European Journal of Pediatrics

, Volume 166, Issue 2, pp 117–123 | Cite as

Variations in prevalence of attention deficit hyperactivity disorder worldwide

  • Maria Skounti
  • Anastas Philalithis
  • Emmanouil GalanakisEmail author


Attention deficit hyperactivity disorder (ADHD) is among the most common, intensely investigated, and yet diagnostically controversial neurobehavioral conditions of childhood. The prevalence of ADHD has been reported with great variations among different studies, ranging from 2.2% to 17.8%. The aim of this review was to investigate the variables that influence the prevalence of ADHD and to derive a best estimate for the prevalence of the disorder. We reviewed all the 39 studies on ADHD prevalence appearing in the Pubmed and published since 1992. These studies indicate that ADHD is more common in boys than girls, in younger than older children and adolescents, in one-setting rather than two-setting screening studies, in studies based on DSM-IV rather than DSM-III-R criteria. Additional factors that may well influence prevalence rates include source of information and assessment of clinical impairment. In conclusion, our findings suggest that population characteristics, methodology features, ethnic and cultural differences and diagnostic criteria involved in studies affect the prevalence of ADHD. Standardized designs may lead to firm conclusions on the true prevalence of ADHD, the estimation of which seems impossible to be achieved by reviewing the already existing literature.


Attention deficit hyperactivity disorder Prevalence DSM-IV Population screening 


  1. 1.
    Almqvist E, Puura K, Kumpulainen K, Tuompo-Johansson E, Henttonen I, Huikko E, Linna S, Ikaheimo K, Aronen E, Katainen S, Piha J, Moilanen I, Rasamen E, Tamminen T (1999) Psychiatric disorders in 8-9-year-old children based on diagnostic interview with the parents. Eur Child Adolesc Psychiatry 8(Suppl 4):17–28PubMedCrossRefGoogle Scholar
  2. 2.
    American Psychiatric Association (1994) The diagnostic and statistical manual of psychiatric disorders, 4th edn. American Psychiatric Association, Washington, DCGoogle Scholar
  3. 3.
    Andres MA, Catala MA, Gomez-Beneyto M (1999) Prevalence, comorbidity, risk factors and service utilisation of disruptive behaviour disorders in a community sample of children in Valencia (Spain). Soc Psychiatry Psychiatr Epidemiol 34:175–179PubMedCrossRefGoogle Scholar
  4. 4.
    Barkley RA (1998) Attention -deficit hyperactivity disorder: a handbook for diagnosis and treatment. The Guilford Press, USAGoogle Scholar
  5. 5.
    Barkley RA, Fischer M, Edelbrock CS, Smallish L (1990) The adolescent outcome of hyperactive children diagnosed by research criteria: I. An 8-year prospective follow-up study. J Am Acad Child Adolesc Psychiatry 29:546–557PubMedCrossRefGoogle Scholar
  6. 6.
    Baumgaertel A, Wolraich ML, Dietrich M (1995) Comparison of diagnostic criteria for attention deficit disorders in a German elementary school sample. J Am Acad Child Adolesc Psychiatry 34:629–638PubMedCrossRefGoogle Scholar
  7. 7.
    Bener A, Qahtani RA, Abdelaal I (2006) The prevalence of ADHD among primary school children in an Arabian society. J Atten Disord 10:77–82PubMedCrossRefGoogle Scholar
  8. 8.
    Benjasuwantep B, Ruangdaraganon N, Visudhiphan P (2002) Prevalence and clinical characteristics of attention deficit hyperactivity disorder among primary school students in Bangkok. J Med Assoc Thail 85(Suppl 4):S1232–S1240Google Scholar
  9. 9.
    Biederman J, Mick E, Faraone SV (2000) Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type. Am J Psychiatry 157:816–818PubMedCrossRefGoogle Scholar
  10. 10.
    Breton JJ, Bergeron L, Valla JP, Berthiaume C, Gaudet N, Lambert J, St-Georges M, Houde L, Lepine S (1999) Quebec child mental health survey: prevalence of DSM-III-R mental health disorders. J Child Psychol Psychiatry 40:375–384PubMedCrossRefGoogle Scholar
  11. 11.
    Brown RT, Freeman WS, Perrin JM, Stein MT, Amler RW, Feldman HM, Pierce K, Wolraich ML (2001) Prevalence and assessment of attention-deficit/hyperactivity disorder in primary care settings. Pediatrics 107(3):E43PubMedCrossRefGoogle Scholar
  12. 12.
    Cohen P, Cohen J, Kasen S, Velez CN, Hartmark C, Johnson J, Rojas M, Brook J, Streuning EL (1993) An epidemiological study of disorders in late childhood and adolescence-I. Age-and gender-specific prevalence. J Child Psychol Psychiatry 34:851–867PubMedCrossRefGoogle Scholar
  13. 13.
    Costello EJ, Mustillo S, Erkanli A, Keeler G, Angold A (2003) Prevalence and development of psychiatric disorders in childhood and adolescence. Arch Gen Psychiatry 60:837–844PubMedCrossRefGoogle Scholar
  14. 14.
    Cuffe SP, Moore CG, McKeown RE (2005) Prevalence and correlates of ADHD symptoms in the national health interview survey. J Atten Disord 9:392–401PubMedCrossRefGoogle Scholar
  15. 15.
    DuPaul GJ, Anastasopoulos AD, Power TJ, Reid R, Ikeda MJ, McGoey KE (1998) Parent ratings of attention deficit/hyperactivity disorder symptoms: factor structure and normative data. J Psych Behav Assessment 20:83–102CrossRefGoogle Scholar
  16. 16.
    Elia J, Ambrosini PJ, Rapoport JL (1999) Treatment of attention-deficit-hyperactivity disorder. N Engl J Med 340:780–788PubMedCrossRefGoogle Scholar
  17. 17.
    Epstein JN, March JS, Conners CK, Jackson DL (1998) Racial differences on the conners teacher rating scale. J Abnorm Child Psychol 26:109–118PubMedCrossRefGoogle Scholar
  18. 18.
    Ersan EE, Dogan O, Dogan S, Somer H (2004) The distribution of symptoms of attention-deficit/hyperactivity disorder and oppositional defiant disorder in school age children in Turkey. Eur Child Adolesc Psychiatry 13:354–361PubMedCrossRefGoogle Scholar
  19. 19.
    Fergusson DM, Horwood LJ, Lynskey MT (1993) Prevalence and comorbidity of DSM-III-R diagnoses in a birth cohort of 15 year olds. J Am Acad Child Adolesc Psychiatry 32:1127–1134PubMedCrossRefGoogle Scholar
  20. 20.
    Ford T, Goodman R, Meltzer H (2003) The British child and adolescent mental health survey 1999: the prevalence of DSM-IV disorders. J Am Acad Child Adolesc Psychiatry 42:1203–1211PubMedCrossRefGoogle Scholar
