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The Prevalence of DSM-IV Attention-Deficit/Hyperactivity Disorder: A Meta-Analytic Review

Abstract

This article describes a comprehensive meta-analysis that was conducted to estimate the prevalence of attention-deficit/hyperactivity disorder (ADHD), as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). A systematic literature review identified 86 studies of children and adolescents (N = 163,688 individuals) and 11 studies of adults (N = 14,112 individuals) that met inclusion criteria for the meta-analysis, more than half of which were published after the only previous meta-analysis of the prevalence of ADHD was completed. Although prevalence estimates reported by individual studies varied widely, pooled results suggest that the prevalence of DSM-IV ADHD is similar, whether ADHD is defined by parent ratings, teacher ratings, or a best estimate diagnostic procedure in children and adolescents (5.9–7.1 %), or by self-report measures in young adults (5.0 %). Analyses of diagnostic subtypes indicated that the predominantly inattentive type is the most common subtype in the population, but individuals with the combined type are more likely to be referred for clinical services. Additional research is needed to determine the etiology of the higher prevalence of ADHD in males than females and to clarify whether the prevalence of ADHD varies as a function of socioeconomic status or ethnicity. Finally, there were no significant prevalent differences between countries or regions of the world after controlling for differences in the diagnostic algorithms used to define ADHD. These results provide important support for the diagnostic validity of ADHD, and argue against the hypothesis that ADHD is a cultural construct that is restricted to the United States or any other specific culture.

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Acknowledgments

The author was supported during the preparation of this manuscript by National Institutes of Health (NIH) grants R01 HD 68728, HD 47264, R01 MH 63207, P50 HD 27802, P50 MH 79485, R01 DA 24002, R01 MH 63941, and R01 MH 62120. Dr. Willcutt is a consultant to the DSM-5 ADHD and Disruptive Behavior Disorders Work Group, and the current review is an extension of a comprehensive meta-analysis of the validity of DSM-IV ADHD symptom dimensions and subtypes that the author completed with several members of the work group and additional co-authors [3]. The author thanks the co-authors of the larger meta-analysis (Joel Nigg, Bruce Pennington, Rosemary Tannock, Mary Solanto, Luis Rohde, Keith McBurnett, Caryn Carlson, Sandra Loo, and Ben Lahey) for input on the current review and constructive feedback on earlier versions of this article. The opinions expressed in this article are those of the author alone, and do not reflect official positions of the American Psychiatric Association or the DSM-5 Workgroup.

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The author of this work has no real or perceived conflict of interest.

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Correspondence to Erik G. Willcutt.

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Willcutt, E.G. The Prevalence of DSM-IV Attention-Deficit/Hyperactivity Disorder: A Meta-Analytic Review. Neurotherapeutics 9, 490–499 (2012). https://doi.org/10.1007/s13311-012-0135-8

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Keywords

  • ADHD
  • Prevalence
  • DSM-IV
  • Subtypes
  • Diagnosis