ADHD Health Perspective

by CDC

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurobehavioral disorder that may affect more than two million school-aged children and can last into adulthood.

ADHD manifests as an unusually high and chronic level of inattention, impulsive hyperactivity, or both. A person with ADHD may struggle with impairments in crucial areas of life, including relationships with peers and family members, and performance at school or work. Increases in unintentional injuries and health care utilization have been noted in some studies of people with ADHD.

As many as half of children with ADHD also have other behavior disorders. Some studies have demonstrated increases in substance abuse, risk-taking, and criminal behaviors among adolescents and adults who have ADHD and these other disorders.

The American Psychiatric Association's Diagnostic & Statistical Manual-IV-TR estimates that 3%-7% of children suffer from ADHD, and some studies have estimated higher prevalence rates in community samples. The cause(s) and risk factors contributing to ADHD are unknown, although it seems to be more prevalent among boys than girls.

During the past decade, prescription for ADHD medications increased dramatically across the United States, with consumption in many states more than quadrupling. Reasons for the increase, and the more recent decline, in the use of methylphenidate-containing drugs are not clear.

ADHD can be managed through medical and psychosocial interventions.

Recent research suggests that combining medical and behavioral therapies is an especially effective approach to treating ADHD and its comorbidities. However, information on the long-term effects of all treatments is lacking, as is knowledge of the effects of long-term use of ADHD medications in children. On-going, systematic monitoring of ADHD, comorbidities, and treatment modalities is needed.

CDC acknowledges the need for further research in ADHD. Specifically, key public health questions yet to be answered include:

What are the causes and risk factors of ADHD? What is the prevalence of ADHD? Is the prevalence increasing?

What social and economic impacts does ADHD have on families; schools; the workforce; and judicial and health systems?

Are ADHD and its comorbidities being appropriately diagnosed and treated? Are people with ADHD able to access appropriate and timely treatment?

How effective are current interventions? What are the long-term effects of drug treatments?

ADHD Research Agenda

Attention-Deficit/Hyperactivity Disorder (ADHD) is a serious public health problem because of the large estimated prevalence1 of the disorder; significant impairment in the areas of school performance and socialization; the chronicity of the disorder; the limited effectiveness of current interventions to attend to all the impairments associated with ADHD; and the inability to demonstrate that intervention provides substantial benefits for long-term outcomes. However, because of the evolution of the case definition and differences in how the case definition is operationalized, there is disagreement as to prevalence and precise characteristics of children with the disorder.

Because of the lack of a single, consistent, and standard research protocol for case identification, variable and disparate findings have been noted in the literature. Consequently, relatively little is known about the etiology of ADHD, although genetic factors are believed to be important contributors. The basic epidemiology of ADHD needs further research to include the basic prevalence and identification of risk factors for ADHD.

The Division of Birth Defects, Child Development, and Disability and Health (proposed) hosted a conference September 23-24, 1999, entitled, "Attention Deficit Hyperactivity Disorder: A Public Health Perspective". The meeting gathered over 150 individuals from a variety of research, consumer, academic, medical, and mental health disciplines to discuss the public health issues related to this disorder and potential future research. The conference presentations and material from the breakout sessions have been used to help prepare a public health research agenda for ADHD. This document delineates that plan.

Public health issues in ADHD can be divided into three areas: the burden of ADHD in the population, epidemiologic research issues in ADHD, and concerns related to interventions for ADHD. These three topical areas were identified by CDC as crucial for examining ADHD, and necessary to address public health concerns and opportunities for action. The Division of Birth Defects, Child Development, and Disability and Health (proposed) has used the information and suggestions from the conference and highlighted the key issues for each topic as well as the necessary actions to address these public health needs. The formal topical areas are:

• Social and Economic Burden of ADHD through the Lifespan
• Epidemiologic Issues in ADHD
• Interventions for ADHD

About the Author

www.cdc.gov
The Centers for Disease Control and Prevention (CDC) is one of the 13 major operating components of the Department of Health and Human Services (HHS), which is the principal agency in the United States government for protecting the health and safety of all Americans and for providing essential human services, especially for those people who are least able to help themselves.