  21. 21.
    Gallucci F, Bird HR, Berardi C, Gallai V, Pfanner P, Weinberg A (1993) Symptoms of attention-deficit hyperactivity disorder in an Italian school sample: findings of a pilot study. J Am Acad Child Adolesc Psychiatry 32:1051–1058PubMedCrossRefGoogle Scholar
  22. 22.
    Gaub M, Carlson C (1997) Behavioral characteristics of DSM-IV ADHD subtypes in a school-based population. J Abnorm Child Psychol 25:103–111PubMedCrossRefGoogle Scholar
  23. 23.
    Gimpel GA, Kuhn BR (2000) Maternal report of attention deficit hyperactivity disorder symptoms in preschool children. Child Care Health Dev 26:163–176; discussion 176–179PubMedCrossRefGoogle Scholar
  24. 24.
    Gittelman R, Mannuzza S, Shenker R, Bonagura N (1985) Hyperactive boys almost grown up. I. Psychiatric status. Arch Gen Psychiatry 42:937–947PubMedGoogle Scholar
  25. 25.
    Gomez R, Harvey J, Quick C, Scharer I, Harris G (1999) DSM-IV AD/HD: confirmatory factor models, prevalence, and gender and age differences based on parent and teacher ratings of Australian primary school children. J Child Psychol Psychiatry 40:265–274PubMedCrossRefGoogle Scholar
  26. 26.
    Gomez-Beneyto M, Bonet A, Catala MA, Puche E, Vila V (1994) Prevalence of mental disorders among children in Valencia, Spain. Acta Psychiatr Scand 89:352–357PubMedGoogle Scholar
  27. 27.
    Graetz BW, Sawyer MG, Hazell PL, Arney F, Baghurst P (2001) Validity of DSM-IV ADHD subtypes in a nationally representative sample of Australian children and adolescents. J Am Acad Child Adolesc Psychiatry 40:1410–1417PubMedCrossRefGoogle Scholar
  28. 28.
    Greenhill LL (1998) Diagnosing attention-deficit/hyperactivity disorder in children. J Clin Psychiatry 59(Suppl 7):31–41PubMedGoogle Scholar
  29. 29.
    Hart EL, Lahey BB, Loeber R, Applegate B, Frick PJ (1995) Developmental change in attention-deficit hyperactivity disorder in boys: a four-year longitudinal study. J Abnorm Child Psychol 23:729–749PubMedCrossRefGoogle Scholar
  30. 30.
    Hill JC, Schoener EP (1996) Age-dependent decline of attention deficit hyperactivity disorder. Am J Psychiatry 153:1143–1146PubMedGoogle Scholar
  31. 31.
    Hudziak JJ, Heath AC, Madden PF, Reich W, Bucholz KK, Slutske W, Bierut LJ, Neuman RJ, Todd RD (1998) Latent class and factor analysis of DSM-IV ADHD: a twin study of female adolescents. J Am Acad Child Adolesc Psychiatry 37:848–857PubMedCrossRefGoogle Scholar
  32. 32.
    Jensen PS, Watanabe HK, Richters JE, Cortes R, Roper M, Liu S (1995) Prevalence of mental disorder in military children and adolescents: findings from a two-stage community survey. J Am Acad Child Adolesc Psychiatry 34:1514–1524PubMedCrossRefGoogle Scholar
  33. 33.
    Kadesjo B, Gillberg C (2001) The comorbidity of ADHD in the general population of Swedish school-age children. J Child Psychol Psychiatry 42:487–492PubMedCrossRefGoogle Scholar
  34. 34.
    Kanbayashi Y, Nakata Y, Fujii K, Kita M, Wada K (1994) ADHD-related behaviour among non-referred children: parents’ ratings of DSM-III-R symptoms. Child Psychiatry Hum Dev 25:13–29PubMedCrossRefGoogle Scholar
  35. 35.
    Landgren M, Pettersson R, Kjellman B, Gillberg C (1996) ADHD, DAMP and other neurodevelopmental/psychiatric disorders in 6-year-old children: epidemiology and co-morbidity. Dev Med Child Neurol 38:891–906PubMedCrossRefGoogle Scholar
  36. 36.
    Magnusson P, Smari J, Gretarsdottir H, Prandardottir H (1999) Attention-Deficit/Hyperactivity symptoms in Icelandic schoolchildren: assessment with the Attention Deficit/Hyperactivity rating scale-IV. Scand J Psychol 40:301–306PubMedCrossRefGoogle Scholar
  37. 37.
    Mann EM, Ikeda Y, Mueller CW, Takahashi A, Tao KT, Humris E, Li BL, Chin D (1992) Cross-cultural differences in rating hyperactive-disruptive behaviors in children. Am J Psychiatry 149:1539–1542PubMedGoogle Scholar
  38. 38.
    Mannuzza S, Klein RG, Bonagura N, Malloy P, Giampino TL, Addalli KA (1991) Hyperactive boys almost grown up. V. Replication of psychiatric status. Arch Gen Psychiatry 48:77–83PubMedGoogle Scholar
  39. 39.
    Montiel-Nava C, Pena JA, Lopez M, Salas M, Zurga JR, Montiel-Barbero I, Pirela D, Cardozo JJ (2002) Estimations of the prevalence of attention deficit hyperactivity disorder in Marabino children. Rev Neurol 35:1019–1024 [In Spanish]PubMedGoogle Scholar
  40. 40.
    Nolan EE, Gadow KD, Sprafkin J (2001) Teacher reports of DSM-IV ADHD, ODD, and CD symptoms in schoolchildren. J Am Acad Child Adolesc Psychiatry 40:241–249PubMedCrossRefGoogle Scholar
  41. 41.
