Attention Deficit Hyperactive Disorder, also known as ADHD, is a very common mental illness among children that affects many aspects of their daily lives. Children diagnosed with ADHD have a harder time focusing and have disruptive behavior patterns. This causes children to struggle in school making it harder for them to be a successful student. When a child shows signs of having the disorder, a doctor may officially diagnose them as having ADHD and also prescribe them drugs to combat the symptoms. Children diagnosed with the disorder also gain certain privileges in school such as an increased test time limit or an isolated room dedicated to test taking. The prevalence of this disorder has increased dramatically over the past few decades. Even though evidence of this increase is clear, no one has pinpointed the exact cause of the rise in diagnoses. Due to the magnitude of the rise in numbers, it is suggested that the new lifestyle of children nowadays compared to past decades could be influencing the rise in this disorder. Research suggests that certain family and school environments can make children more susceptible to ADHD as well as children within a certain race, age, ethnicity, and gender. It is also believed that the diagnostic procedures used to diagnose ADHD are only adding to the problem, causing more children to be inaccurately diagnosed. The increase in the prevalence of ADHD is caused by inadequate diagnostic procedures, sociocultural factors, age, gender, and environmental factors present in children’s daily lives. 

Attention Deficit Hyperactive Disorder according to the National Institutes of Health is a brain disorder that is recognizable “by an ongoing pattern of inattention and/or hyperactivity-impulsivity” that affects functioning or development. The three key behaviors noticeable in people with ADHD are inattention, the inability to remain focused on a task, hyperactivity, the inability to remain still, and impulsivity which is the urge to make hasty decisions without thinking through them first. Some sufferers only have issues with one single behavior while most children suffer from a combination of the behaviors. The article states that while it is normal for children to have these behaviors, children with ADHD exceed the norm because the behaviors are so severe that it interferes with their functionality in their daily lives. Signs of ADHD can begin to show as early as the age of three, and the symptoms a person experiences can change as they grow older. For a child to be diagnosed with this disorder, they must undergo an evaluation by a licensed physician such as a psychologist, pediatrician, or psychiatrist. During this evaluation, they must present at least one or a combination of the three symptoms associated with ADHD: inattention, hyperactivity, or impulsivity. The symptoms presented also must be so severe that they interfere with the child’s functionality, their development, and they must be chronic. This disorder can be treated with stimulants, non-stimulants, therapy, and education (Attention Deficit Hyperactivity Disorder). While it seems the qualifiers for a diagnosis are high, the number of diagnoses has increased dramatically. 

ADHD diagnoses in kids have completely skyrocketed in recent years. Patricia N. Pastor and Cynthia A. Reuben point out that throughout the past thirty years, learning and behavioral disorders have surfaced as “major chronic conditions” that are affecting development of kids and teens in the United States. Educators and pediatricians have both reported an increase in these conditions (Pastor and Reuben). This has not always been the case, however. Less than five percent of children before the 1990s were considered to have the disorder. Now, early in 2013, some data provided by Centers for Disease Control and Prevention said that as much as eleven percent of kids had received a diagnosis of ADHD with ages ranging from four to seventeen (Koerth-Baker). That is a forty-three percent increase in diagnoses from 2003 to 2011. By 2015, a report published by The Journal of Clinical Psychiatry reported that 5.8 million kids from ages five to seventeen had been diagnosed with ADHD (Welch). These numbers are causing concern and having researchers look at all the possible causes of the dramatic rise in diagnoses. Some believe that one factor may be the role that age plays in diagnosing a child with ADHD. 

Age has been found to be an important factor when looking at the rates of children being diagnosed with ADHD. Overall, it is found that younger children are more likely be diagnosed and treated for the disorder than older children. This fact causes issues in the health of these children. Deborah Brauser discusses a study conducted by Richard L Morrow, MA, and interviews him about the findings. In his study, he investigated younger children born in December, which is the cutoff month for school entry in B.C., and those born the previous January, the older children. Investigators found that children born in the month of December, the younger children, were more likely to receive a diagnosis and medicinal treatment of ADHD than their older classmates. Morrow states in his interview within the article that these findings could be a cause of a “lack of maturity” in the younger kids in the classroom being misread as ADHD symptoms including hyperactivity and inability to focus (Brauser). The reason he believes that these behaviors are being misread is because the youngest students are being compared to their oldest classmates who may be more mature. These findings are beginning to become a cause for concern about the harms over diagnosing and overprescribing can cause children. This study shows that we should emphasize behaviors outside of the school environment to avoid the role a child’s age plays into their risk of an ADHD diagnosis (Brauser). Age is not the only risk factor that could increase the probability for ADHD, however. Race has also been shown to play a role in a child’s diagnosis. 

Children of a certain race and ethnicity have been found to have a higher chance of being diagnosed with ADHD. Individual races and ethnicities being diagnosed more than others can cause ADHD rates to rise when the number of children within these socio-cultural groups increase. A study conducted by Noemi Reyes found some evidence to support this claim. It was found in the study that was performed in Wisconsin that ADHD prevalence was more common among blacks than whites (Reyes). It was also found in a separate study that non-Hispanic white children and non-Hispanic black children were more likely to be diagnosed with ADHD than Hispanic children. An explanation for this phenomenon is that Hispanic children and other minorities have less access to health care which was found to be correlated to a lower probability to be diagnosed with ADHD. Language barriers also play a role in this trend (Pastor and Reuben). This research provides evidence of the role a child’s race and ethnicity can play in their risk of being diagnosed with the disorder. This becomes an important factor in prevalence when the number of children within the pegged races and ethnicities continue to increase overtime, causing an increase in the number of diagnoses made by doctors. Another uncontrollable factor that may raise a child’s probability of being diagnosed is if they are a certain gender.

There is a significant difference in the numbers of diagnoses between male and female children. Pastor and Reuben found that girls are less likely than boys to receive a diagnosis. ADHD was found to be present in 6.7% of boys which is more than double than that of diagnoses found in 2.5% of girls. The study reported that their results were like many other studies that have been conducted on the topic, but the reasons for these results “are not fully understood” (Pastor and Reuben). However, one possible explanation is the higher frequency of troublesome behavior from boys compared to girls particularly in the school environment, causing them be diagnosed more with ADHD (Pastor and Reuben). As we continue to stigmatize boys for their behavior and blame it on ADHD, the phenomenon will only get worse, and more and more boys will be diagnosed. Many uncontrollable risk factors have been proven to predict an ADHD diagnosis. Some controllable factors, however, such as the family and school environment can also be a risk factor. 

The conditions and surroundings in a child’s school can easily make them either more or less susceptible to being diagnosed with ADHD. Mark L. Wolraich, MD, was interviewed by Deborah Brauser and said that certain behaviors in children are caused by a mixture of their environment, including the school environment, and biological factors. He explains that even though the school environment plays a role in ADHD, like the classroom organization by a teacher, it does not directly cause the disorder. However, a dysfunctional environment can make it worse which can cause an increase in diagnoses if the child is only observed in the school environment for a diagnosis (Brauser). Children now at the elementary level have more homework and a lot less recess and free time to play and release some energy. It is not difficult to look towards ADHD as an excuse for children who adversely behave consequently. Another cause for an increase is the inclusion of ADHD in the Individuals With Disabilities Education Act in 1991. This inclusion allowed children suffering from ADHD to have access to tutors and extended time allowed on tests. When these new school policies were compared to the rising rates of diagnoses, it was found that states with laws recognizing or punishing schools for their test scores saw an increase in ADHD prevalence. This same phenomenon happened when President George W. Bush implemented the No Child Left Behind Act. People have also begun to normalize disruptive behaviors by either giving them a label, moralizing them, or by treating them with medicine or therapy (Koerth-Baker). These higher expectations for children to perform put an increased stress on them to behave and score high on tests, making their normal child-like behavior seem disruptive leading to its medicalization as a disorder. The more the expectations for children continue to rise, the more ADHD diagnoses are going to be made. Not only is the school environment causing a rise in diagnoses, but the environment at home for these children have a similar effect as well.

The family atmosphere has been found to have an influence on a child’s risk of being diagnosed with ADHD. Gabriel Pheula performed a study that discovered the effects different family variables have on the prevalence of ADHD. The researcher used different ways to measure the family environment such as Rutter’s indicators which include low social class, large family size, marital strife, etc., the Family Environment Scale which measure cohesion, conflict, and expressiveness, and the FRI which is an index used to measure family relationship. The results of the study show that a child’s probability of being diagnosed with ADHD rose as the number of Rutter’s indicators within their family rose. Also, children in families with a lower score on the Family Environment Scale and the FRI had a higher risk of being diagnosed with ADHD. These results conclude that families with greater adversity raise children with a higher risk for the disorder (Pheula). Furthering this idea, it was found that children who live in a single mother home were more likely than children living in a two-parent home to have the diagnosis. This same conclusion was also found for children whose mothers only had “intermediate levels of education” such as graduating from high school but not college (Pastor and Reuben). Even their insurance coverage influenced diagnostic rates. Children with private insurance coverage and no coverage at all were less likely to receive a diagnosis than those who were covered by Medicaid (Pastor and Reuben). It is concluded that a family's socioeconomic status as well as their wellbeing has a drastic effect on their children's probability of being diagnosed with ADHD.  As family conflict and adversity rise in society as well as the number of families with a low socioeconomic status, so does the number of ADHD diagnoses. This is concerning as the number of families with these issues changes over the next couple of years, causing a score of children to be misdiagnosed leading to an over diagnosis of the disorder and overtreatment using medication. A child’s personal and family environment may not be the only factor affecting their risk of a diagnosis. Some societal factors such as diagnostic procedures for ADHD and the world of advertisement have the potential to raise their risk.

Diagnostic criteria are very inadequate, and are beginning to become even worse over the next couple of years. These lenient procedures are causing doctors to increase their diagnoses, leading to more kids being diagnosed with ADHD than ever. Robert E. McKeown studied the effects changing the criteria of the DSM, which is the diagnostic criteria used to diagnose mental disorders, for ADHD had on prevalence rates. He found that teachers and parents reported an average of 25.2% of children had ADHD symptoms if you required them to report at least six symptoms. He then required the “criteria for impairment and onset” be at age seven, and this requirement dropped the average of reported children to 16.9% which is the current requirement under the DSM 4(McKeown). He then revised the age of onset for ADHD to twelve years old instead of seven, which would be the new requirement under the new upcoming DSM 5, and found that this increased the rates of reported children being observed to present ADHD symptoms. These results illuminate the enormous importance that diagnostic procedures have on prevalence rates. This finding supports the claim that the new DSM 5 criteria will raise rates of prevalence among children due to the raise in age of onset to age twelve from seven. He also found evidence that requiring symptoms to be reported strictly from teachers reduced the rates of children reported to have symptoms, so the environment the child is observed also has a major impact on rates (McKeown). Allen Frances explains that the new DSM 5 would continue to inflate the problem of over diagnoses rather than extinguish it. If the DSM 5 becomes official, Frances believes that ADHD diagnosis will become “even more ubiquitous” and routine. The diagnostic criteria is a major influencer of prevalence rates among children, but is not the only societal factor raising rates. The way drug companies are now advertising ADHD medications also has a major impact.

The advertisement of new ADHD medications has an adverse effect on the way children are being diagnosed with the disorder. According to Frances, this ADHD epidemic is a craze that has been greatly encouraged by drug companies, a hypothesis strongly favored by circumstantial evidence. He explains that rates began rising right after new medications for ADHD were marketized which were more expensive than the old ones, providing an affluent profit reason for an influx of marketing, and when the FDA unregulated the advertising powers companies had to directly advertise to consumers. The companies took advantage of their new freedom to advertise their new medications. This allowed for them to sensitize parents, teachers, and even doctors to consider normal behavior a sign of ADHD. Even though this may have helped kids who needed treatment, it caused many kids to be misdiagnosed and treated unnecessarily (Frances). If this advertisement continues to be unregulated, prevalence rates will continue to rise due to doctors and caretakers misinterpreting a child’s behavior. 

There are a wide range of factors contributing to the rise in ADHD prevalence. These contributors include even ones that cannot be controlled like age, race, and sex. These children are distinguished from their other classmates and are at a higher risk for ADHD. Also as the school environment and the family conditions for many children continue to become more stressful, it is certain ADHD will be at an even higher prevalence in the future, and this phenomenon is only getting worse with the new diagnostic criteria. While it seems that these numbers are increasing at an unstoppable rate, there are steps that can be taken to help reduce these numbers in the future. Children’s disruptive behavior and inability to focus needs to try to be managed by using other methods such as behavior or environmental modification before diagnoses and medications come into play (Frances). Drew Erhardt explains that when the diagnosis is being made, doctors need to “rule out other possibilities” that could explain the child’s behavior. This could include other psychological diagnoses, medical problems, “psychosocial variables,” developmental problems, and culture (Erhardt). ADHD will continue to increase due to factors that should be unrelated to the disorder, yet have been proven to have a drastic effect on prevalence unless action is taken to stop it. The steps and solutions suggested must be implemented to reduce the prevalence of ADHD and halt the epidemic, allowing children to avoid being over diagnosed and overtreated for this disorder. 

 