Diagnosed Attention Deficit

Hyperactivity Disorder and

Learning Disability:

United States, 2004–2006

2008 July 237 Number 10, iesSer
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Suggested citation

Pastor PN, Reuben CA. Diagnosed attention deficit hyperactivity disorder and

learning disability: United States, 2004–2006. National Center for Health

Statistics. Vital Health Stat 10(237). 2008.

Library of Congress Cataloging-in-Publication Data

Pastor, Patricia N.

Diagnosed attention deficit hyperactivity disorder and learning disability,

United States, 2004–2006 : data from the National Health Interview Survey.

p. ; cm.— (DHHS publication; no. (PHS) 2008-1565) (Vital and health

statistics ; series 10, no. 237)

‘‘July 2008.’’

By Patricia N. Pastor and Cynthia A. Reuben.
 

Includes bibliographical references.
 

ISBN-13: 978-0-8406-0623-5
 

ISBN-10: 0-8406-0623-5
 

1. Attention-deficit-disordered children—United States. 2. Learning disabled

children–United States. 3. Learning disabilities—United States. I. Reuben,

Cynthia A. II. National Health Interview Survey (U.S.) III. National Center for

Health Statistics (U.S.) IV. Title. V. Series. VI. Series: Vital and health statistics.

Series 10, Data from the National Health Survey ; no. 237. [DNLM: 1. Attention

Deficit Disorder with Hyperactivity—epidemiology—United States. 2. Child—

United States. 3. Learning Disorders—epidemiology—United States. W2

A N148vj no. 237 2008

RJ506.H9P387 2008]

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2008018192

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Printed on acid-free paper.
Series 10, Number 237

Diagnosed Attention Deficit

Hyperactivity Disorder and

Learning Disability:

United States, 2004–2006

Data From the National Health

Interview Survey

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Hyattsville, Maryland

July 2008

DHHS Publication No. (PHS) 2008–1565
National Center for Health Statistics

Edward J. Sondik, Ph.D., Director

Jennifer H. Madans, Ph.D., Acting Co-Deputy Director

Michael H. Sadagursky, Acting Co-Deputy Director

Jennifer H. Madans, Ph.D., Associate Director for Science

Jennifer H. Madans, Ph.D., Acting Associate Director for

Planning, Budget, and Legislation

Michael H. Sadagursky, Associate Director for

Management and Operations

Lawrence H. Cox, Ph.D., Associate Director for Research

and Methodology

Linda B. Torian, Acting Director for Information Technology

Linda B. Torian, Acting Director for Information Services

Linda T. Bilheimer, Ph.D., Associate Director for Analysis

and Epidemiology

Charles J. Rothwell, M.S., Director for Vital Statistics

Jane E. Sisk, Ph.D., Director for Health Care Statistics

Jane F. Gentleman, Ph.D., Director for Health Interview

Statistics

Clifford L. Johnson, M.S.P.H., Director for Health and

Nutrition Examination Surveys

Office of Analysis and Epidemiology

Linda T. Bilheimer, Ph.D., Director

Diane Makuc, Dr.P.H., Associate Director for Science

Pauline Mendola, Ph.D., Chief, Infant, Child and

Women’s Health Statistics Branch
Contents
 

Abstract .................................................................................................. 1 
 

Highlights ................................................................................................ 1 
 

Prevalence .............................................................................................. 1 
 

Other Health Conditions .................................................................................. 1 
 

Use of Health Care and Educational Services ................................................................. 1 
 

Introduction .............................................................................................. 1 
 

Data and Methods ......................................................................................... 2 
 

Survey Procedures ....................................................................................... 2 
 

Measurement of Diagnosed ADHD and LD ................................................................... 2 
 

Results .................................................................................................. 3 
 

Trends in Diagnosed ADHD and LD, 1997–2006 .............................................................. 3 
 

Prevalence of Diagnosed ADHD and LD by Selected Sociodemographic Characteristics, 2004–2006 .................... 3 
 

Discussion ................................................................................................ 5 
 

Prevalence of Diagnosed ADHD and LD ..................................................................... 5 
 

Factors Associated with Diagnosed ADHD and LD ............................................................ 7 
 

Health Conditions and Service Use .......................................................................... 8 
 

Study Limitations ........................................................................................ 8 
 

Conclusion ............................................................................................. 9 
 

References ............................................................................................... 9 
 

Appendix I .............................................................................................. 14 
 

Technical Notes ........................................................................................ 14 
 

Text Figures

1.	 

2.	 

3.	 

4.	 

5.	 

6.	 

7.	 

8.	 

9.	 

All diagnoses of ADHD and learning disability (LD) among children 6–17 years of age: United States, 1997–2006 .... 3 
 

All diagnoses of ADHD among children 6–17 years of age, by sex: United States, 1997–2006 ..................... 4 
 

All diagnoses of ADHD among children 6–17 years of age, by age group: United States, 1997–2006 ............... 4 
 

ADHD and learning disability (LD) among children 6–17 years of age, by sex: United States, 2004–2006 ........... 5 
 

ADHD and learning disability (LD) among children 6–17 years of age, by age group: United States, 2004–2006 ...... 5 
 

ADHD and learning disability (LD) among children 6–17 years of age, by race and ethnicity: United States,
 

2004–2006 ......................................................................................... 6 
 

ADHD and learning disability (LD) among children 6–17 years of age, by insurance coverage
 

at interview: United States, 2004–2006 .................................................................. 6 
 

Mental retardation or other developmental delay and asthma among children 6–17 years of age, by diagnostic group:
 

United States, 2004–2006 ............................................................................. 7 
 

Use of prescription medication and special education among children 6–17 years of age, by diagnostic group:
 

United States, 2004–2006 ............................................................................. 7 
 

iii
Detailed Tables

1.	 

2.	 

3.	 

4.	 

Diagnosed attention deficit hyperactivity disorder (ADHD) and learning disability (LD) among children 6–17 years of
 

age, by selected characterisitics: United States, 2004–2006 ................................................. 10 
 

Diagnosed attention deficit hyperactivity disorder (ADHD) and learning disability (LD) among children 6–17 years of
 

age, by sex, age group, and selected characteristics: United States, 2004–2006 ................................. 11 
 

Selected health conditions among children 6–17 years of age, by diagnostic group, sex, and age group: United States,
 

2004–2006 ........................................................................................ 12 
 

Use of selected educational and health care services among children 6–17 years of age, by diagnostic group, sex, and
 

age group: United States, 2004–2006 ................................................................... 13 
 

iv
Objectives

This report presents national

estimates of the prevalence of

diagnosed attention deficit hyperactivity

disorder (ADHD) and learning disability

(LD) in U.S. children 6–17 years of age

and describes the prevalence of these

conditions for children with selected

characteristics. The use of educational

and health care services and the

prevalence of other health conditions

are contrasted for children with ADHD

without LD, LD without ADHD, both

conditions, and neither condition.

Methods

Estimates are based on data from

the National Health Interview Survey

(NHIS), an ongoing national household

survey of the civilian noninstitutionalized

population of the United States. The

analysis focuses on 23,051 children

6–17 years of age in the child sample

of the 2004, 2005, and 2006 NHIS.

Results

About 5% of children had ADHD

without LD, 5% had LD without ADHD,

and 4% had both conditions. Boys were

more likely than girls to have each of

the diagnoses (ADHD without LD, LD

without ADHD, and both conditions).

Children 12–17 years of age were more

likely than children 6–11 years of age to

have each of the diagnoses. Hispanic

children were less likely than nonHispanic white and non-Hispanic black

children to have ADHD (with and

without LD). Children with Medicaid

coverage were more likely than

uninsured children and privately insured

children to have each of the diagnoses.

Children with each of the diagnoses

were more likely than children with

neither ADHD nor LD to have other

health conditions. Children with ADHD

were more likely than children without

ADHD to have contact with a mental

health professional, use prescription

medication, and have frequent health

care visits. Children with LD were more

likely than children without LD to use

special education services.

Keywords: children’s health c

learning and behavioral disorders c

health care utilization

Diagnosed Attention Deficit

Hyperactivity Disorder and

Learning Disability:

United States, 2004–2006

by Patricia N. Pastor, Ph.D., and Cynthia A. Reuben, M.A.,

Office of Analysis and Epidemiology

Highlights
 

Prevalence

+	 The percentage of children 6–17

years of age with ADHD (with and

without LD) increased slowly from

1997 through 2006, whereas the

percentage of children with LD

(with and without ADHD) did not

change significantly.

+	 Approximately 5% of children had

ADHD without LD, 5% had LD

without ADHD, and 4% had both

conditions.

+	 Boys were more likely than girls to

have each of the diagnoses (ADHD

without LD, LD without ADHD,

and both conditions).

+	 Hispanic children were less likely

than non-Hispanic black children

and non-Hispanic white children to

have ADHD (with and without LD).

+	 Children with Medicaid were more

likely than uninsured children or

privately insured children to have

each of the diagnoses.

Other Health Conditions

+	 Children with each of the diagnoses

(ADHD without LD, LD without

ADHD, and both conditions) were

more likely than children with

neither ADHD nor LD to have other

chronic health conditions.

Use of Health Care and

Educational Services

+	 Children with each of the diagnoses

(ADHD without LD, LD without

ADHD, and both conditions) were

more likely than children with

neither condition to use health care

and educational services.

+	 Children with ADHD (with and

without LD) were more likely than

children without ADHD to have

contact with a mental health

professional, use prescription

medication, and have frequent health

care visits.

+	 Children with LD (with and without

ADHD) were more likely than

children without LD to use special

education services.

Introduction

Over the past three decades in the

United States, behavioral and learning

disorders have emerged as major

chronic conditions affecting the

development of school-aged children

and adolescents (1,2). Educators have

reported a rise in the number of children

with these disorders (3). Pediatricians

have also reported an increased number

of children with outpatient visits related

to behavioral and emotional disorders

(4,5). During this period, special

education programs have expanded

greatly, thereby increasing the number

of students receiving services for

Page 1
Page 2 [ Series 10, Number 237

behavioral and learning disorders (6,7).

Additionally, a marked increase has also

been observed in the number of children

with emotional and behavioral disorders

who are treated with psychotropic

medications (8). All these trends indicate

the need for health surveys to monitor

the number and characteristics of

children diagnosed with behavioral and

learning disorders.

This report examines two

commonly diagnosed conditions causing

behavioral and learning problems in

children, attention deficit hyperactivity

disorder (ADHD) and learning disability

(LD). The findings update and expand

upon the estimates presented in a 2002

Vital and Health Statistics series report,

‘‘Attention Deficit Disorder and

Learning Disability: United States,

1997–98,’’ which examined the

prevalence of diagnosed ADHD and LD

in children 6–11 years of age (9). This

report provides a national picture of

children with diagnosed ADHD and LD

by describing 1) recent trends in these

diagnoses, 2) the prevalence of these

diagnoses among children with selected

sociodemographic characteristics, 3)

other health conditions of children with

these diagnoses, and 4) the use of

educational and health services by

children with these diagnoses.

In contrast to many previous studies

that have examined the characteristics of

all children with ADHD or all children

with LD, this report takes into account

the frequent co-occurrence of ADHD

and LD. Most of the analyses are for

children with ADHD without LD, LD

without ADHD, both conditions, and

neither condition. Analyses of the trends

in ADHD and LD examine the changes

over time in the percentage of children

with all diagnoses of ADHD (with and

without LD) and children with all

diagnoses of LD (with and without

ADHD). This report presents estimates

for all children 6–17 years of age and

compares findings for boys, girls,

children 6–11 years of age, and children

12–17 years of age.

Data and Methods
 

Survey Procedures

The data source for this report is

the 2004, 2005, and 2006 National

Health Interview Survey (NHIS). The

NHIS is an ongoing multistage

probability sample survey conducted by

the National Center for Health Statistics

(NCHS) and is representative of the

civilian noninstitutionalized population

of the United States. The sampling

design for the NHIS permits the

merging of data from 2004, 2005, and

2006 into a single sample. During these

3 survey years, 104,292 households

participated in NHIS, resulting in a

response rate of 87%.

In each family with children under

18 years of age, one child was randomly

selected to be included in the child

sample. Additional information for this

child was obtained by interviewing an

adult family member who was

knowledgeable about the child’s health.

This report examines data for the 23,051

children 6–17 years of age in the

2004–2006 child sample. The final

response rate for sample children from

2004 through 2006 was 78% to 79%. In

approximately 92% of the families, a

parent was the respondent providing

information about the sample child. The

respondent for the child is referred to as

a parent throughout this report. In

addition, the term ‘‘younger children’’

refers to children 6–11 years of age, and

the term ‘‘older children’’ refers to

children 12–17 years of age.

Data were collected on the child’s

sociodemographic characteristics,

including age at interview, sex, race,

ethnicity, birthweight, family structure,

mother’s level of education, and health

insurance coverage. The information

collected about health conditions

included diagnoses of ADHD, LD,

mental retardation and other

developmental delay, hearing and vision

problems, allergies, asthma, and other

chronic health conditions. Use of

educational services was measured by

asking if a child was currently receiving

special education services and if these

services were for an emotional or

behavioral problem. Use of health care

services during the past 12 months was

assessed by asking if a parent had seen

or talked to various types of providers

about the health of the child and how

often the child had been seen by a

health care provider. Use of medication

was determined by asking if a child had

a condition for which he or she had

regularly taken prescription medication

for at least 3 months. A detailed

description of the NHIS sample design

and the survey questionnaires for 2004,

2005, and 2006 are available from the

website, http://www.cdc.gov/NCHS/

about/major/nhis/quest_data_related_

1997_forward.htm.

Percentages and standard errors

were calculated using SUDAAN, a

statistical program for survey data

analysis that adjusts for the effects of

complex sampling designs (10).

Differences between percentages were

evaluated for statistical significance at

the 0.05 level with two-tailed statistical

tests. No adjustments were made for

multiple comparisons. Logistic

regression was used to determine the

average annual percentage change in the

prevalence of ADHD and LD from 1997

through 2006.

Measurement of Diagnosed

ADHD and LD

Parents were asked the following

questions to determine if a child had a

previous diagnosis of ADHD or LD:

+	 Has a doctor or health professional

ever told you that (sample child)

had attention deficit hyperactivity

disorder (ADHD) or attention deficit

disorder (ADD)?

+	 Has a representative from a school

or a health professional ever told

you that (sample child) had a

learning disability?

The item nonresponse rate for the

questions on ADHD and LD was 0.4%.

The final sample for the analysis (n =

22,969) excluded 82 children who had

missing information on ADHD or LD.

Diagnosed cases reported by parents

were not verified by comparing survey

responses with information from the

medical or school records of children.
Undiagnosed cases of ADHD and LD

were not included because the survey

questions only asked parents about

diagnosed cases of ADHD and LD. In

the results section of this report,

mentions of children with ADHD, LD,

or both diagnoses refer to children

whose parents reported that their child

was ever diagnosed with ADHD, LD, or

both conditions.

Results

Trends in Diagnosed

ADHD and LD, 1997–2006

+	 The average annual increase in the

percentage of children with all

diagnoses of ADHD (with and

without LD) was 3% from 1997

through 2006. No significant

average annual change was found in

the percentage of children with all

diagnoses of LD (with and without

ADHD) (Figure 1).

+	 An increase in the percentage of

children with ADHD was observed

among both boys (2%) and girls

(4%) (Figure 2).

+ Among younger children 6–11 years

of age, no significant change was

found in the percentage of children

with ADHD. However, among older

children 12–17 years of age, an

increase occurred in the percentage

of children with ADHD, an average

annual increase of 4% (Figure 3).

Prevalence of Diagnosed

ADHD and LD by Selected

Sociodemographic

Characteristics, 2004–2006

Overall prevalence

+	 Approximately 4.7% of children

6–17 years of age had ADHD

without LD, 4.9% had LD without

ADHD, and 3.7% had both

conditions (Table 1).

Sex

+	 Boys were more likely than girls to

have each of the diagnoses (ADHD

without LD, LD without ADHD,

and both conditions) (Table 1 and

Figure 4).

+	 Boys (6.7%) were more than twice

as likely as girls (2.5%) to have

ADHD without LD (Table 1 and

Figure 4).

+	 Boys (5.1%) were about twice as

likely as girls (2.3%) to have both

conditions (Table 1 and Figure 4).

+	 Boys (5.6%) were about one-third

more likely than girls (4.3%) to

NOTES: ADHD is attention deficit hyperactivity disorder. “All diagnoses of ADHD” includes ADHD with and without LD. 

“All diagnoses of LD” includes LD with and without ADHD. 

SOURCE: CDC/NCHS, National Health Interview Surveys, 1997–2006. Percent 

Year 

0 

2 

4 

6 

8 

10 

12 

14 

All diagnoses of ADHD 

All diagnoses of LD 

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Figure 1. All diagnoses of ADHD and learning disability (LD) among children 6–17 years of

age: United States, 1997–2006

Series 10, Number 237 [ Page 3

have LD without ADHD (Table 1

and Figure 4).

Age

+	 Older children 12–17 years of age

were more likely than younger

children 6–11 years of age to have

each of the diagnoses (ADHD

without LD, LD without ADHD,

and both conditions) (Table 1 and

Figure 5).

Low birthweight

+	 Children with low birthweight were

more likely than children without

low birthweight to have LD (with

and without ADHD) (Table1).

+	 Low birthweight was not associated

with ADHD without LD (Table 1).

+	 In each sex and age group, children

with low birthweight were more

likely than children without low

birthweight to have LD (with and

without ADHD) (Table 2).

Race and ethnicity

+	 Hispanic children were less likely

than non-Hispanic black children or

non-Hispanic white children to have

ADHD (with and without LD)

(Table 1 and Figure 6).

+	 No significant racial or ethnic

differences were found in the

percentage of children having LD

without ADHD (Table 1 and

Figure 6).

+	 In each sex and age group, Hispanic

children were less likely than

non-Hispanic children to have

ADHD without LD (Table 2).

Family structure

+	 Children who lived in a mother-only

family were more likely than those

in a two-parent family to have each

of the three diagnoses (ADHD

without LD, LD without ADHD,

and both conditions) (Table 1).

+	 In each sex and age group, children

living in a mother-only family were

more likely than those living in a

two-parent family to have both

ADHD and LD (Table 2).

