Studying the epidemiology of attention-deficit hyperactivity disorder: screening method and pilot results.
OBJECTIVE
As part of a larger epidemiologic study of risk factors for attention-deficit hyperactivity disorder (ADHD), this pilot study combined parent and teacher information to estimate ADHD prevalence among elementary school children in a North Carolina county. The methods developed for this study and the pitfalls we encountered illustrate the challenges involved in conducting population-based studies of ADHD.


METHODS
We employed 2-stage screening using DSM-IV criteria. Teachers completed behaviour-rating scales for all children. We then administered a structured telephone interview to parents of potential cases. We screened 362 of 424 (85%) children in grades 1 to 5 in 4 schools.


RESULTS
According to parent reports, 43 children (12%) had previously been diagnosed with ADHD by a health professional. Thirty-four children (9%) were taking ADHD medication. Forty-six children (12.7%) met study case criteria for ADHD, based on combined teacher and parent reports. Of the 46 cases, 18 (39%) had not been previously identified. Eight previously diagnosed children, however, did not meet case criteria. After we adjusted for nonresponse, the estimated prevalence was 16% (95%CI, 12% to 20%).


CONCLUSIONS
These data suggest that the DSM-IV prevalence of ADHD has been substantially underestimated, although the true prevalence in this population may be less than the 16% estimated here. Population-based studies of ADHD are feasible and may provide important information about practice and treatment patterns in community settings, as well as a broader understanding of the etiology and life course of this common disorder.
Rowland
A S
AS
Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina, USA. arowland@salud.unm.edu
Umbach
D M
DM
Catoe
K E
KE
Stallone
L
L
Long
S
S
Rabiner
D
D
Naftel
A J
AJ
Panke
D
D
Faulk
R
R
Sandler
D P
DP
D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening; D009657:North Carolina / Q000453:epidemiology; D010552:Personality Assessment; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors