By Azadeh Ansari
September 3, 2015
One-third of children with attention deficit hyperactivity disorder (ADHD) in the United States have been found to be diagnosed before 6 years old, according to a new report.
While there's concern about possible misdiagnosis at a such a young age, researchers involved with the report say the data shows promising trends on how children with the neurobehavioral disorder are being diagnosed.
ADHD rates have been rising at about 5% a year for well over a decade, and there is still no definitive test for diagnosis. That's especially true for children younger than 6, for which there are fewer measures available to those trying to make an accurate diagnosis.
"Since many of the hallmark traits of ADHD can resemble typical behavior from a young child, it's important for the disorder to be properly recognized, diagnosed and treated to determine when that line is crossed," said Dr. Susanna Visser, lead author of the report and an epidemiologist with the National Center on Birth Defects and Developmental Disabilities at the CDC.
"But these findings give us really good information that physicians are largely using recommend practices for diagnosing children across the board."
Diagnosis Includes Input from Multiple Sources
Those recommendations include a combination of clinical evaluations and input from multiple sources close to the child, including parents and teachers, researchers say. More than half of children with ADHD were first diagnosed by a primary care physician, according to the report published Thursday by the National Centers for Health Statistics.
However, there are limitations to the current process.
Not all first response physicians have the time to vet the collective input on a child's behaviors from parents, teachers and school personnel.
"Primary care physicians and pediatricians are asked to do so much in so little time, that providing a complete and comprehensive evaluation for ADHD which rules out other psychological disorders can be challenging," said Dr. Robert Doyle, child and adolescent psychiatrist at Massachusetts General Hospital.
"You can't diagnose ADHD in a vacuum; there are a multitude of factors at play," Doyle explained. "ADHD is also a highly genetic condition, if a man and a women get together, and each of them have ADHD, their risk for having a child with ADHD is about 75%."
More Health Care Providers Diagnosing ADHD
Studies referenced in this new report, based on parental survey responses, indicate that 11% of school-aged children have ADHD. This is a 42% increase in diagnosis by health care providers from 2003-2004 as compared with 2011-2012.
"Despite the increase, we found that physicians are using the standard behavior rating scales and incorporating feedback from adults outside the family," said Visser. "This should really give us some confidence that physicians are using recommended practices for diagnosis."
Among the children diagnosed with ADHD, the report found that 64.7% of the initial concern about the child's behavior was expressed by a family member but schools also played an important part in flagging the initial symptoms. For about one-third of the children diagnosed with ADHD, their restless behaviors were flagged from someone at school or day care, the report indicates.
"The research shows there is a higher likelihood that someone with ADHD could also have another condition, such as a learning disability, sleep disorder, anxiety or depression. So all these other factors must also be factored out," said Rachel Scheinfield, Ph.D., a school psychologist based in Atlanta.
She also addressed concerns some have about being able to accurately diagnose children younger than 6 years old.
"Prior to this age, the diagnostic measures are more limited, and the diagnosis may be made without a comprehensive evaluation," Scheinfield said. "When I conduct psychological assessments, I want to ensure that I rule out any other contributing factors, and utilize various measures to get a comprehensive picture of the children's daily functioning relative to his/her same-aged peers."
There are still many missing pieces in this puzzle, but the collective approach toward diagnosing ADHD has proved effective, researchers involved with the study say.
"A clinical interview, in combination with gaining insights into the child's environment, a child's family health history and feedback on their behavior from teachers and parents, can all be key factors in making an accurate diagnosis," said Visser.
This report only looked at diagnosis and did not consider treatments for the disorder.
Results of this diagnostic report were drawn from the largest national sample of data collected on ADHD: the National Survey of Children's Health in 2011-2012 and the National Survey of the Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder and Tourette Syndrome in 2014.