+	 Among boys, younger children, and

older children, those living in a
Page 4 [ Series 10, Number 237

0 

2 

4 

6 

8 

10 

12 

14 

Girls 

Boys 

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Percent 

Year 

NOTE: ADHD is attention deficit hyperactivity disorder. 

SOURCE: CDC/NCHS, National Health Interview Surveys, 1997–2006. 

Figure 2. All diagnoses of ADHD among children 6–17 years of age, by sex: United States,

1997–2006

NOTE: ADHD is attention deficit hyperactivity disorder. 

SOURCE: CDC/NCHS, National Health Interview Surveys, 1997–2006. Percent 

Year 

0 

2 

4 

6 

8 

10 

12 

14 

12–17 years 

6–11 years 

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Figure 3. All diagnoses of ADHD among children 6–17 years of age, by age group:

United States, 1997–2006

mother-only family were more likely Health insurance coverage

than those living in a two-parent

+	 Children with Medicaid coverage family to have ADHD without LD

were more likely than uninsured (Table 2). children and privately insured +	 Among boys and younger children, children to have each of the those living in a mother-only family diagnoses (ADHD without LD, LD were more likely than those in a

without ADHD, and both conditions) two-parent family to have LD

(Table 1 and Figure 7). without ADHD (Table 2).

+	 Among boys and younger children,

those with Medicaid coverage were

more likely than either uninsured or

privately insured children to have

each of the diagnoses (Table 2).

+	 Among girls and older children,

those with Medicaid coverage were

more likely than uninsured or

privately insured children to have

LD (with and without ADHD)

(Table 2).

Mother’s level of education

+	 Overall, a curvilinear relationship

was found between mother’s

education and ADHD without LD.

This diagnosis was most often

reported for children whose mothers

had intermediate levels of education

(having a high school diploma but

not having a bachelor’s degree)

(Table 1).

+	 In each sex and age group, children

with the least educated mothers

were more likely than children with

the most educated mothers to have

LD without ADHD (Table 2).

+	 Among older children, those with

the most educated mothers were

twice as likely as children with the

least educated mothers to have

ADHD without LD (Table 2).

Health conditions of children

+	 Children with each of the diagnoses

(ADHD without LD, LD without

ADHD, and both conditions) were

more likely than children with

neither ADHD nor LD to have other

chronic health conditions (Table 3).

+	 Among children with each of the

diagnoses, the prevalence of mental

retardation and other developmental

delay was lowest among children

having ADHD without LD and

highest among children having LD

without ADHD (Table 3 and

Figure 8).

+	 The prevalence of asthma did not

differ significantly among children

with each of the diagnoses (Table 3

and Figure 8).

+	 The prevalence of each of the other

chronic health conditions was

similar for all children with LD

(with and without ADHD) (Table 3).

+	 Among children in each sex and age

group, children with LD (with and

without ADHD) were much more

likely than children with neither
Percent 

NOTES: ADHD is attention deficit hyperactivity disorder. “Both” is ADHD and LD. “All ADHD” includes ADHD with and 

without LD. “All LD” includes LD with and without ADHD. 

SOURCE: CDC/NCHS, National Health Interview Surveys, 2004–2006. 

0 

2 

4 

6 

8 

10 

12 

14 

LD without Both All ADHD All LD

ADHD 

ADHD 

without LD 

Boys Girls

Figure 4. ADHD and learning disability (LD) among children 6–17 years of age, by sex:

United States, 2004–2006 Percent 

NOTES: ADHD is attention deficit hyperactivity disorder. “Both” is ADHD and LD. “All ADHD” includes ADHD with and 

without LD. “All LD” includes LD with and without ADHD. 

SOURCE: CDC/NCHS, National Health Interview Surveys, 2004–2006. 

0 

2 

4 

6 

8 

10 

12 

14 

LD without Both All ADHD All LD

ADHD 

ADHD 

without LD 

6–11 years 12–17 years

Figure 5. ADHD and learning disability (LD) among children 6–17 years of age, by age

group: United States, 2004–2006

condition to have other health

conditions (Table 3).

Use 

educational services

of health care and

+	 Children with each of the diagnoses

(ADHD without LD, LD without

ADHD, and both conditions) were

more likely than children with

neither condition to use health care

and educational services (Table 4).

+	 Children with both ADHD and LD

were more likely than children with

ADHD without LD, LD without

ADHD, or neither condition to use

most types of health care and

educational services (Table 4).

+	 Children with ADHD (with and

without LD) were more likely than

children without ADHD to have

contact with a mental health

professional, use prescription

medication, and have frequent health

care visits (Table 4 and Figure 9).

