Rates of Adult ADHD Diagnosis are Increasing

The rate of adults being diagnosed with attention-deficit/hyperactivity disorder (ADHD) is increasing, especially among white individuals, according to a study published in JAMA Network Open.

In this cohort study, researchers assessed trends in ADHD diagnosis among 5,282,877 adult patients (21.9% aged 25-34, 50.5% women, 41.7% white) who identified as Black, Native American, Pacific Islander, Latino or Hispanic, non-Hispanic white, Asian American, or other using the Kaiser Permanente Northern California health plan medical records from January, 2007, to December, 2016. The study’s key endpoints were defined as the prevalence and incidence of clinical ADHD diagnosis in adults, and the prevalence of licensed mental health clinicians diagnosing ADHD in children between the ages of five and 11. The researchers performed their data analysis from January 2017 through September 2019.

According to the results of the study, the annual prevalence of ADHD among adults increased for every race/ethnicity, with white individuals having the highest prevalence rates (white individuals: 0.67% to 1.42%; black individuals: 0.22% to 0.69%; Native American individuals: 0.56% to 1.14%; Pacific Islander individuals: 0.11% to 0.39%; Hispanic or Latino individuals: 0.25% to 0.65%; Asian American individuals: 0.11% to 0.35%; individuals from other races/ethnicities: 0.29% to 0.71%).

The increased odds of ADHD diagnosis were linked to younger people (eg, >65 years vs 18-24 years: OR=0.094; 95% CI, 0.088 to 0.101; P < .001), men (women: OR=0.943; 95% CI, 0.928 to 0.959; P < .001), being divorced (OR=1.131; 95% CI, 1.09 to 1.171; P < .001), being employed (eg, retired vs employed persons: OR=0.278; 95% CI, 0.267 to 0.290; P < .001), and having a higher median education level (OR=2.156; 95% CI, 2.062 to 2.256; P < .001).

Moreover, having an eating disorder (OR=5.192; 95% CI, 4.926 to 5.473; P < .001), depressive disorder (OR=4.118; 95% CI, 4.030 to 4.207; P < .001), bipolar disorder (OR= 4.722; 95% CI, 4.556 to 4.894; P < .001), or anxiety disorder (OR=2.438; 95% CI, 2.385 to 2.491; P < .001) was also linked with increased odds of being diagnosed with ADHD.

Bridging Important Gaps

“Irrespective of the explanations for racial/ethnic differences in ADHD diagnoses, our findings suggest 2 important future efforts to bridge gaps in recognition, diagnosis, and treatment of ADHD in racial/ethnic subgroups,” the authors wrote in their conclusion.

“First, there should be an increased focus on careful, unbiased, structured screening and documentation of symptoms across development, especially as the field attempts to further delineate the temporal precedence of ADHD, patterns of comorbidity, and its consequences. Second, greater consideration must be placed on cultural influences on health care seeking and delivery, along with an increased understanding of the various social, psychological, and biological differences among races/ethnicities as well as culturally sensitive approaches to identify and treat ADHD in the total population.”