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Understanding the Problem with ADHD

- A Public Health Perspective

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurobehavioral disorder that may affect more than two million school-aged children and can last into adulthood.

• ADHD problems manifest as an unusually high and chronic level of inattention, impulsive hyperactivity, or both. A person with ADHD may struggle with impairments in crucial areas of life, including relationships with peers and family members, and performance at school or work. Increases in unintentional injuries and health care utilization have been noted in some studies of people with ADHD.

• As many as half of children with ADHD also have other behavior disorders. Some studies have demonstrated increases in substance abuse, risk-taking, and criminal behaviors among adolescents and adults who have ADHD and these other disorders.

• The American Psychiatric Association's Diagnostic & Statistical Manual-IV-TR estimates that 3%-7% of children suffer from ADHD, and some studies have estimated higher prevalence rates in community samples. The cause(s) and risk factors contributing to ADHD are unknown, although it seems to be more prevalent among boys than girls.

• During the past decade, prescription for ADHD medications increased dramatically across the United States, with consumption in many states more than quadrupling. Reasons for the increase, and the more recent decline, in the use of methylphenidate-containing drugs are not clear.

ADHD can be managed through medical and psychosocial interventions.

Recent research suggests that combining medical and behavioral therapies is an especially effective approach to treating ADHD and its comorbidities. However, information on the long-term effects of all treatments is lacking, as is knowledge of the effects of long-term use of ADHD medications in children. On-going, systematic monitoring of ADHD, comorbidities, and treatment modalities is needed to better understand ADHD.

CDC acknowledges the need for further research in ADHD. Specifically, key public health questions yet to be answered include:

  • What are the causes and risk factors of ADHD?
  • What is the prevalence of ADHD?
  • Is the prevalence increasing?
  • What social and economic impacts does ADHD have on families; schools; the workforce; and judicial and health systems?

  • Are ADHD and its comorbidities being appropriately diagnosed and treated?

  • Are people with ADHD able to access appropriate and timely treatment?

  • How effective are current interventions?

  • What are the long-term effects of drug treatments?






Mark, age 14, has more energy than most boys his age. But then, he's always been overly active. Starting at age 3, he was a human tornado, dashing around and disrupting everything in his path. At home, he darted from one activity to the next, leaving a trail of toys behind him. At meals, he upset dishes and chattered nonstop. He was reckless and impulsive, running into the street with oncoming cars, no matter how many times his mother explained the danger or scolded him. On the playground, he seemed no wilder than the other kids. But his tendency to overreact--like socking playmates simply for bumping into him--had already gotten him into trouble several times. His parents didn't know what to do. Mark's doting grandparents reassured them, "Boys will be boys. Don't worry, he'll grow out of it." But he didn't.



At age 17, Lisa still struggles to pay attention and act appropriately. But this has always been hard for her. She still gets embarrassed thinking about that night her parents took her to a restaurant to celebrate her 10th birthday. She had gotten so distracted by the waitress' bright red hair that her father called her name three times before she remembered to order. Then before she could stop herself, she blurted, "Your hair dye looks awful!"


In elementary and junior high school, Lisa was quiet and cooperative but often seemed to be daydreaming. She was smart, yet couldn't improve her grades no matter how hard she tried. Several times, she failed exams. Even though she knew most of the answers, she couldn't keep her mind on the test. Her parents responded to her low grades by taking away privileges and scolding, "You're just lazy. You could get better grades if you only tried." One day, after Lisa had failed yet another exam, the teacher found her sobbing, "What's wrong with me?"



Although he loves puttering around in his shop, for years Henry has had dozens of unfinished carpentry projects and ideas for new ones he knew he would never complete. His garage was piled so high with wood, he and his wife joked about holding a fire sale.


Every day Henry faced the real frustration of not being able to concentrate long enough to complete a task. He was fired from his job as stock clerk because he lost inventory and carelessly filled out forms. Over the years, afraid that he might be losing his mind, he had seen psychotherapists and tried several medications, but none ever helped him concentrate. He saw the same lack of focus in his young son and worried.

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