ADHD Continues to Rise in Children

Salina Graves, MD

ADHD, or attention-deficit/hyperactivity disorder, is one of the most common behavioral health conditions among children in the US. According to a study of medical claims by the Blue Cross Blue Shield Association (BCBSA), there has been an increase of more than 30% in the number of commercially insured children being diagnosed with ADHD between 2010 and 2017.

It’s commonly known that children with ADHD have difficulty paying attention and struggle to control their impulses. The claims data reveals that these behaviors—and therefore diagnoses—were most prevalent among middle school students, particularly boys, who are twice as likely as girls to be diagnosed with the disorder.

The findings, which cover children between the ages of 2 and 18, are alarming and underscore the need for continued vigilance and proper treatment of ADHD by the nation’s family doctors and pediatricians.

Of particular concern is the study’s finding that only 27% of the children diagnosed with ADHD were receiving behavioral therapy in addition to medication. About half were given medication only. The American Academy of Pediatrics recommends behavior therapy as a first line of treatment in children under the age of 6 and medication coupled with behavioral therapy for all children with ADHD over the age of 6.

The most popular stimulants used to treat children with ADHD can interfere with sleep, boost heart rates, and increase blood pressure. It’s also unclear what long-term impact these medicines will have on children as they move into adulthood.

Behavioral therapy is especially important because studies show other behavioral health disorders often accompany ADHD. The recent BCBSA study revealed 4 in 10 children diagnosed with ADHD also had at least 1 other behavioral health disorder, such as anxiety or depression, both of which dramatically increase when a child with ADHD enters high school.

The findings are presented in the full report, The Impact of Attention Deficit Hyperactivity Disorder on the Health of America’s Children, the 25^th study of The Health of America Report series by BCBSA. Research indicates ADHD is caused by both hereditary and environmental factors. Unlike some other disorders, there is no blood test for it. Instead, doctors need to rely on diagnostic criteria developed by the American Psychiatric Association in its Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which involve reasoned judgements on the part of clinicians.

National studies indicate anywhere from 5% to 11% of American children suffer from ADHD. Different sampling methods account for the variation. Whatever the method of counting; however, all recent studies, including the new study by BCBSA, indicate the disorder is on the rise.

Additional findings from the BCBSA study include:

• In 2010, ADHD diagnoses for children who are commercially insured represented 4.8% of all diagnoses made by doctors. By 2017, the figure had jumped to 6.4%, an increase of 31%.
• 9% of middle-school students, aged 11 to 13, were diagnosed with ADHD. They were followed by elementary school students, aged, 6 to 10, at 7.4%; high-school students, aged 14 to 18, at 7.2%; and pre-school students, aged 2 to 5, at 1%.
• ADHD diagnosis rates were higher in the south and lower in the west. In the south, the rate was 7.3 to 11 per 100 children versus 3.1 to 5.1 in the west.

It’s never too early to be on the lookout for ADHD during well-child visits, beginning at age 2. While the “terrible twos” often bring headaches for parents, there is also an opportunity for doctors to be on the lookout for emerging signs of ADHD such as the inability to sit still, wanting to be in constant movement, and inability to focus attention.

Although ADHD is a chronic disorder that cannot be cured, early diagnosis and proper treatment with both medication and behavioral therapy can make a huge difference in children’s lives. With ADHD diagnoses on the rise, it is crucial to better understand the treatment and impact of this condition that is affecting an increasing number of American children.

Salina Graves, MD, is medical director of Independence Blue Cross Blue Shield of Pennsylvania, where she has worked for the past 14 years. Prior to that, she spent 16 years in family medicine, including 15 years at a community health center in West Philadelphia. The piece reflects her views, not necessarily those of the publication.

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