+	 Children with LD (with and without

ADHD) were more likely than those

without LD to use special education

services (Table 4 and Figure 9).

Series 10, Number 237 [ Page 5

+	 In each sex and age group, children

with each of the diagnoses were

more likely than children with

neither ADHD nor LD to use most

health care and educational services

(Table 4).

Discussion

ADHD and LD are among the most

prevalent and widely researched

diagnoses of U.S. children. In 2006,

NCHS estimated that 4.5 million

school-aged children (5–17 years of age)

had ever been diagnosed with ADHD

and 4.6 million children with LD (11).

The economic effect of these conditions

on families, schools, and the health care

system is substantial. A recent review,

using conservative prevalence estimates,

calculated the annual societal ‘‘cost of

illness’’ for ADHD to be between $36

and $52 billion in 2005 dollars (12).

About one-half of the students currently

receiving special education services

nationally are entitled to these services

because of learning disability (3).

Additionally, a recent national survey of

special education students showed that

children with ADHD are a rapidly

growing group of students within special

education programs (13). Given the

economic and social costs associated

with ADHD and LD, monitoring the

number and characteristics of children

who have been diagnosed with these

conditions is critical.

Prevalence of Diagnosed

ADHD and LD

Past estimates of the prevalence of

ADHD and LD have varied, in part,

because of differences in the criteria

used for identifying these conditions and

the types of samples selected. The aim

of this study was to describe the

prevalence of diagnosed ADHD and LD

using parent reports from a large,

nationally representative health survey.

Because this study focused on the

prevalence of diagnosed conditions, the

findings reflect not only the underlying

prevalence of these conditions, but also

the effects of factors related to a

professional diagnosis of these
Page 6 [ Series 10, Number 237 Percent 

NOTES: ADHD is attention deficit hyperactivity disorder. “Both” is ADHD and LD. “All ADHD” includes ADHD with and 

without LD. “All LD” includes LD with and without ADHD. 

SOURCE: CDC/NCHS, National Health Interview Surveys, 2004–2006. 

0 

2 

4 

6 

8 

10 

12 

14 

LD without Both All ADHD All LD

ADHD 

ADHD 

without LD 

Non-Hispanic white Non-Hispanic black Hispanic

Figure 6. ADHD and learning disability (LD) among children 6–17 years of age, by race

and ethnicity: United States, 2004–2006 Percent 

NOTES: ADHD is attention deficit hyperactivity disorder. “Both” is ADHD and LD. “All ADHD” includes ADHD with and 

without LD. “All LD” includes LD with and without ADHD. 

SOURCE: CDC/NCHS, National Health Interview Surveys, 2004–2006. 

0 

2 

4 

6 

8 

10 

12 

14 

Uninsured Medicaid Private insurance

LD without Both All ADHD All LD

ADHD 

ADHD 

without LD 

Figure 7. ADHD and learning disability (LD) among children 6–17 years of age, by

insurance coverage at interview: United States, 2004–2006

conditions. Factors influencing the

likelihood that a child with these

conditions receives a diagnosis include

access to health care and educational

services, local practices of health care

and education professionals, and

parental attitudes toward behavioral and

learning conditions.

Few studies have estimated the

national prevalence of diagnosed

ADHD. Recently, two other studies

using data from national surveys

reported prevalence estimates of

diagnosed ADHD among school-age

children similar to the prevalence rate of

this study—8.4% (95% confidence

interval: 8.1%–8.8%). Visser et al.,

using data from the 2003 National

Survey of Children’s Health (NSCH),

estimated the prevalence of diagnosed

ADHD among U.S. children 4–17 years

of age to be 7.8% (95% confidence

interval: 7.4%–8.1%) (14). Braun et al.,

using data from the 1999–2002 National

Health and Nutrition Examination

Survey (NHANES), estimated the

prevalence of diagnosed ADHD among

children 4–15 years of age to be 8.2%

(15).

Other recent findings from the

2001–2004 NHANES indicate that

children with parent reports of

diagnosed ADHD and children meeting

the Diagnostic and Statistical Manual of

Mental Disorders (DSM-IV) criteria for

ADHD are overlapping, although not

identical, groups of children (16). Using

detailed data from the Diagnostic

Interview Schedule for Children in the

2001–2004 NHANES, Froehlich et al.

determined that 8.7% of children 8–15

years of age met the DSM-IV criteria

for ADHD during the year prior to the

survey. Another 3.3% of children did

not meet the diagnostic criteria for

ADHD, but had a parent report of a

previous diagnosis of ADHD and had

received ADHD medications during the

year prior to the survey. Among all

children meeting the DSM-IV criteria

for ADHD, approximately one-half had

a parent report of a previous diagnosis

of ADHD.

