School policy may fuel dramatic increase in ADHD diagnoses among children in U.S.

Differences in state-by-state education policy could be driving a growing number of ADHD cases among school children in the U.S., according to new research funded by the Robert Wood Johnson Foundation. 

In a new book, The ADHD Explosion, Stephen Hinshaw, PhD, and Richard Scheffler, PhD, recipients of Robert Wood Johnson Foundation Investigator Awards in Health Policy Research, examine the overall marked increase in ADHD diagnosis over the past decade, along with significant regional differences in the number of ADHD cases diagnosed. They find that education policy could be a major factor fueling the trend. 

Based on data from the National Survey of Children’s Health, Hinshaw and Scheffler's study found that the states with academic-performance policies that tie school funding to standardized test scores are experiencing a surge in ADHD diagnoses, especially for children at or near the poverty level. In states with these laws, poor children experienced a 58 percent increase in ADHD diagnoses, versus only a 3.4 percent increase among more affluent youth.  

“We’re seeing a major incentive to game the system,” said Scheffler, a professor of health economics and public policy at the University of California, Berkeley. “These accountability laws could actually encourage ADHD diagnoses, because treatment may boost achievement test scores and, in some cases, diagnosed youth are excluded from a school district’s average test score.”

North Carolina was one of the first states to implement accountability laws designed to restrict funding for schools that did not meet achievement-related benchmarks and reward others for exceeding them. By 2001, 30 states had implemented similar statutes. According to 2007 data, 15.6 percent of all children aged 4-17 had been diagnosed with ADHD at some point in North Carolina, including nearly one in three teenage boys. Yet rates in states such as California and Nevada remain fairly low at around 6 percent. North Carolina’s medication rate was 77.4 percent, in contrast to California’s rate of 49 percent.

Recent data by the Centers for Disease Control and Prevention show that ADHD diagnosis rates among children have increased by 40 percent since 2003. Among 4- to 17-year-olds nationwide, one in nine (or 11 percent) has been diagnosed.  Among middle-school and high-school boys specifically, the number is one in five.  About 70 percent of all youth with a diagnosis receive medication.  

“ADHD is a real problem with biological and social underpinnings, and we must take a public health approach to reversing this troubling trend,” said Hinshaw, a professor of psychology at the University of California, Berkeley. “Our ultimate goal is to help these patients afflicted with ADHD. Our findings offer a reality check to educators, medical practitioners, and families on how we assess children and properly treat the disorder in a way that focuses on helping them build the skills they need to excel in and outside the classroom.”

The research is published in a new book to be released on March 3, 2014 entitled, The ADHD Explosion: Myths, Medication, Money, and Today’s Push for Performance by Oxford University Press.

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Investigator Awards in Health Policy Research, a national program of the Robert Wood Johnson Foundation (RWJF), supports researchers whose crosscutting and innovative ideas promise to contribute meaningfully to improving health and health care policy. The program provides one of the few funding opportunities in the United States for investigator-initiated projects that are broad in scope, innovative in approach, and have national policy relevance. 

For more than 40 years the Robert Wood Johnson Foundation has focused on the most pressing health issues facing our country. We are committed to fostering a national culture of health that will enable all Americans to live longer, healthier lives now and for generations to come. For more information, visit www.rwjf.org. Follow the Foundation on Twitter at www.rwjf.org/twitter or on Facebook at www.rwjf.org/facebook.