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Attention deficit hyperactivity disorder in children and adolescents: Epidemiology and pathogenesis

Author
Kevin R Krull, PhD
Section Editor
Marilyn Augustyn, MD
Deputy Editor
Mary M Torchia, MD

INTRODUCTION

Attention deficit hyperactivity disorder (ADHD) is a disorder that manifests in childhood with symptoms of hyperactivity, impulsivity, and/or inattention. The symptoms affect cognitive, academic, behavioral, emotional, and social functioning [1].

This topic review focuses on the epidemiology and pathogenesis of ADHD. The evaluation, diagnosis, management, and prognosis of ADHD in children and ADHD in adults are discussed separately. (See "Attention deficit hyperactivity disorder in children and adolescents: Clinical features and diagnosis" and "Attention deficit hyperactivity disorder in children and adolescents: Overview of treatment and prognosis" and "Pharmacology of drugs used to treat attention deficit hyperactivity disorder in children and adolescents" and "Attention deficit hyperactivity disorder in adults: Epidemiology, pathogenesis, clinical features, course, assessment, and diagnosis".)

DEFINITION

ADHD is a disorder that manifests in early childhood with symptoms of hyperactivity, impulsivity, and/or inattention. The symptoms affect cognitive, academic, behavioral, emotional, and social functioning [1]. (See "Attention deficit hyperactivity disorder in children and adolescents: Clinical features and diagnosis", section on 'Clinical features' and "Attention deficit hyperactivity disorder in children and adolescents: Clinical features and diagnosis", section on 'Core symptoms'.)

EPIDEMIOLOGY

Prevalence — The reported prevalence of ADHD in children varies from 2 to 18 percent depending upon the diagnostic criteria and the population studied (eg, primary care versus referral) [1-9]. The prevalence in school-age children is estimated to be between 8 and 11 percent, making it one of the most common disorders of childhood [2,3,6-8,10-12]. In a meta-analysis of 175 studies (including 1,023,071 subjects over 36 years), the estimated pooled prevalence of ADHD was 7.2 percent (95% CI 6.7 to 7.8) [13]. The studies were from a broad geographic distribution (eg, Europe, Asia, North America). Most were conducted in school-age children. The prevalence estimates were relatively stable over time and between editions of the Diagnostic and Statistical Manual of Mental Disorders.

In the 2011 National Survey of Children's Health (NSCH), the prevalence of a parent-reported diagnosis of ADHD (ever) among children aged 4 to 17 years of age in the United States was estimated to be 11 percent [12]. This is a 42 percent increase from the estimated prevalence of 7.8 percent in 2003. Approximately one-third of children were diagnosed with ADHD before age six years [14]. ADHD is more common in boys than girls (male to female ratio 4:1 for the predominantly hyperactive type and 2:1 for the predominantly inattentive type) [3]. In the 2011 NSCH, the prevalence was 15.1 percent in boys and 6.7 percent in girls [12]. The prevalence of ADHD increased with increasing age (7.7 percent in 4- to 10-year-olds; 14.3 percent among 11- to 14-year-olds; and 14.0 percent in 15- to 17-year-olds).

                  

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