The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication.
01 Apr 2006-American Journal of Psychiatry (American Psychiatric Association)-Vol. 163, Iss: 4, pp 716-723
TL;DR: Efforts are needed to increase the detection and treatment of adult ADHD and research is needed to determine whether effective treatment would reduce the onset, persistence, and severity of disorders that co-occur with adult ADHD.
Abstract: Objective: Despite growing interest in adult attention deficit hyperactivity disorder (ADHD), little is known about its prevalence or correlates. Method: A screen for adult ADHD was included in a probability subsample (N=3,199) of 18–44-year-old respondents in the National Comorbidity Survey Replication, a nationally representative household survey that used a lay-administered diagnostic interview to assess a wide range of DSM-IV disorders. Blinded clinical follow-up interviews of adult ADHD were carried out with 154 respondents, oversampling those with positive screen results. Multiple imputation was used to estimate prevalence and correlates of clinician-assessed adult ADHD. Results: The estimated prevalence of current adult ADHD was 4.4%. Significant correlates included being male, previously married, unemployed, and non-Hispanic white. Adult ADHD was highly comorbid with many other DSM-IV disorders assessed in the survey and was associated with substantial role impairment. The majority of cases were u...
Citations
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TL;DR: It is concluded that multiple Imputation for Nonresponse in Surveys should be considered as a legitimate method for answering the question of why people do not respond to survey questions.
Abstract: 25. Multiple Imputation for Nonresponse in Surveys. By D. B. Rubin. ISBN 0 471 08705 X. Wiley, Chichester, 1987. 258 pp. £30.25.
3,216 citations
TL;DR: Family, twin, and adoption studies provide compelling evidence that genes play a strong role in mediating susceptibility to ADHD, and seven genes for which the same variant has been studied in three or more case-control or family-based studies show statistically significant evidence of association with ADHD.
2,087 citations
TL;DR: In this article, a comprehensive meta-analysis 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).
1,646 citations
Cites background from "The prevalence and correlates of ad..."
...In fact, in 1 of these studies [26] and in a study of adult ADHD based on retrospective ratings [34], it was found that non-Hispanic-White individuals were more likely to meet criteria for ADHD than Hispanic individuals....
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TL;DR: Prevalence of ADHD in adults declines with age in the general population and the unclear validity of DSM–IV diagnostic criteria for this condition can lead to reduced prevalence rates by underestimation of the prevalence of adult ADHD.
Abstract: Background In spite of the growing literature about adult attention-deficit hyperactivity disorder (ADHD), relatively little is known about the prevalence and correlates of this disorder. Aims To estimate the prevalence of adult ADHD and to identify its demographic correlates using meta-regression analysis. Method We used the MEDLINE, PsycLit and EMBASE databases as well as hand-searching to find relevant publications. Results The pooled prevalence of adult ADHD was 2.5% (95% CI 2.1–3.1). Gender and mean age, interacting with each other, were significantly related to prevalence of ADHD. Metaregression analysis indicated that the proportion of participants with ADHD decreased with age when men and women were equally represented in the sample. Conclusions Prevalence of ADHD in adults declines with age in the general population. We think, however, that the unclear validity of DSM–IV diagnostic criteria for this condition can lead to reduced prevalence rates by underestimation of the prevalence of adult ADHD.
1,257 citations
TL;DR: Estimates of ADHD prevalence and correlates in the World Health Organization World Mental Health Survey Initiative should be considered more seriously in future epidemiological and clinical studies than is currently the case.
Abstract: Background Little is known about the epidemiology of adult attention-deficit hyperactivity disorder (ADHD). Aims To estimate the prevalence and correlates of DSM-IV adult ADHD in the World Health Organization World Mental Health Survey Initiative. Method An ADHD screen was administered to respondents aged 18-44 years in ten countries in the Americas, Europe and the Middle East (n=11422). Masked clinical reappraisal interviews were administered to 154 US respondents to calibrate the screen. Multiple imputation was used to estimate prevalence and correlates based on the assumption of cross-national calibration comparability. Results Estimates of ADHD prevalence averaged 3.4% (range 1.2-7.3%), with lower prevalence in lower-income countries (1.9%) compared with higher-income countries (4.2%). Adult ADHD often co-occurs with other DSM-IV disorders and is associated with considerable role disability. Few cases are treated for ADHD, but in many cases treatment is given for comorbid disorders. Conclusions Adult ADHD should be considered more seriously in future epidemiological and clinical studies than is currently the case.
1,219 citations
References
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TL;DR: Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups.
