The mainstream media couldn't figure out whether a new study finding rising ADHD diagnoses reflected a real increase in the condition or better awareness. At least that's the way the media framed a recent study out of Southern California in JAMA finding rates of new ADHD diagnoses in kids aged 5 to 11 rose from 2.5% in 2001 to 3.1% in 2010. That's a 24% increase in less than a decade.
Are more kids truly suffering from hyperactivity and attention deficits, or are we simply better at catching children who show any symptoms? ADHD Diagnoses Continue to Climb, Time HealthlandGreat question. The answer? It depends. Mainly on the news organization.
Most hedged their bets, reporting the study offered evidence of a true rise and heightened awareness, either indirectly or directly but usually without sufficient explanations one way or another. Some decided to stress better awareness, others, a real increase.
Let's take the real increase explanation. Why would this study support it?
New ADHD Diagnoses by Ethnic Groups in 2001 and 2010:
White: 4.7% - 5.6% (@30 increase
Black: 2.6%- 4.1% (@70% increase)
Hispanic: 1.7 - 2.5% (@60% increase)
The size of the study, and the variation in ADHD diagnosis rates among different populations, supports the idea that not all of the rise can be attributed to increased awareness among doctors, teachers and parents of the disorder. ADHD Diagnoses Continue to Climb, Time HealthlandThough the article never spelled out exactly why these factors support the real rise theory. This was the final line so it was left to the reader to resolve. Again, it has to do with all things equivalent, groups should show similar rates. The size of the study, by the way, is not a good piece of evidence either way.
Now it's a stretch to say all the kids had equal access and awareness. Obviously I'm not as certain as the authors of the study who've mentioned it. Nor apparently was the New York Daily News that went with better awareness in their sub-title:
The proportion of five- to 11-year olds diagnosed with ADHD increased from 2.5 percent in 2001 to 3.1 percent in 2010, a large jump that researchers think may be due in part to heightened awareness of the condition. ADHD diagnoses spike in the past decade, California study findsOne of the authors also stressed awareness. At least that's the comment Science Daily typed up:
While the reasons for increasing ADHD rates are not well understood, contributing factors may include heightened awareness of ADHD among parents and physicians, which could have led to increased screening and treatment," said Dr. Getahun. Childhood Diagnosis of ADHD Increased Dramatically Over 9-Year Period, Science DailyObviously more and more kids, save the Asian kids, are coming down with a case of inattention and poor impulse control. I understand the feeling...
Speaking of the Asian kids, one of the authors also pointed out another important factor in ADHD rates because obviously we have no reason to believe Asian kids are immune to ADHD:
"Our study findings suggest that there may be a large number of factors that affect ADHD diagnosis rates, including cultural factors that may influence the treatment-seeking behavior of some groups," said study lead author Darios Getahun, MD, PhD, from Kaiser Permanente Southern California's Department of Research & Evaluation. Childhood Diagnosis of ADHD Increased Dramatically Over 9-Year Period, Science Daily
Even if some of the reported increase is due to better awareness, these data seem to speak to a true increase. There's a fairly substantial list of environmental factors that have been linked to ADHD," says Dr. Philip Landrigan, Director of the Children's Environmental Health Center at Mount Sinai School of Medicine. California Data Shows ADHD Cases Rising, CNN HealthHere's their argument translated:
We see a real increase in these numbers. Forget "seem to speak." We're sure it's there somewhere and hey, look at all the evidence we have over here in the Environmental Toxin Lab, forget about their data, look at ours.
All the uncertainty and mixed messages stand as proof this study offered up less than definitive evidence of the particular extent to which increasing rates reflect anything be it true increases of ADHD, increased awareness, increased access or increased patience among the field researchers combing through 840,000 medical records. That said, it's reasonable to talk about better awareness or access as responisble for some of the increase, especially among the Black and Hispanic kids who appeared to be "under-diagnosed" to some extent. It's not like these groups suddenly began showing symptoms (and did not 10 years ago). It's reasonable to expect some was due to increasing symptomotology.
Just in case you are not confused enough, your mind distracted by the mixed messages, here's one more important detail frequently left out of the media.This study addressed new diagnoses and not the overall rates (i.e. the entire % ever diagnosed). Some articles failed to clarify that point or muddled it.
The CNN Health blog, The Chart kinda sorta got it but then kinda lost it:
Overall, in 2001, 2.5% of children aged 5 to 11 were diagnosed with ADHD, but that number crept up to 3.1% by 2010. California Data Shows ADHD Cases Rising, CNN Health
Still, the overall rate of ADHD diagnosis was highest in white children, at 5.6% in 2010. California Data Shows ADHD Cases Rising, CNN Health
The percentage of children ever diagnosed with attention deficit hyperactivity disorder (ADHD) increased from 7% to 9% from 1998–2000 through 2007–2009. NHIS, via the CDC
Phew. Done. If you are still reading this in my totally unprofessional opinion you likely do not have ADHD.
Darios Getahun, MD, PhD; Steven J. Jacobsen, MD, PhD; Michael J. Fassett, MD; Wansu Chen, MS; Kitaw Demissie, MD, PhD; George G. Rhoads, MD, MPH