Pediatric visits for ADHD have risen and the condition is increasingly being managed by psychiatrists
Attention deficit hyperactivity disorder (ADHD) is common among children and adolescents in the United States. Diagnosis from 2003–2007 increased 21.8 percent among children aged 4–17 years, from 7.6 percent to 9.5 percent, representing 5.4 million children. Changes in clinical practice guidelines, the introduction of new medications such as atomoxetine (Strattera®), as well as growing medication-related concerns, prompted researchers to take a fresh look at the diagnosis and treatment of ADHD from 2000 to 2010. During this period, ambulatory visits coded with a diagnosis of ADHD increased by two-thirds and management of these cases by psychiatrists increased, according to a team of Chicago- and Boston-based researchers. The number of ADHD-related visits increased from 6.2 million in 2000 to 10.4 million in 2010.
As the number of patients being treated increased, the percentage receiving stimulants decreased from 98 percent in 2001 to 87 percent in 2010. The share of those receiving atomoxetine (originally used as an antidepressant) decreased from 15 percent when the drug was introduced to 6 percent in 2010. In 2000, approximately one fourth (24 percent) of all visits in which ADHD was coded were visits to the psychiatrist. By 2010, more than one-third (36 percent) of ADHD-related visits were to psychiatrists, while the share of ADHD-related visits to pediatricians shrank from 54 to 47 percent. This shift toward greater specialist care was not accompanied by evidence of an increase in illness severity in treated cases. Several factors may account for this shift, note the researchers.
Advocacy efforts and publicity campaigns may have led to greater public awareness. Also, increased provider knowledge of ADHD from the dissemination of clinical guidelines and continuing medical education may have led to parents, children, and providers identifying behavioral and conduct disorders as ADHD. A growing number of medications, as well as marketing and promotion by pharmaceutical firms, may have also contributed to this trend. This study was supported in part by the Agency for Healthcare Research and Quality (HS189960).
See "Trends in attention deficit hyperactivity disorder ambulatory diagnosis and medical treatment in the United States, 2000–2010," by Craig F. Garfield, M.D., E. Ray Dorsey, M.D., Shu Zhu, M.P.H., and others in Academic Pediatrics 12, pp. 110-116, 2012.
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