    Pelham WE Jr, Gnagy EM, Greenslade KE, Milich R (1992) Teacher ratings of DSM-III-R symptoms for the disruptive behavior disorders. J Am Acad Child Adolesc Psychiatry 3:210–218CrossRefGoogle Scholar
  42. 42.
    Pineda DA, Lopera F, Palacio JD, Ramirez D, Henao GC (2003) Prevalence estimations of attention-deficit/hyperactivity disorder: differential diagnoses and comorbidities in a Colombian sample. Int J Neurosci 113:49–71PubMedCrossRefGoogle Scholar
  43. 43.
    Reid R, DuPaul GJ, Power TJ, Anastopoulos AD, Rogers-Adkinson D, Noll MB, Riccio C (1998) Assessing culturally different students for attention deficit hyperactivity disorder using behavior rating scales. J Abnorm Child Psychol 26:187–198PubMedCrossRefGoogle Scholar
  44. 44.
    Rohde LA, Biederman J, Busnello EA, Zimmermann H, Schmitz M, Martins S, Tramontina S (1999) ADHD in a school spample of Brazialian adolescents: A study of prevalence, comorbid conditions, and impairments. J Am Acad Child Adolesc Psychiatry 38:716–722PubMedCrossRefGoogle Scholar
  45. 45.
    Rowland AS, Umbach DM, Catoe KE, Stallone L, Long S, Rabiner D, Naftel AJ, Panke D, Faulk R, Sandler DP (2001) Studying the epidemiology of attention-deficit hyperactivity disorder: screening method and pilot results. Can J Psychiatry 46:931–940PubMedGoogle Scholar
  46. 46.
    Scahill L, Schwab-Stone M (2000) Epidemiology of ADHD in school-age children. Child Adolesc Psychiatr Clin N Am 9:541–555PubMedGoogle Scholar
  47. 47.
    Shaffer D, Fisher P, Dulcan MK, Davies M, Piacentini J, Schwab-Stone ME, Lahey BB, Bourdon K, Jensen PS, Bird HR, Canino G, Regier DA (1996) The NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3): description, acceptability, prevalence rates, and performance in the MECA Study. Methods for the Epidemiology of Child and Adolescent Mental Disorders Study. J Am Acad Child Adolesc Psychiatry 35:865–877PubMedCrossRefGoogle Scholar
  48. 48.
    Simonoff E, Pickles A, Meyer JM, Silberg JL, Maes HH, Loeber R, Rutter M, Hewitt JK, Eaves LJ (1997) The Virginia Twin Study of adolescent behavioral development. Influences of age, sex, and impairment on rates of disorder. Arch Gen Psychiatry 54:801–808PubMedGoogle Scholar
  49. 49.
    Skounti M, Philalithis A, Mpitzaraki K, Vamvoukas M, Galanakis E (2006) Attention deficit hyperactivity disorder in schoolchildren in Crete. Acta Paed 95:658–663CrossRefGoogle Scholar
  50. 50.
    Stanger C, Lewis M (1993) Agreement among parents’ teachers and children on internalizing and externalizing behavior problems. J Clin Child Psychol 22:107–115CrossRefGoogle Scholar
  51. 51.
    Sugawara M, Mukai T, Kitamura T, Toda MA, Shima S, Tomoda A, Koizumi T, Watanabe K, Ando A (1999) Psychiatric disorders among Japanese children. J Am Acad Child Adolesc Psychiatry 38:444–452PubMedCrossRefGoogle Scholar
  52. 52.
    Swanson JM, Sergeant JA, Taylor E, Sonuga-Barke EJ, Jensen PS, Cantwell DP (1998) Attention-deficit hyperactivity disorder and hyperkinetic disorder. Lancet 351:429–433PubMedCrossRefGoogle Scholar
  53. 53.
    Verhulst FC, van der Ende J, Ferdinand RF, Kasius MC (1997) The prevalence of DSM-III-R diagnoses in a national sample of Dutch adolescents. Arch Gen Psychiatry 54:329–336PubMedGoogle Scholar
  54. 54.
    Wang YC, Chong MY, Chou WJ, Yang JL (1993) Prevalence of attention deficit hyperactivity disorder in primary school children in Taiwan. J Formos Med Assoc 92:133–138PubMedGoogle Scholar
  55. 55.
    WHO (1993) The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines 1992; diagnostic criteria for research 1993. WHO, GenevaGoogle Scholar
  56. 56.
    Wolraich ML, Hannah JN, Baumgaertel A, Feurer ID (1998) Examination of DSM-IV criteria for attention deficit/hyperactivity disorder in a county-wide sample. J Dev Behav Pediatr 19:162–168PubMedCrossRefGoogle Scholar
  57. 57.
    Wolraich ML, Hannah JN, Pinnock TY, Baumgaertel A, Brown J (1996) Comparison of diagnostic criteria for attention-deficit hyperactivity disorder in a county-wide sample. J Am Acad Child Adolesc Psychiatry 35:319–324PubMedCrossRefGoogle Scholar
  58. 58.
    Zohar AH, Ratzoni G, Pauls DL, Apter A, Bleich A, Kron S, Rappaport M, Weizman A, Cohen DJ (1992) An epidemiological study of obsessive-compulsive disorder and related disorders in Israeli adolescents. J Am Acad Child Adolesc Psychiatry 31:1057–1061PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Maria Skounti
    • 1
  • Anastas Philalithis
    • 2
  • Emmanouil Galanakis
    • 1
    Email author
  1. 1.Department of PaediatricsUniversity of CreteHeraklionGreece
  2. 2.Department of Social MedicineUniversity of CreteHeraklionGreece

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