Similarly, national estimates of

diagnosed LD are scarce. Recently,

Altarac and Saroha, using data from the

2003 NSCH, estimated the prevalence of

diagnosed LD among children 3–17

years of age to be 9.7% (95%

confidence interval: 9.4%–10.1%) (17).

This estimate is slightly higher than the

prevalence rate of diagnosed LD in this

study of 8.7% of children 6–17 years of

age (95% confidence interval:

7.9%–9.4%). Both survey estimates of

the prevalence of LD substantially

exceed the national estimate of

approximately 6% based on special

education enrollment data. The

discrepancy between the estimates of

LD based on survey results and the

estimates based on enrollment data may

be due, in part, to parents’ interpretation

of the term ‘‘learning disability.’’

Because the survey questions only asked

about ‘‘a learning disability’’ and did not

define specifically which disorders are

considered LD, parents may have

interpreted the term to describe a wide

range of learning and developmental

problems. Additionally, the survey

questions asked parents about any

previous diagnosis of LD, whereas

special education enrollment data only

describe children in special education

with a current diagnosis of LD.
Percent 

NOTES: ADHD is attention deficit hyperactivity disorder. LD is learning disability. “Neither” is neither ADHD nor LD. 

“Both” is ADHD and LD. 

SOURCE: CDC/NCHS, National Health Interview Surveys, 2004–2006. 

0 

20 

40 

60 

80 

100 

Neither ADHD without LD LD without ADHD Both

Mental retardation or Asthma

other developmental delay 

Figure 8. Mental retardation or other development delay and asthma among children 6–17

years of age, by diagnostic group: United States, 2004–2006 Percent 

NOTES: ADHD is attention deficit hyperactivity disorder. LD is learning disability. “Neither” is neither ADHD nor LD. 

“Both” is ADHD and LD. 

SOURCE: CDC/NCHS, National Health Interview Surveys, 2004–2006. 

0 

20 

40 

60 

80 

100 

Prescription medication Special education

Neither ADHD without LD LD without ADHD Both

Figure 9. Use of prescription medication and special education among children 6–17

years of age, by diagnostic group: United States, 2004–2006

Recent survey estimates of

diagnosed ADHD and LD have not

examined the joint occurrence of these

conditions. However, many clinical and

community studies have reported

differing estimates of the co-occurrence

of ADHD and LD (18). In this study,

28% of children diagnosed with either

ADHD or LD had reports of having

been diagnosed with both conditions.

The co-occurrence of diagnosed ADHD

and LD reflects the effect of shared

genetic and environmental factors that

are associated with the development and

the diagnosis of both of these

conditions. Additionally, simply being

diagnosed with one condition may

increase the likelihood that a child is

evaluated for the other condition.

In regard to trends, no other recent

survey estimates of changes in the

prevalence of either diagnosed ADHD

or LD are available. Results from past

community and clinical studies and

reviews of patient records suggest that

the number of children having a

diagnosis of ADHD and the number

using ADHD medication have increased

greatly since the 1970s (19). Findings

from this study show that, more

recently, the prevalence of diagnosed

ADHD has continued to increase,

Series 10, Number 237 [ Page 7

especially among older children.

Similarly, special education enrollment

data suggest that the percentage of

students with a specific learning

disability increased markedly during the

1970s and 1980s (3). More recently,

though, the increase in the percentage of

students enrolled in special education

for a specific learning disability has

slowed. Estimates from this study also

show no significant change in the

prevalence of diagnosed LD reported by

parents from 1997 through 2006.

Factors Associated with

Diagnosed ADHD or LD

Demographic factors—The current

finding that older children compared

with younger children were more likely

to have been diagnosed with either

ADHD or LD is similar to the findings

from the 2003 NSCH (14,17). Although

a number of factors may contribute to

differences between younger and older

children, a higher ‘‘lifetime’’ prevalence

rate among older children would be

expected because of their longer

exposure to the possibility of evaluation

and diagnosis. Additionally, the finding

that boys compared with girls were

more likely to have been diagnosed with

either ADHD or LD is also similar to

the findings from the 2003 NSCH. This

result is not surprising because nearly

all studies of ADHD and LD have

reported a higher prevalence of these

conditions in boys than in girls (19).

Although the reasons that boys are more

often diagnosed with ADHD, LD, or

both conditions are not fully understood,

the more frequent disruptive behavior of

boys, especially in school settings, has

been mentioned as a possible

explanation for the sex disparity in

diagnosed ADHD (20).

The finding of a positive association

between low birthweight (less than

2,500 grams) and the prevalence of

diagnosed LD (with and without

ADHD) in this study also concurs with

the results of other recent investigations.

