ADHD Diagnosed According to AAP Guidelines

Since the 1990s, the rate of attention-deficit/hyperactivity disorder (ADHD) diagnoses has been on the rise. Does this indicate that ADHD is over-diagnosed? According to a new report from the Centers for Disease Control and Prevention’s National Center for Health Statistics, the vast majority of ADHD diagnoses are rendered according to the American Academy of Pediatrics’ (AAP) guidelines. This suggests that ADHD is not over-diagnosed and that there is some other cause for the rise in ADHD prevalence.

For the study, the researchers investigated how ADHD diagnoses are made. Data came from the largest US survey to-date on ADHD in children. The survey included a nationally representative sample of nearly 3,000 children. Parents responded to the survey with information about their child’s diagnosis and treatment. They answered questions about their child’s age at diagnosis, the type of health care provider that rendered the diagnosis, and the methods used to evaluate the child for ADHD.

Overall, ADHD diagnoses were consistent with AAP guidelines. Around 90 percent of evaluations used behavioral ratings or checklists as the AAP recommends. In 82 percent of evaluations, the healthcare provider used reports from adults outside the family—like teachers or child care providers—which is part of establishing the diagnostic criterion that ADHD symptoms are present in multiple environments. Additionally, 68 percent of children received neuropsychological testing and 30 percent of children went through neurological imaging or laboratory tests.

The median age of ADHD diagnosis was seven years. Approximately half of children were diagnosed by a pediatrician or primary care provider. One in three children were diagnosed before age six. However, children diagnosed before age six were more likely to be diagnosed by a psychiatrist. It can be difficult to distinguish typical development in early childhood from ADHD symptoms. The researchers report that the involvement of specialists in the diagnosis of younger children is an indication that ADHD is being appropriately evaluated.