiveness Review Summary Guides for Clinicians [Internet].

Rockville (MD): Agency for Healthcare Research and Quality (US); 2007-.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.