Report: 43 Percent Increase in ADHD Diagnosis for U.S. Children Between 2003-2011

A report finds the overall number of children in the United States diagnosed with Attention Deficit/Hyperactivity Disorder (ADHD) jumped 43 percent between 2003 and 2011.

In 2003, 7.8 percent of 3-17 year-olds were diagnosed with ADHD, but in 2011 12 percent of children and teens had the diagnosis. According to researchers Dr. Sean Cleary of the Milken Institute School of Public Health at George Washington University and Kevin Collins of Mathematica Policy Research, the analysis finds that 5.8 million U.S. children between the ages of 5 and 17 now have the ADHD diagnosis.

The analysis, published in the Journal of Clinical Psychiatry, used the reports of ADHD diagnosis by parents – data that was sponsored by the Maternal and Child Health Bureau and the National Center for Health Statistics of the Centers for Disease Control and Prevention (CDC) – during the period between 2003 and 2011.

“We found rising rates of ADHD overall and very sharp jumps in certain subgroups,” Cleary said, according to Science Daily.

Specifically, the researchers found the 43 percent increase in parent-reported ADHD overall among children. For children aged 10–14 years the increase was 47 percent over the eight-year period, and the jump for teens between 15–17 years was 52 percent.

In addition, ADHD prevalence was found highest among whites, though increases were observed for all racial/ethnic groups with the most remarkable among Hispanics where an increase of 83 percent was found from 2003 to 2011. Researchers also found a greater increase in ADHD among females – 55 percent – compared with males at 40 percent.

According to the American Psychological Association (APA), the U.S. Drug Enforcement Agency (DEA) raised the quota for production of stimulant medications used to treat ADHD – such as Adderall and Ritalin – when it was discovered that demand for the drugs outpaced supply and pharmacies were sold out.

Psychologist Dr. Stephen Hinshaw and health economist Dr. Richard Scheffler examined the issues surrounding the jump in ADHD diagnoses in their book, The ADHD Explosion: Myths, Medication, Money, and Today’s Push for Performance.

“The hard part is that ADHD is just like depression, just like autism, just like schizophrenia in that it’s a symptom-based mental disorder,” Hinshaw told APA. “We don’t have a blood test or a brain scan yet that’s definitive. I believe that ADHD is a real condition, but it’s on a spectrum, just the way that high blood pressure and autism are. It’s always a bit arbitrary as to who is actually above the cut and who is below because we don’t know exactly where the cut is.”

Hinshaw said after exploring many factors that might account for the varying state and regional rates of ADHD diagnosis, the researchers ultimately could not explain the major differences.

Looking outside of psychology and the health care system, however, the researchers said they found their answer in education.

Scheffler observes:

We found that during the late 1980s and throughout the 1990s, several states passed consequential accountability laws, which basically changed the philosophy of schools: Instead of funding schools based on the number of students in them, funding became based on their students’ standardized math and reading test scores. Schools were rewarded for doing better. At the same time, standardized test scores in the South were the lowest in the nation — and as a result, these states didn’t get as much funding.

That’s when we knew we were onto something, because if you want to improve test scores, one way of doing that is to have children diagnosed so you can get extra money from the school district to help tutor them or put them in smaller classes. Basically, you diagnose these kids because improving their performance helps the school’s performance.

Some states even allowed you to take students diagnosed with ADHD out of the pool that was used to judge your school, with the understanding that these kids probably perform lower, and if you have more of them, that shouldn’t be held against you.

The researchers were able to compare 30 states that passed accountability laws prior to 2002 – when No Child Left Behind (NCLB) went into effect, thereby setting standards and establishing measurable goals in order to close the achievement gap between white and minority students – to the 20 states that did not have accountability laws until NCLB took effect.

Hinshaw explains the results:

What we found was that standards-based education reform had likely played a large role in the nation’s huge increase in ADHD diagnoses. Between 2003 and 2007, in those 20 states that didn’t get consequential accountability until No Child Left Behind was implemented, we found a 59 percent increase in ADHD diagnoses among children who were within 200 percent of the federal poverty limit — so among the poorest kids in the state. Among middle- or upper-class kids in those states, there was only a 3 percent increase in ADHD diagnosis. That’s a huge and statistically significant difference. But in states that had already passed the accountability laws before No Child Left Behind, rates of ADHD diagnosis only went up 20 percent, which is pretty much the national average, and there was no difference between poor and rich kids.

Hinshaw says that while the study did not prove a causal relationship between consequential accountability and the high rate of ADHD diagnosis, the data show a “really strong association.”

“[A]nd it’s almost a smoking gun that when test scores really, really count in the public schools, for the poorest kids in a state, ADHD diagnoses go up dramatically shortly thereafter,” he asserted.

Now that NCLB is history, and the latest version of the Elementary and Secondary Education Act – the Every Student Succeeds Act (ESSA) – has been signed into law, establishment Washington Republicans have boasted that the new law reduces the federal footprint on education, returns education to the states, and stops the federal government from mandating the Common Core nationalized standards.

“In fact, ESSA will have pretty much the opposite effect,” writes Jane Robbins, senior fellow at American Principles Project, at The Pulse 2016. “It lays out particular requirements for state standards and uses code language throughout that gives the federal government the tools to pressure the states to stick with Common Core rather than risking their federal money by adopting something better.”

“It maintains the federally dictated testing regimen and requires states to implement assessments that are expensive, that have been proven to be ineffective and unworkable, and that operate not by assessing students’ academic knowledge but rather by measuring their attitudes and dispositions,” she continues.

Since a strong association has been found between consequential accountability in schools and rate of ADHD diagnosis, there is no indication the rate of ADHD diagnosis will fall any time soon and fewer children will be medicated.

As Education Week observes, with ESSA, the U.S. Department of Education must still approve states’ “interim tests” that will provide “summative results” for the purpose of accountability, but how this is done is yet to be determined because the “administrative state” makes the rules on that point.

“Which interim tests the U.S. Department of Education will consider acceptable for summative results is an open question, since regulations and guidance on the new law haven’t been written yet,” the report states. “And states will have to prove to the Education Department that their tests are valid for their intended purpose.”