title: How common is attention-deficit/hyperactivity disorder? Incidence in a population-based birth cohort in Rochester, Minn.
abstract: BACKGROUND
  The frequency of occurrence of attention-deficit/hyperactivity disorder (AD/HD) is in dispute. This uncertainty has contributed to the concern that too many children in the United States are being treated with stimulant medication.
  
  
  OBJECTIVE
  To determine the cumulative incidence of AD/HD in a population-based birth cohort and to estimate the prevalence of pharmacologic treatment for children who fulfill research criteria for AD/HD.
  
  
  METHODS
  Population-based birth cohort study.
  
  
  METHODS
  All children born between 1976 and 1982 in Rochester, Minn, who remained in the community after age 5 years (N = 5718).
  
  
  METHODS
  Medical and school records were reviewed for clinical diagnoses of AD/HD and supporting documentation (symptoms consistent with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and positive results for AD/HD-related questionnaires). Research-identified cases were defined as: (1) "definite" AD/HD (clinical diagnosis and at least one type of supporting documentation); (2) "probable" AD/HD (clinical diagnosis but no supporting documentation or no clinical diagnosis but both types of supporting documentation); (3) "questionable" AD/HD (no clinical diagnosis, but at least one type of supporting documentation); and (4) "not AD/HD" (all other subjects). Information about pharmacologic treatment for AD/HD was abstracted for all subjects.
  
  
  RESULTS
  The highest estimate of the cumulative incidence at age 19 years (with 95% confidence interval) of AD/HD (definite plus probable plus questionable AD/HD) was 16.0% (14.7-17.3). The lowest estimate (definite AD/HD only) was 7.4% (6.5-8.4). Prevalence of treatment with stimulant medication was 86.5% for definite AD/HD, 40.0% for probable AD/HD, 6.6% for questionable AD/HD, and 0.2% for not AD/HD.
  
  
  CONCLUSIONS
  These results provide insight into the apparent discrepancies in estimates of the occurrence of AD/HD, with less stringent criteria resulting in higher cumulative incidence. Children who met the most stringent criteria for AD/HD were most likely to receive pharmacologic treatment.
authors.affiliation: Division of Developmental and Behavioral Pediatrics, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. barbaresi.william@mayo.edu
authors.forename: William J
authors.initials: WJ
authors.lastname: Barbaresi
authors.forename: Slavica K
authors.initials: SK
authors.lastname: Katusic
authors.forename: Robert C
authors.initials: RC
authors.lastname: Colligan
authors.forename: V Shane
authors.initials: VS
authors.lastname: Pankratz
authors.forename: Amy L
authors.initials: AL
authors.lastname: Weaver
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Weber
authors.forename: David A
authors.initials: DA
authors.lastname: Mrazek
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Jacobsen
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D004363:Drug Utilization; D005260:Female; D006801:Humans; D008297:Male; D011159:Population Surveillance; D015995:Prevalence; D016016:Proportional Hazards Models; D011619:Psychotropic Drugs / Q000008:administration & dosage*; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology
chemical_list: D011619:Psychotropic Drugs