NCHS Data Brief ■ No. 269 ■ January 2017

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Physician Office Visits for Attention-deficit/Hyperactivity 

Disorder in Children and Adolescents Aged 4–17 Years: 

United States, 2012–2013

Michael Albert, M.D., M.P.H., Pinyao Rui, M.P.H., and Jill J. Ashman, Ph.D.

Key findings 

Data from the National 

Ambulatory Medical Care 

Survey

● During 2012–2013, an 

estimated annual average of 

6.1 million physician office 

visits were made by children 

aged 4–17 years with a primary 

diagnosis of attention-deficit/

hyperactivity disorder (ADHD). 

● The ADHD visit rate among 

children aged 4–17 years was 

more than twice as high for 

boys (147 per 1,000 boys) as 

for girls (62 per 1,000 girls).

● Central nervous system 

stimulant medications were 

provided, prescribed, or 

continued at about 80% of 

ADHD visits among children 

aged 4–17 years. 

● Among ADHD visits by 

children aged 4–17 years, 29% 

included a diagnostic code for 

an additional mental health 

disorder.

● A total of 48% of visits for 

ADHD by children aged 4–17 

years were with pediatricians, 

36% were with psychiatrists, 

and 12% were with general and 

family practitioners.

Attention-deficit/hyperactivity disorder (ADHD) is one of the most 

commonly diagnosed neurobehavioral disorders of childhood (1–3). ADHD 

is characterized clinically by inattention and/or hyperactivity-impulsivity that 

interferes with functioning or development (4). This report describes the rate 

and characteristics of physician office visits by children aged 4–17 years with 

a primary diagnosis of ADHD. Four years of age was chosen as the lower limit 

because the American Academy of Pediatrics guidelines for the diagnosis and 

treatment of ADHD begin at this age (5).

Keywords: ADHD • National Ambulatory Medical Care Survey

Did the ADHD visit rate vary by sex and age? 

● The visit rate for ADHD was 105 per 1,000 children aged 4–17 years, 

and was similar for children aged 4–12 years and 13–17 years: 108 per 

1,000 children and 99 per 1,000 children, respectively (Figure 1).

Figure 1. Rate of physician office visits for attention-deficit/hyperactivity disorder among children 

aged 4–17 years, by sex: United States, 2012–2013

1

The visit rate for boys is significantly different (p < 0.05) from the rate for girls, based on a two-tailed t test.

NOTES: Estimates are based on 2-year averages. Attention deficit/hyperactivity visits have a principal diagnostic code of 

ICD–9–CM 314.00 or 314.01. Visit rates are based on the July 1, 2012, and July 1, 2013, set of estimates of the civilian 

noninstitutionalized population of the United States, as developed by the Population Division, U.S. Census Bureau. Access data 

table for Figure 1 at: http://www.cdc.gov/nchs/data/databriefs/db269_table.pdf#1.

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2012–2013.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
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● The visit rate for ADHD was higher for boys than for girls among children aged 4–17 years 

(147 per 1,000 boys compared with 62 per 1,000 girls).The difference was observed within 

both age groups evaluated: for children aged 4–12 years (156 per 1,000 boys compared with 

59 per 1,000 girls) and for children aged 13–17 years (130 per 1,000 boys compared with 67 

per 1,000 girls). 

How frequently were central nervous system (CNS) stimulant medications 

provided, prescribed, or continued at ADHD visits, and did this vary by 

age?

● CNS stimulant medications were mentioned (i.e., provided, prescribed, or continued) at 80% 

of ADHD visits by children aged 4–12 years and 81% of ADHD visits by children aged 

13–17 years (Figure 2). 

● Methylphenidate or dexmethylphenidate was mentioned more frequently than the drug 

combination of amphetamine-dextroamphetamine at ADHD visits both for children aged 

4–12 years (48% compared with 13%) and for those aged 13–17 years (46% compared with 

14%). 

● No significant difference was observed in the mention of CNS stimulants for those aged 

4–12 years compared with those aged 13–17 years.

Figure 2. Percentage of physician office visits for attention-deficit/hyperactivity disorder with mention of one or more

central nervous system stimulants among children aged 4–17 years: United States, 2012–2013

1

Percentage of methylphenidate or dexmethylphenidate mentions is significantly different (p < 0.05) from mentions of amphetamine-dextroamphetamine, based 

on a two-tailed t test.

