By  Dr. Justin Curry
Feb. 9, 2023

U.S. Navy Photo by Seaman Apprentice Samantha Schuster

Attention deficit/hyperactivity disorder is one of the most common neurodevelopmental conditions impacting children in the United States and around the world. ADHD is marked by difficulty maintaining attention or focus, butting in or interrupting others, fidgeting/squirming, making careless mistakes, and forgetfulness. While all children may experience these problems from time to time, children with ADHD struggle with attention and impulsivity more than their peers, and these problems can interfere with performance in school, at home, and in social situations.¹

Within the U.S., ADHD is one of the leading mental health concerns among children. Researchers from the Centers for Disease Control recently released data from 2016 to 2019 from the National Survey of Children’s Health and the National Health Interview Survey, which estimated 9.6% to 9.8% of children aged three to 17 had ever been diagnosed with ADHD; at the time the survey data were collected, between 8.2% and 8.7% met the criteria for ADHD.²  The second estimate range is necessarily lower because ADHD had resolved in some portion of the sample.

Data from the Military Health System (MHS) are similar to those reported for the general U.S. population. On average, in Fiscal Year 2017 through FY2022, around 124,000 children between the ages of three and 17 were treated each year for ADHD in either the direct care (treatment received at MHS clinics and hospitals) or purchased care (treatment received from TRICARE providers) systems. That puts the annual prevalence estimate for ADHD among children in the MHS at about 6.3%., While this is somewhat lower than national prevalence estimates, differences in how these estimates were derived prohibit direct comparison.

Between FY2017 and FY2019, the MHS delivered ADHD-related care within the direct care system valued at roughly $54 million annually and paid out an average of $73 million each year in claims from the purchased care system (accurate direct care value information is not currently available for FY2020 and later). ADHD-care accounts for 3.2% of pediatric primary care encounters and 31% of pediatric encounters in specialty mental health clinics within the MHS.³

For many years, conventional wisdom has suggested that roughly half of ADHD cases resolve by adulthood. However, many patients who no longer met diagnostic criteria for ADHD have continued to experience symptoms at a level that impacted their functioning in one or more important areas of life. The Multimodal Treatment Study of ADHD is a longitudinal study of children diagnosed with ADHD that has followed patients over nearly two decades and sheds new light on the developmental presentation of ADHD. Researchers recently reported that among 558 ADHD patients, only 9.1% achieved and sustained remission of ADHD symptoms whereas 10.8% demonstrated persistent symptoms of ADHD across all study time-points. The majority of subjects (63.8%) experienced a waxing and waning course that included periods of full remission followed by recurrence.

This research offers valuable insight into the course of one of the most common mental health concerns for children in the MHS and can inform expectations and treatment planning by clarifying the variable course of ADHD. A clear understanding of how a medical concern is likely to progress over time empowers patients and their families and may reduce stress and uncertainty in the medical management of the condition.

References

1. Centers for Disease Control and Prevention. (2022, August 9). Attention Deficit/Hyperactivity Disorder (ADHD). U.S. Department of Health and Human Services. https://www.cdc.gov/ncbddd/adhd/facts.html
2. Bitsko, R.H., Claussen, A.H., Lichstein J., et al. (2022). Mental Health Surveillance Among Children — United States, 2013–2019. Morbidity and Mortality Weekly Report Supplement. 71(Suppl-2):1–42. DOI: http://dx.doi.org/10.15585/mmwr.su7102a1
3. Military Health System Management Analysis and Reporting Tool (14DEC2022).
4. Sibley, M.H., Arnold, L.E., Swanson, J.M., et al. (2022). Variable Patterns of Remission From ADHD in the Multimodal Treatment Study of ADHD. American Journal of Psychiatry. 179:142–151. DOI: 10.1176/appi.ajp.2021.21010032

Justin Curry, Ph.D. serves as the Chief of the Surveillance Section at the Psychological Health Center of Excellence. He is a clinical psychologist by training and a veteran of the U.S. Army.