National Trends in Severe ADHD and Treatment Among U.S. Children, 2016-2024.

Objectives

While Attention Deficit Hyperactivity Disorder (ADHD) prevalence is increasing in the United States, the trend of severe ADHD remains unclear. We aimed to examine national trends and characteristics of children with severe ADHD and the treatment among these children through 2024.

Methods

We analyzed 2016-2024 National Survey of Children's Health (NSCH) data (N=326,999) for children aged 3-17 years. Outcomes included current ADHD diagnosis, severity of ADHD, and treatment among severe cases. Trends were assessed using Joinpoint regression. Multivariable log-binomial regression estimated adjusted prevalence ratios (aPRs) comparing post-COVID-19 (2023-2024) with pre-COVID-19 (2016-2019) periods.

Results

ADHD prevalence increased significantly from 8.8% to 11.6% with significant change found between 2019 and 2024 (Annual Percentage Change, APC=6.0%, P=0.001), while severe ADHD remained stable across the period (1.3%-1.8%; P>0.05). Notably, severe ADHD prevalence exceeded 2.0% among non-Hispanic Black children, those from households with below-national income, and children with public insurance. Despite stable burden of severe ADHD, treatment in this group declined significantly: any treatment decreased from 93.1% to 88.8% (APC=-0.6, P=0.017), and medication use from 81.5% to 73.3% (APC=-1.6%, P=0.032). Compared with the pre-pandemic period, children in 2023-2024 were less likely to receive treatment (aPR=0.45; 95% CI, 0.28-0.84), with the largest declines among low-income households (aPR=0.37; 95% CI, 0.16-0.88) and those with lower parental education (aPR=0.08; 95% CI, 0.02-0.30).

Conclusions

These findings highlight a widening gap between stable high-need ADHD burden and declining treatment prevalence, particularly among socioeconomically disadvantaged children, suggesting growing inequities in access to care for severe ADHD.