NOTES: CNS is central nervous system. Estimates are based on 2-year averages. Attention-deficit/hyperactivity disorder visits have a principal diagnostic code of 

ICD–9–CM 314.00 or 314.01. A CNS stimulant mention is documentation in a patient’s medical record of a CNS stimulant provided, prescribed, or continued at a 

visit (information for up to 10 drugs collected per visit). Drug categories are based on the Cerner Multum Lexicon (https://www.cerner.com/cerner_multum/). 

Access data table for Figure 2 at: http://www.cdc.gov/nchs/data/databriefs/db269_table.pdf#2.

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2012–2013. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
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What percentage of ADHD visits had an additional mental health disorder 

as a second- or third-listed ICD diagnosis?

● A total of 29% of ADHD visits by children and adolescents aged 4–17 had an additional 

mental health disorder as a second- or third-listed ICD diagnosis (Figure 3). 

● Additional mental health disorders included episodic mood disorder (7%); anxiety, 

dissociative, and somatoform disorder (7%); and disturbance of emotions specific to 

childhood and adolescence (4%).

Figure 3. Percentage of physician office visits for attention-deficit/hyperactivity disorder with an additional diagnosis of a 

mental health disorder among children aged 4–17 years: United States, 2012–2013

* Estimate does not meet standards of reliability or precision because it has a relative standard error of greater than 30%.

NOTES: Estimates are based on 2-year averages. Attention-deficit/hyperactivity disorder visits have a principal diagnostic code of ICD–9–CM 314.00 or 314.01. 

Additional mental health disorder is defined as the second- or third-listed ICD diagnosis with an ICD–9–CM code of 290–313.9 or 314.1–319. More than one 

disorder may be reported per visit. Only diagnoses with 30 visits or more are shown; these diagnoses are also included in “Any additional mental health disorder.” 

Access data table for Figure 3 at: http://www.cdc.gov/nchs/data/databriefs/db269_table.pdf#3.

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2012–2013.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
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What was the specialty of the physician providing care at ADHD visits?

● At 48% of ADHD visits by children aged 4–17 years, a pediatrician provided care and at 

36% of visits a psychiatrist provided care (Figure 4). 

● At ADHD visits by children aged 4–17 years, pediatricians and psychiatrists were more 

frequently seen compared with general and family medicine physicians (12%).

Figure 4. Percentage of physician office visits for attention-deficit/hyperactivity disorder among children aged 4–17 years, 

by physician specialty: United States, 2012–2013

* Estimate does not meet standards of reliability or precision because it has a relative standard error of greater than 30%.

1

Significantly different (p < 0.05) from the percentage of visits to general and family medicine, based on a two-tailed t test. 

NOTES: Estimates are based on 2-year averages. Attention-deficit/hyperactivity disorder visits have a principal diagnostic code of ICD–9–CM 314.00 or 314.01. 

Access data table for Figure 4 at: http://www.cdc.gov/nchs/data/databriefs/db269_table.pdf#4.

SOURCE: NCHS, National Ambulatory Medical Care Survey, 2012–2013.

 

 

 

 

 

 
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Summary

Health care utilization related to ADHD is of interest because the prevalence of parent-reported 

ADHD diagnosis among U.S. children and adolescents has increased in recent years (3,6,7). In 

addition, stimulant medications are commonly used to treat patients with ADHD, and public 

health monitoring of this practice has been recommended (3,7). This analysis indicated that 

during 2012–2013, an annual average of 6.1 million physician office visits in the United States 

were made by children and adolescents aged 4–17 years with a primary diagnosis of ADHD. This 

corresponded to a visit rate of 105 per 1,000 children. ADHD visit rates were higher for boys 

than girls among children aged 4–17 years and in the two age groups of 4–12 years and 13–17 

years. Treatment with CNS stimulant medications such as methylphenidate or amphetaminedextroamphetamine was common for ADHD visits, with these medicines provided, prescribed, 

or continued in about 80% of visits among both children aged 4–12 years and those aged 13–17 

years. More than one-quarter of ADHD visits among children aged 4–17 years had an additional 

mental health disorder listed as a second- or third-listed ICD diagnosis. Pediatricians (48%) and 

psychiatrists (36%) provided most of the care at ADHD visits by children aged 4–17 years, with 

12% of the care being provided by general and family medicine physicians.

Definitions

Attention-deficit/hyperactivity disorder (ADHD) visit: A visit with ADHD as the principal or 

first-listed diagnosis using the International Classification of Diseases, Ninth Revision, Clinical 

Modification (ICD–9–CM) codes of 314.00 or 314.01 (8).

