14. Who Has Attention-Deficit Hyperactivity Disorder?
ADHD in Children
In the US, the diagnosis of ADHD in children increased from
1.1% of office visits in 1990 to 3.6% in 1996, or from nearly
950,000 to over 2,400,000 children. Estimates of prevalence
of the disorder range from 1.7% to 17.8% depending on where
and how the studies were conducted. Many experts believe
that the disorder is both over- and underdiagnosed, depending
on different factors. Ritalin's popularity has encouraged
some parents and teachers to pressure physicians into prescribing
this standard ADHD drug for children, usually boys, who
are simply difficult to control or who have poor grades.
In one study of fifth graders in two different cities, 18%
and 20% of white boys were being treated with medications.
In addition, those more likely to receive medication were
young for their grade. In spite of the fact that there seems
to be no difference in the disorder among population groups,
African-American children with ADHD are half as likely to
receive medications for the problem as Caucasian children.
One study suggested that in children who are highly active
or slow learners physicians may tend to diagnosis ADHD first
rather than examine the child for other possible diagnoses,
including no abnormality at all. In one center, after careful
testing, ADHD was the actual diagnosis in only 11% of children
referred for ADHD and 18% had no disability. On the other
hand, some experts believe the disorder is underdiagnosed,
particularly in girls, and that its prevalence is as high
as 10%. Girls with ADHD, for example may be more likely
to have the inattentive subtype or their aggressive behavior
man not be perceived as threatening, so many may be overlooked
by adults. (Ritalin prescriptions for girls, however, increased
almost fourfold between 1990 and 1995.) It is important
to note that the US accounts for 90% of worldwide prescriptions
for stimulants for ADHD. Some experts believe that more
research is needed to determine if this represents real
progress or is an indication that the culture is not adequately
meeting the real needs of parents, children, and schools
or that it places excessive expectations for normalcy and
academic achievement on its children.
ADHD
in Adults
Although ADHD is primarily thought of as a childhood disorder,
diagnoses of attention-deficit disorder in adults are definitely
on the rise. The disorder seems to be distributed equally
between women and men in adulthood, although women have
twice the reported incidence in young adulthood. It was
estimated that Ritalin would be prescribed in nearly 800,000
adults in the US in 1997, nearly three times the number
in 1992. One study found, however, that only 32% of adults
who believed they had ADHD actually fulfilled diagnostic
criteria for the disorder, and another 36% met some of the
criteria but did not have a history of childhood ADHD. Good
diagnostic tests, however, are not yet available to definitely
diagnose adult ADHD. Symptoms in adults may differ from
those in children, with severe attention problems being
most prominent in older people. In one study, only 2% of
adults diagnosed with ADHD referred to themselves as hyperactive
and impulsive.
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© 2003 The Kids Clinic
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