In nearly every ADHD diagnosis, a health care provider discussed the child's behavior with a parent.
Attention-deficit hyperactivity disorder (ADHD) is prevalent in the US, with parental reports indicating that 11% of school-aged children have been diagnosed with the condition - approximately 6.4 million children.
This number has increased steadily in recent years, rising by 42% between 2003-2004 and 2011-2012.
The report from the Centers for Disease Control and Prevention (CDC) uses data from the 2014 National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome (NS-DATA).
For this survey, information was obtained from the parents of children who had previously been identified as having ADHD or Tourette Syndrome. The parents were asked various questions concerning the child's diagnosis, who information was sought from and who first became concerned with the child's behavior.
Recommendations from the American Academy of Pediatrics (AAP) state that information used to make a diagnosis should come from a range of informants, such as parents, teachers and other adults who care for the child.
The researchers found that the first individual to become concerned with a child's behavior was most often a family member, although concern was expressed first by an adult at school or daycare for around one third of children.
In nearly all cases, health care providers discussed the child's behavior with their parents, and an adult from outside the family played a part in around 8 out of 10 diagnostic processes (81.9%). Around half of diagnoses were made by primary care physicians - typically pediatricians - although psychologists, psychiatrists and neurologists were also involved in others.
Few valid diagnostic tools for children below the age of 6
An interesting age difference noted by the researchers was that children who first received their ADHD diagnosis from a psychiatrist were more likely to be under the age of 6 than older. Conversely, children first receiving their diagnosis from a psychologist were more likely to be older than 6.
There are concerns that when diagnoses are made at an early age, they could be made without comprehensively evaluating all available information. Before the age of 6, the researchers note that there are few valid diagnostic tools to support diagnosis.
- The average age of diagnosis for ADHD is 7 years
- Around half of preschoolers with ADHD receive medication for the disorder
- Children with ADHD are reported to be three times more likely to have peer problems than those without a history of ADHD.
However, the survey also indicates that physicians are utilizing the standard diagnostic methods where possible in the majority of cases. For 9 in 10 children with ADHD, health care providers used behavior rating scales or checklists to assess them for their condition.
"Despite the increase, we found that physicians are using the standard behavior rating scales and incorporating feedback from adults outside the family," reports lead author Dr. Susanna Visser. "This should really give us some confidence that physicians are using recommended practices for diagnosis."
With an adult from outside the family being involved in the diagnostic process for 81.9% of children with ADHD, however, the findings indicate that almost 1 in 5 children were diagnosed by health care providers who only utilized information obtained from family members. This finding suggests there is still room for improvement in ADHD diagnosis.
"The estimates suggest that physicians who diagnose ADHD are largely using two recommended practices - behavior rating scales and incorporating feedback from adults other than family members - in their diagnosis of ADHD in children," the CDC conclude. "This information will also inform future efforts to make sure that the diagnosis of ADHD reflects best practice recommendations."
Recently, Medical News Today reported on a study finding links between traumatic brain injury and a history of ADHD. The findings suggest that adults who have a history of brain injuries may find improved screening for ADHD beneficial.