Additional mental health disorder: This includes all visits with a second- or third-listed

ICD–9–CM diagnosis code from 290–319 (excluding 314.00 or 314.01 [ADHD]). Selected 

disorders and corresponding ICD–9–CM codes shown in Figure 3 include the following: episodic 

mood disorder (296); anxiety, dissociative, and somatoform disorder (300); and disturbance of 

emotions specific to childhood and adolescence (313) (8).

CNS stimulant mention: Documentation in a patient’s medical record of a CNS stimulant 

provided, prescribed, or continued. Information for up to 10 drugs is collected for each visit. Drug 

categories are based on the Cerner Multum Lexicon (https://www.cerner.com/cerner_multum/). 

Data source and methods

Data for this analysis are from the 2012–2013 National Ambulatory Medical Care Survey 

(NAMCS), which is conducted annually by the National Center for Health Statistics (NCHS). 

NAMCS is a national probability sample survey of nonfederal office-based physicians. NAMCS 

uses multistage probability sampling designs. Detailed information on the methodology of 

NAMCS, including changes to the survey that began in 2012, is available elsewhere (9,10). 
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In NAMCS for 2012–2013, a sample was made of 946 visits by children aged 4–17 years with a 

primary diagnosis of ADHD. Data were imputed for patient age (1.0%) and sex (2.3%). NCHS 

considers an estimate to be reliable if it is based on at least 30 visits and has a relative standard 

error of 30% or less (9). Estimates with an asterisk in Figures 3 and 4 have a relative standard 

error exceeding 30%. Mental health disorders with fewer than 30 visits are not shown in Figure 3. 

Data analyses were performed using the statistical packages SAS version 9.4 (SAS Institute, Cary, 

N.C.) and SAS-callable SUDAAN version 11.0 (RTI International, Research Triangle Park, N.C.). 

Differences among subgroups were evaluated using a two-tailed t test (p < 0.05). 

About the authors

Michael Albert and Jill J. Ashman are with the National Center for Health Statistics, Division of 

Health Care Statistics, Ambulatory and Hospital Care Statistics Branch. Pinyao Rui is with

Karna, LLC.

References

1. CDC. Attention-deficit/hyperactivity disorder (ADHD): Facts about ADHD. Available from: 

http://www.cdc.gov/ncbddd/adhd/facts.html. 

2. Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, et al. Lifetime 

prevalence of mental disorders in U.S. adolescents: Results from the National Comorbidity 

Survey Replication–Adolescent Supplement (NCS–A). J Am Acad Child Adolesc Psychiatry 

49(10):980–9. 2010.

3. Visser SN, Danielson ML, Bitsko RH, Holbrook JR, Kogan MD, Ghandour RM, et al. 

Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/

hyperactivity disorder: United States, 2003–2011. J Am Acad Child Adolesc Psychiatry

53(1):34–46. 2014.

4. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. 

Washington, DC. 2013. 

5. Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality 

Improvement and Management; Wolraich M; Brown L; Brown RT; DuPaul G; Earls M; et al. 

ADHD: Clinical practice guideline for the diagnosis, evaluation, and treatment of attentiondeficit/hyperactivity disorder in children and adolescents. Pediatrics 128(5):1007–22. 2011.

6. Akinbami LJ, Liu X, Pastor PN, Reuben CA. Attention deficit hyperactivity disorder among 

children aged 5–17 years in the United States, 1998–2009. NCHS data brief, no 70. Hyattsville, 

MD: National Center for Health Statistics. 2011.

7. Visser SN, Zablotsky B, Holbrook JR, et al. Diagnostic experiences of children with 

attention-deficit/hyperactivity disorder. National health statistics reports; no 81. Hyattsville, MD: 

National Center for Health Statistics. 2015.

8. Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services. 

International classification of diseases, ninth revision, clinical modification. 6th ed. DHHS Pub 

No. (PHS) 11–1260. 2011. Available from: http://www.cdc.gov/nchs/icd/icd9cm.htm.
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9. National Center for Health Statistics. 2012 NAMCS micro-data file documentation. 

Hyattsville, MD. 2015.

10. National Center for Health Statistics. 2013 NAMCS micro-data file documentation. 

Hyattsville, MD. 2016.
NCHS Data Brief ■ No. 269 ■ January 2017

Suggested citation

Albert M, Rui P, Ashman JJ. Physician 

office visits for attention-deficit/

hyperactivity disorder in children and 

adolescents aged 4–17 years: United States, 

2012–2013. NCHS data brief, no 269. 

Hyattsville, MD: National Center for Health 

Statistics. 2017.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health Care Statistics

Denys T. Lau, Ph.D., Acting Director

Alexander Strashny, Ph.D., Associate 

Director for Science

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