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12 Prevalence of Attention Deficit Hyperactivity Disorder
Pages 211-226

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From page 211...
... Questions have been raised publicly about the validity of ADHD as a major reason for the increases in SSI benefits for mental health conditions in children. While the large ADHD contribution is a fact, it should be noted that ADHD allowances usually include a comorbid condition that may have a substantial effect on functional impairment in the SSI disability program.
From page 212...
... . Prevalence of ADHD Prevalence of ADHD Based on National Surveys of Parents The prevalence of ADHD has been reported from several nationally representative surveys, but rarely using clinical criteria, which require multiple informants, a range of symptoms, and significant functional impairment (Birmaher et al., 2007)
From page 213...
... treatment NSCH, 2012a 2011/2012 Current ADHD, 5.4% (CI 2–17 current medication 5.1–5.7%) treatment Visser et al., 2007 Current ADHD, no 7.8% (95% CI 4–17 2007 current medication 7.4%–8.1%)
From page 214...
... SOURCES: Boyle et al., 1996, 2011; Perou et al., 2013. TABLE 12-3  Percentage of Children Ages 3 to 17 Reported to Have Ever Been Diagnosed by a School or a Health Professional as Having ADHD: 1997–2013 Year 1997 1998 1999 2000 2001 2002 2003 2004 Total 5.5 5.9 5.6 6.6 6.4 7.2 6.4 7.4 Sex Male 8.3 8.5 8.4 9.3 9.1 10.3 9.0 10.2 Female 2.6 3.2 2.7 3.8 3.5 4.0 3.6 4.5 Race/Hispanic origin Non-Hispanic white 6.5 7.0 6.7 8.0 7.4 8.3 7.5 8.7 Non-Hispanic black 4.3 4.9 4.3 5.0 5.7 7.8 6.0 8.1 Hispanic 3.3 3.5 2.7 3.8 3.5 3.7 3.7 4.0 Non-Hispanic other 2.4 2.2 3.8 2.1 3.7 1.8 3.1 2.6 Age group Ages 3–4 0.5 0.7 0.6 1.0 0.8 1.0 0.7 1.9 Ages 5–11 5.9 6.1 5.3 6.5 6.3 6.8 6.3 6.5 Ages 12–17 6.8 7.5 7.7 8.6 8.3 9.6 8.3 10.3 Poverty status Below federal poverty – 6.7 7.7 7.0 7.1 9.7 7.0 7.5 level (FPL)
From page 215...
... . In addition, there is also evidence that health care professionals frequently do not fully comply with accepted guidelines for diagnosis (Epstein et al., 2014)
From page 216...
... Column 2 shows the number of child recipients who received SSI benefits on the basis of ADHD in December of each year. Column 3 shows the estimated number of children in households with family income below 200 percent of the federal poverty level (FPL)
From page 217...
... Figure 12-1 plots the percentages from columns 4 and 5 along with the 10-year average of the percentages of allowances and recipients for ADHD as a visual reference point. Over the 10-year period from 2004 to 2013, the rate of child SSI ADHD recipients increased, while the rate of child SSI ADHD allowances may have decreased.
From page 218...
... Trends in the number of ADHD allowances and recipients should be interpreted cautiously, keeping in mind that the ADHD impairment code contributes by far the largest number determinations every year in the SSI program. As mentioned in Chapter 3, the ADHD impairment code is 40 to 50 percent of all determinations each year, and more than triple any other mental disorder impairment code reviewed in this study.
From page 219...
... Column 1 shows the percentage of ADHD diagnoses among all Medicaid enrollees1 for each year. Column 2 shows the percentage of ADHD diagnoses among the smaller subpopulation of Medicaid enrollees who were eligible to be enrolled in Medicaid on the basis of receiving SSI benefits.2 As shown in Figure 12-2, the rates of ADHD diagnoses among all child Medicaid enrollees and among child SSI-eligible Medicaid enrollees both increased between 2001 and 2010.
From page 220...
... For the years in which the Medicaid data and the SSI administrative data overlapped, 2004–2010, the rate of ADHD diagnoses among all Medicaid-enrolled children increased by 40 percent; the rate of ADHD diagnoses among SSI-eligible Medicaid-enrolled children increased by 35 percent; and the rate of SSI recipients for ADHD among children in households under 200 percent FPL increased by 38 percent. These trends are remarkably similar and confirm that the numbers of children who received SSI benefits on the basis of an ADHD diagnosis have not grown faster than comparison populations.
From page 221...
... Since the SSI program requires a "medically determinable impairment" and relies on a diagnosis -- or diagnoses, in the case of comorbid conditions -- from an "acceptable medical source," changes in medical diagnostic practice will directly affect the rates of disorders in the SSI program. In other words, the changes in diagnostic access and practices that have resulted in an increase in the number of ADHD diagnoses will be observed in the Medicaid data, and reflected in the national survey data and SSI program, because these latter two sources rely on reports of a diagnosis from a health care provider.
From page 222...
... • Estimates of the prevalence of ADHD that apply diagnostic criteria based on assessment of a child's symptoms, are lower than esti mates derived from parent reports of health care provider diagno ses of ADHD. There is no evidence of an increase in the prevalence of ADHD based on assessments of a child's symptoms; however, there is evidence of an increase in the frequency of diagnoses for ADHD based on parent report and from Medicaid billing records.
From page 223...
... Parameters used to generate the numbers include get count of: persons in poverty universe (everyone except unrelated individuals under 15) ; years: 2004 to 2013; Census 2010 weights; row variable: age; column variable: income-to-poverty ratio; and customized formatting: income-to-poverty ratio percent cutoff of 200 percent.
From page 224...
... 2014. Original analysis by Child Trends of National Health Interview Survey data 1997–2013.
From page 225...
... :980–989. National Health Interview Survey and National Center for Health Statistics.


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