CDC: ADHD Diagnoses Rise Sharply Among U.S. Children, Treatment Lags
- Stephen
- Sep 16, 2024
- 5 min read
In 2022, the number of children with diagnosed ADHD rose to 7.1 million — up from 6.1 million in 2016 — but medication and behavioral treatment among diagnosed children decreased, according to a new CDC report.
June 18, 2024
About 1 in 9 U.S. children received an ADHD diagnosis in 2022, contributing to an increase of 1 million new pediatric diagnoses since 2016, according to a new report from the Centers for Disease Control and Prevention (CDC). The total number of children aged 3 to 17 diagnosed with ADHD increased from 6.1 million in 2016 to 7.1 million in 2022.
Nearly 60% of newly diagnosed children experienced moderate or severe ADHD, the CDC says. Further, 78% reported having at least one co-occurring condition (behavioral problems, anxiety, depression, or learning disorders), corroborating previous research on the prevalence of ADHD comorbidities.
“Co-occurring conditions with ADHD are so common that “we might say this is the rule rather than the exception,” said Theresa Cerulli, M.D., during the June 2021 ADDitude webinar “Complex ADHD: The New Approach to Understanding, Diagnosing, and Treating Comorbidities in Concert.” “ADHD’s heterogeneous presentation, as well as the parts of the brain implicated in ADHD, may explain why comorbidities are not only frequent but also wide-ranging.”
Gender Differences in ADHD Diagnoses
Boys are likelier to receive an ADHD diagnosis than are girls, but that gap is narrowing. In prior years, the CDC reported a 2:1 ratio of boys to girls diagnosed with ADHD; that ratio was 1.8:1 in 2022.
Lotta Borg Skoglund, M.D., Ph.D., author and associate professor at Uppsala University, Department for Women’s and Children’s Health in Sweden, thinks more work is needed to identify and diagnose girls with ADHD.
“ADHD is still viewed from a largely male-centric point of view,” she said during the January 2024 ADDitude webinar “The Emotional Lives of Girls with ADHD.” “This bias toward recognizing externalizing symptoms and disruptive behaviors means that female manifestations of ADHD — including the critical role of hormonal fluctuations on symptoms and functioning — are all but disregarded. Clinicians readily misattribute the downstream consequences of undiagnosed ADHD in women, and this is why, in a bizarre twist, girls and women often show up everywhere in the healthcare system before they’re identified with ADHD.
The CDC study also found that children living in rural or suburban areas in the Northeast, Midwest, or South were more likely to be diagnosed with ADHD than were children living in urban areas or the West. Children from lower-income households and those with public insurance also reported higher incidences of ADHD, the CDC reported.
Education Contributes to Rise in ADHD Diagnoses
Diagnoses rose, in part, due to greater public awareness and understanding of ADHD, particularly among girls and adolescents, and less stigma surrounding diagnosis and treatment, according to the study authors. In addition, the COVID-19 pandemic may have exacerbated ADHD symptoms. “Virtual learning, changes in daily routines, and increased stress levels during the pandemic might have affected the recognition and management of ADHD symptoms,” the study’s authors wrote.
“The last quarter century has been pivotal, yielding myriad advances in our understanding of ADHD,” Dave Anderson, Ph.D., said during the March 2023 ADDitude webinar “ADHD Then and Now: How Our Understanding Has Evolved.” “Thanks to ongoing research on diagnosis and treatment, we know more about the causes of ADHD, its trajectory, how it presents across different groups, and the treatments that work — plus those that don’t.”
ADHD Diagnoses Up; ADHD Treatment Down
Despite the rise in ADHD diagnoses, fewer children received treatment in 2022 than in previous years. Slightly more than half of children with ADHD used medication in 2022 (down from 62% in 2016); 44.4% received behavioral therapy in 2022 (down from 46.7% in 2016).
Access to treatment professionals with experience in ADHD, side effects of ADHD medication, long wait times for care, and the downstream effects of the Adderall shortage were the biggest impediments to effective treatment, according to a 2023 ADDitude treatment survey of more than 11,000 adults with ADHD and caregivers of children with the condition. Other barriers include:
Side effects.
Long wait times.
Poor access to diagnosing clinicians.
Comorbid conditions that complicate evaluation and treatment (82% of children with ADHD report comorbid diagnoses).
Findings of the CDC report show that close to one-third of children received no ADHD-specific treatment in 2022 compared to 23% in 2016. Notably, older children aged 12 to 17 and children living in non-English-speaking households were more likely than younger children aged 6 and 11 to go untreated.
Disruptions to healthcare services during the COVID-19 pandemic and the stimulant shortage, which began in 2022, may have contributed to restricted access to ADHD medication in 2022 compared to 2016, the CDC suggests.
Stimulant Shortage Disrupts ADHD Treatment
In a recent ADDitude poll about how the stimulant shortage has impacted their ability to manage their ADHD and co-existing conditions, 16% said delayed access to medications has been a real problem, and 15% said there’s an increased reliance on non-medication strategies.
Roughly 38% of caregivers and adults with ADHD who participated in the September 2023 ADDitude treatment survey reported having trouble finding and filling their prescription medication over the last year, and 21% continue to suffer treatment disruptions.
“Finding stimulants is a nightmare,” an ADDitude reader says. “I am a PMHNP and prescribe them for patients who cannot find them and also have to find the medications for my three kids with ADHD.”
Says another, “We started rationing medications for our two sons by only giving them medicine five days a week instead of seven. “Because of the need to ration, we skip Sunday School and weekend sports, as our children’s behavior without medication is too much for coaches to handle.”
The CDC study examined data from more than 45,000 parent responses to the 2022 National Survey of Children’s Health (NSCH)
“Pediatric ADHD remains an ongoing and expanding public health concern,” the study’s authors wrote. “Estimates from the 2022 NSCH provide information on pediatric ADHD during the last full year of the COVID-19 pandemic and can be used by policymakers, government agencies, healthcare systems, public health practitioners, and other partners to plan for the needs of children with ADHD.”
Untreated ADHD affects multiple domains of life. “Individuals with ADHD are more likely to be in traffic accidents, experience peer difficulties and tumultuous interpersonal relationships, and drop out of school, be expelled from school, and experience academic failure earlier,” said Anderson, vice president of school and community programs and former senior director of the ADHD & Behavior Disorders Center at the Child Mind Institute. 5 “The latter is particularly troubling when we consider that ADHD has historically been underrecognized and undertreated in marginalized and disadvantaged communities; academic difficulties and expulsions can start the school-to-prison pipeline, which disproportionately impacts Black youth. Individuals may end up incarcerated before ever learning that they have ADHD and that it was the root cause of their difficulties in school and early life.
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