U.S. national, regional, and state-specific socioeconomic factors correlate with child and adolescent ADHD diagnoses pre-COVID-19 pandemic

Abstract

Attention-deficit/hyperactivity disorder (ADHD), the most diagnosed emerging neurodevelopmental disorder in children, is a growing health crisis in the United States. Due to the potential increase in ADHD severity during and post the COVID-19 pandemic, we analyzed recent national and two state-specific ADHD data distribution among U.S. children and adolescents by investigating a broad range of socioeconomic status (SES) factors. Child and adolescent ADHD diagnosis and treatment data were parent-reported via National Survey of Children’s Health (NSCH). The nationwide childhood prevalence of ADHD is 8.7%, and 62.1% of diagnosed children are taking medication. Louisiana (15.7%) has the highest percentage of children diagnosed with ADHD and California (5.6%) has the lowest, followed by Nevada (5.9%). Multiple correspondence analysis (MCA, n = 51,939) examining 30 factors highlights four areas of interest at the national and state level: race/ethnicity, financial status, family structure, and neighborhood characteristics. Positive correlations between ADHD diagnosis and unsafe school, unsafe neighborhood, and economic hardship are evident nationally and statewide, while the association between a lack of ADHD diagnosis and higher urban neighborhood amenities are evident nationally, but not in two opposing outlier states—Louisiana or Nevada. National and state-specific hierarchical analyses demonstrate significant correlations between the various SES factors and ADHD outcomes. Since the national analysis does not account for the demographic heterogeneity within regions or individual states, the U.S. should rely on comprehensive, county-specific, near real-time data reporting to effectively model and mitigate the ADHD epidemic and similar national health crises.

Regional disparities in prescription methamphetamine and amphetamine distribution across the United States in 2019

“…Previous studies using data from the National Health Interview Survey (NHIS) by the CDC found that from 1997-2016, weighted prevalence of ADHD diagnosis was highest in the Northeast (10.8-13.6%, 95 CI) and lowest in the West (6.1-7.8%, 95CI) [22]. This is consistent with other findings in which highest rates of ADHD diagnosis and medication use in children aged 3-17 years old for 2018-2019 were highest in Southern regions (10.97% and 7.52%, respectively) and lowest in Western regions (7.46% and 4.14%, respectively) [23].…”

State-Level Estimates of the Prevalence of Parent-Reported ADHD Diagnosis and Treatment Among U.S. Children and Adolescents, 2016 to 2019

“…Consistent with previous examinations of state-level estimates for ADHD diagnosis and treatment (Blue Cross Blue Shield, 2019; Board et al, 2020;Bozinovic et al, 2021;Centers for Disease Control and Prevention, 2010;McDonald & Jalbert, 2013;Piper et al, 2018;Visser et al, 2014Visser et al, , 2015Visser et al, , 2016, data from the 2016 to 2019 NSCH suggests that there is substantial variation in state-level prevalence of diagnosed ADHD and associated treatment among children and adolescents aged 3 to 17 years. The percentage of children who ever received an ADHD diagnosis was more than twice as high in the states with the highest prevalence (Louisiana, Mississippi, and West Virginia) than the state with the lowest prevalence (California); most states with high ever diagnosed and current ADHD prevalence estimates were in the South.…”

“…A number of factors might contribute to the observed variation in ADHD diagnosis and treatment estimates across states. First, differences have been previously documented in the diagnosis and treatment of ADHD by demographic subgroups, such as those based on race/ethnicity or poverty status (Bozinovic et al, 2021; Danielson et al, 2018; Visser et al, 2014), and differences in state-level demographics may be driving the differences in state-level rates of ADHD diagnosis and treatment. State-level educational or health care system policies could also affect the diagnostic and treatment practices for ADHD in a given state.…”

“…Previous studies have shown that there is significant state-level variation in the diagnosis of mental disorders and related treatment among children and adolescents (Bitsko et al, 2022; Whitney & Peterson, 2019), including ADHD (Bozinovic et al, 2021; Centers for Disease Control and Prevention, 2010; Visser et al, 2014, 2015; Visser, Blumberg, et al, 2013). State-level estimates of current ADHD prevalence from the National Survey of Children’s Health (NSCH) collected in 2011 to 2012 ranged from 4% to 15% among children aged 4 to 17 years, with 2% to 10% of all children receiving current ADHD medication treatment, regardless of ADHD diagnosis status (Visser et al, 2014).…”

The Impact of the COVID-19 Pandemic on Diagnosing and Treating Attention Deficit Hyperactivity Disorder: New Challenges on Initializing and Optimizing Pharmacological Treatment

“…Attention deficit hyperactivity disorder (ADHD) is a prevalent, impairing condition that is frequently comorbid with other psychiatric disorders and creates a substantial burden for the individual, their family, and the community ( 1 ). Positive correlations between ADHD diagnosis and unsafe school, unsafe neighborhood, and economic hardship are evident in a recent United States national research ( 2 ). Pharmacological treatment is part of the comprehensive multimodal evidence-based strategy to achieve adequate control of core ADHD symptoms and comorbid conditions, minimizing functional impairments and improving quality of life ( 3 ).…”