Abstract: Context Little is known about lifetime prevalence or age of onset of DSM-IV disorders. Objective To estimate lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the recently completed National Comorbidity Survey Replication. Design and Setting Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview. Participants Nine thousand two hundred eighty-two English-speaking respondents aged 18 years and older. Main Outcome Measures Lifetime DSM-IV anxiety, mood, impulse-control, and substance use disorders. Results Lifetime prevalence estimates are as follows: anxiety disorders, 28.8%; mood disorders, 20.8%; impulse-control disorders, 24.8%; substance use disorders, 14.6%; any disorder, 46.4%. Median age of onset is much earlier for anxiety (11 years) and impulse-control (11 years) disorders than for substance use (20 years) and mood (30 years) disorders. Half of all lifetime cases start by age 14 years and three fourths by age 24 years. Later onsets are mostly of comorbid conditions, with estimated lifetime risk of any disorder at age 75 years (50.8%) only slightly higher than observed lifetime prevalence (46.4%). Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups. Conclusions About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth.
17,213 citations
Book•
01 Jan 1987
TL;DR: In this article, a survey of drinking behavior among men of retirement age was conducted and the results showed that the majority of the participants reported that they did not receive any benefits from the Social Security Administration.
Abstract: Tables and Figures. Glossary. 1. Introduction. 1.1 Overview. 1.2 Examples of Surveys with Nonresponse. 1.3 Properly Handling Nonresponse. 1.4 Single Imputation. 1.5 Multiple Imputation. 1.6 Numerical Example Using Multiple Imputation. 1.7 Guidance for the Reader. 2. Statistical Background. 2.1 Introduction. 2.2 Variables in the Finite Population. 2.3 Probability Distributions and Related Calculations. 2.4 Probability Specifications for Indicator Variables. 2.5 Probability Specifications for (X,Y). 2.6 Bayesian Inference for a Population Quality. 2.7 Interval Estimation. 2.8 Bayesian Procedures for Constructing Interval Estimates, Including Significance Levels and Point Estimates. 2.9 Evaluating the Performance of Procedures. 2.10 Similarity of Bayesian and Randomization--Based Inferences in Many Practical Cases. 3. Underlying Bayesian Theory. 3.1 Introduction and Summary of Repeated--Imputation Inferences. 3.2 Key Results for Analysis When the Multiple Imputations are Repeated Draws from the Posterior Distribution of the Missing Values. 3.3 Inference for Scalar Estimands from a Modest Number of Repeated Completed--Data Means and Variances. 3.4 Significance Levels for Multicomponent Estimands from a Modest Number of Repeated Completed--Data Means and Variance--Covariance Matrices. 3.5 Significance Levels from Repeated Completed--Data Significance Levels. 3.6 Relating the Completed--Data and Completed--Data Posterior Distributions When the Sampling Mechanism is Ignorable. 4. Randomization--Based Evaluations. 4.1 Introduction. 4.2 General Conditions for the Randomization--Validity of Infinite--m Repeated--Imputation Inferences. 4.3Examples of Proper and Improper Imputation Methods in a Simple Case with Ignorable Nonresponse. 4.4 Further Discussion of Proper Imputation Methods. 4.5 The Asymptotic Distibution of (Qm,Um,Bm) for Proper Imputation Methods. 4.6 Evaluations of Finite--m Inferences with Scalar Estimands. 4.7 Evaluation of Significance Levels from the Moment--Based Statistics Dm and Dm with Multicomponent Estimands. 4.8 Evaluation of Significance Levels Based on Repeated Significance Levels. 5. Procedures with Ignorable Nonresponse. 5.1 Introduction. 5.2 Creating Imputed Values under an Explicit Model. 5.3 Some Explicit Imputation Models with Univariate YI and Covariates. 5.4 Monotone Patterns of Missingness in Multivariate YI. 5.5 Missing Social Security Benefits in the Current Population Survey. 5.6 Beyond Monotone Missingness. 6. Procedures with Nonignorable Nonresponse. 6.1 Introduction. 6.2 Nonignorable Nonresponse with Univariate YI and No XI. 6.3 Formal Tasks with Nonignorable Nonresponse. 6.4 Illustrating Mixture Modeling Using Educational Testing Service Data. 6.5 Illustrating Selection Modeling Using CPS Data. 6.6 Extensions to Surveys with Follow--Ups. 6.7 Follow--Up Response in a Survey of Drinking Behavior Among Men of Retirement Age. References. Author Index. Subject Index. Appendix I. Report Written for the Social Security Administration in 1977. Appendix II. Report Written for the Census Bureau in 1983.
14,574 citations
TL;DR: The prevalence of psychiatric disorders is greater than previously thought to be the case, and morbidity is more highly concentrated than previously recognized in roughly one sixth of the population who have a history of three or more comorbid disorders.
