By Steven Reinberg
Tuesday, September 4, 2007 12:00 AM
MONDAY, Sept. 3 (HealthDay News) -- Nearly 9 percent of American children have attention-deficit/hyperactivity disorder (ADHD), but only 32 percent of them are getting the medication they need.
That's the sobering conclusion of a landmark new study, the first of its kind based on what doctors consider the "gold standard" of diagnostic criteria -- the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition.
"There is a perception that ADHD is overdiagnosed and overtreated," said lead researcher Dr. Tanya E. Froehlich, a developmental-behavioral pediatrician at Cincinnati Children's Medical Center. "But our study shows that for those who meet the criteria for ADHD, the opposite problem -- underdiagnosis and undertreatment -- seems to be occurring."
The researchers found that some 2.4 million children between the ages of 8 and 15 meet the medical definition of ADHD, but an estimated 1.2 million children haven't been diagnosed or treated, Froehlich said, adding that "girls were more likely to be undiagnosed."
What's more, children from poor families, who have the highest rates of ADHD, were the least likely to have consistent treatment with medication, Froehlich noted. "In addition, children without health insurance were less likely to be diagnosed and treated," she said.
The findings were published in the September issue ofArchives of Pediatrics & Adolescent Medicine.
ADHD is a condition that becomes apparent in some children in the preschool and early school years and is characterized by hyperactivity, inattention and impulsivity, according to the U.S. National Institute of Mental Health.
To arrive at their findings, Froehlich and her colleagues collected data on 3,082 children who participated in the National Health and Nutrition Examination Survey. Using interviews, the researchers were able to establish the presence of ADHD. They also used data from doctors and the numbers of ADHD medications being used to establish diagnosis and treatment patterns, according to the report.
The researchers found that of the 8.7 percent of children who met the criteria for ADHD, only 47.9 percent had been diagnosed with the condition and only 32 percent were treated consistently with medications.
Froehlich said medications can be quite effective, and people with ADHD can lead successful lives if they have been properly diagnosed and treated.
"There are many successful professionals who have ADHD," Froehlich said. "On the flip side, there can be a lot of negative consequences associated with the disorder, such as lower rates of school and career achievement and higher rates of substance abuse, incarceration, injuries and car accidents," she said.
Froehlich said more needs to be done to identify and treat children with ADHD. "It's not a trivial disorder," she said. "It can have an impact on the child and the family if it is not diagnosed and addressed. We need to redouble our efforts to help doctors spot the symptoms of ADHD and make an accurate diagnosis."
Dr. Jon A. Shaw, director of child and adolescent psychiatry at the University of Miami School of Medicine, agrees that ADHD is underdiagnosed and undertreated.
"The study is confirmatory of the general scientific literature," he said. "ADHD is a highly prevalent disorder, the most common psychiatric diagnosis in children, and that, in general, it is being underdiagnosed and undertreated in our community."
Shaw noted that those children most at risk receive the worst care. "It is clear once again that it is the poorest of our community who are deprived of the benefits of the most effective treatment -- psychopharmacology for this condition," he said.
The discovery that ADHD is more common among poorer people is probably related to other risk factors for the disorder, such as use of tobacco, low birth weight and lead exposure, Shaw said.
For more on ADHD, visit the U.S. National Institute of Mental Health.
SOURCES: Tanya E. Froehlich, M.D., developmental-behavioral pediatrician, Cincinnati Children's Medical Center; Jon A. Shaw, M.D., professor and director, child and adolescent psychiatry, University of Miami School of Medicine; September 2007Archives of Pediatrics & Adolescent Medicine