Abstract: Background: This study presents estimates of lifetime and 12-month prevalence of 14 DSM-III-R psychiatric disorders from the National Comorbidity Survey, the first survey to administer a structured psychiatric interview to a national probability sample in the United States. Methods: The DSM-III-R psychiatric disorders among persons aged 15 to 54 years in the noninstitutionalized civilian population of the United States were assessed with data collected by lay interviewers using a revised version of the Composite International Diagnostic Interview. Results: Nearly 50% of respondents reported at least one lifetime disorder, and close to 30% reported at least one 12-month disorder. The most common disorders were major depressive episode, alcohol dependence, social phobia, and simple phobia. More than half of all lifetime disorders occurred in the 14% of the population who had a history of three or more comorbid disorders. These highly comorbid people also included the vast majority of people with severe disorders. Less than 40% of those with a lifetime disorder had ever received professional treatment, and less than 20% of those with a recent disorder had been in treatment during the past 12 months. Consistent with previous risk factor research, it was found that women had elevated rates of affective disorders and anxiety disorders, that men had elevated rates of substance use disorders and antisocial personality disorder, and that most disorders declined with age and with higher socioeconomic status. Conclusions: The prevalence of psychiatric disorders is greater than previously thought to be the case. Furthermore, this morbidity is more highly concentrated than previously recognized in roughly one sixth of the population who have a history of three or more comorbid disorders. This suggests that the causes and consequences of high comorbidity should be the focus of research attention. The majority of people with psychiatric disorders fail to obtain professional treatment. Even among people with a lifetime history of three or more comorbid disorders, the proportion who ever obtain specialty sector mental health treatment is less than 50%. These results argue for the importance of more outreach and more research on barriers to professional help-seeking.
11,648 citations
"The prevalence and correlates of ad..." refers background or methods in this paper
...In order to obtain more accurate estimates of prevalence and correlates, an adult ADHD screen was included in the National Comorbidity Survey Replication (NCS-R) (14) and clinical reappraisal interviews were carried out with screened positives....
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...The US National Comorbidity Survey Replication (NCS-R): design and field procedures....
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...Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R)....
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...As an indication of this neglect, adult ADHD was not included in either major US psychiatric epidemiological survey of the past two decades, the Epidemiologic Catchment Area Study (6) and the National Comorbidity Survey (7)....
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...Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen H-U, Kendler KS. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: Results from the National Comorbidity Survey....
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TL;DR: A theoretical model that links inhibition to 4 executive neuropsychological functions that appear to depend on it for their effective execution is constructed and finds it to be strongest for deficits in behavioral inhibition, working memory, regulation of motivation, and motor control in those with ADHD.
Abstract: Attention deficit hyperactivity disorder (ADHD) comprises a deficit in behavioral inhibition. A theoretical model is constructed that links inhibition to 4 executive neuropsychological functions that appear to depend on it for their effective execution: (a) working memory, (b) self-regulation of affect-motivation-arousal, (c) internalization of speech, and (d) reconstitution (behavioral analysis and synthesis). Extended to ADHD, the model predicts that ADHD should be associated with secondary impairments in these 4 executive abilities and the motor control they afford. The author reviews evidence for each of these domains of functioning and finds it to be strongest for deficits in behavioral inhibition, working memory, regulation of motivation, and motor control in those with ADHD. Although the model is promising as a potential theory of self-control and ADHD, far more research is required to evaluate its merits and the many predictions it makes about ADHD.
6,958 citations
TL;DR: An overview of the World Mental Health Survey Initiative version of the WHO Composite International Diagnostic Interview (CIDI) is presented and a discussion of the methodological research on which the development of the instrument was based is discussed.
Abstract: This paper presents an overview of the World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) and a discussion of the methodological research on which the development of the instrument was based. The WMH-CIDI includes a screening module and 40 sections that focus on diagnoses (22 sections), functioning (four sections), treatment (two sections), risk factors (four sections), socio-demographic correlates (seven sections), and methodological factors (two sections). Innovations compared to earlier versions of the CIDI include expansion of the diagnostic sections, a focus on 12-month as well as lifetime disorders in the same interview, detailed assessment of clinical severity, and inclusion of information on treatment, risk factors, and consequences. A computer-assisted version of the interview is available along with a direct data entry software system that can be used to keypunch responses to the paper-and-pencil version of the interview. Computer programs that generate diagnoses are also available based on both ICD-10 and DSM-IV criteria. Elaborate CD-ROM-based training materials are available to teach interviewers how to administer the interview as well as to teach supervisors how to monitor the quality of data collection.
4,232 citations
"The prevalence and correlates of ad..." refers background in this paper
...0 (23), a fully structured lay-administered diagnostic interview....
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