Using data from the 2002 NHIS, Stein

et al. found moderately low birthweight

(1,500–2,499 grams) was associated

with a higher prevalence of any

diagnosis of ADHD or LD in children

3–12 years of age (21). The association
Page 8 [ Series 10, Number 237

between moderately low birthweight and

each of the conditions persisted even

after controlling for confounding factors.

Social and economic factors—

Because of differences in the coding of

race, findings from this study cannot be

compared with those in the 2003 NSCH.

In regard to ethnicity, though, a few

comparisons are possible. This study

and the 2003 NSCH reported a lower

prevalence of diagnosed ADHD among

Hispanic chidren compared with

non-Hispanic children. Less access to

health care and language barriers are

explanations that have been offered for

the lower prevalence of diagnosed

ADHD reported by Hispanic parents

(22).

Many of the findings related to

other socioeconomic factors in this

study were also similar to the results of

the 2003 NSCH. Children in motheronly families were noted in both surveys

to have a higher prevalence of

diagnosed ADHD and LD. Children

with health insurance coverage (any

type) were noted in both surveys to

have a higher prevalence of diagnosed

ADHD. This study further found that

the prevalence of diagnosed ADHD was

similar among children with private

insurance coverage and children with

Medicaid. Although many factors may

contribute to the differences between

insured and uninsured children, access

to health care may make it more likely

that a child with ADHD will be

diagnosed. Additionally, the positive

association between Medicaid and

diagnosed ADHD may reflect, in part,

the influence of a diagnosis of ADHD

on a child’s eligibility for Medicaid

coverage (23).

The findings from this study and

those based on the 2003 NSCH suggest

a complex relationship between a

mother’s level of education and the

conditions of ADHD and LD. As

expected from other studies of learning

difficulties and poor academic outcomes,

both studies show a lower prevalence of

LD (with and without ADHD) among

children whose mothers had the highest

level of education, compared with

children whose mothers had the lowest

level of education. The unexpected

result of an overall curvilinear

relationship between mothers’ education

and diagnosed ADHD (children whose

mothers had intermediate levels of

education had the highest prevalence of

this diagnosis) may be due, in part, to

the confounding effects of other factors

such as Hispanic ethnicity.

Health Conditions and

Service Use

Past clinical and community studies

have reported a higher prevalence of

other mental and physical disorders

among children with ADHD, compared

with children without ADHD (19).

Similarly, studies of children with

learning disorders have noted a higher

prevalence of developmental, behavioral,

and physical disorders in these children,

compared with children without learning

disorders (17). This study also showed

that children with diagnoses of ADHD

without LD, LD without ADHD, or both

conditions more often had reports of

other health conditions compared with

children with neither condition. The

finding that children with diagnosed

ADHD or LD are seen more often by

health care professionals may explain

partially the higher prevalence of other

health conditions among children with

diagnosed ADHD, LD, or both

conditions. In this study, the full extent

of co-occurring health conditions is

probably understated because of the

absence of questions in the NHIS about

other mental health conditions. Other

recent studies have shown that many

children with diagnosed ADHD meet the

criteria for at least one other mental

disorder. Among the most frequently

co-occurring disorders in children with

ADHD are oppositional defiant disorder

and conduct disorder (19).

Children with diagnosed ADHD,

LD, or both conditions also used

educational and health care services

much more often than children with

neither condition. Given the potential

effect of ADHD and LD on a child’s

academic progress, family relationships,

and peer interactions, the higher level of

health care and educational service use

among diagnosed children, compared

with undiagnosed children, is not

surprising. Moreover, the other health

conditions of children with diagnosed

ADHD and LD may be another factor

contributing to the greater use of health

care and educational services.

Study Limitations

The results of this study are limited

in several ways. First, the results only

describe the prevalence,

sociodemographic characteristics, health

conditions, and service use of children

with a parent report of diagnosed

ADHD or LD. The results do not

describe the prevalence and

characteristics of children who have the

conditions but who have never been

diagnosed. Furthermore, among children

with parent reports of diagnosed LD,

what is not known is if all parents

understood ‘‘learning disability’’ to

mean one of the specific LDs

(disabilities related to listening,

speaking, basic reading skills, reading

comprehension, written expression,

mathematical calculation, or

mathematical reasoning). Some parents

may have interpreted the term in a more

general sense that could include any

difficulty that a child has with learning,

such as learning problems due to visual,

hearing, or motor disabilities; mental

retardation; emotional disturbance; or

environmental, cultural, or economic

disadvantage. The relatively large

percentage of children with LD who

were reported by parents to also have

mental retardation or some other

developmental delay suggests that

parents may have interpreted the

question about LD to include learning

problems other than specific LDs.

Neither school nor health records were

obtained to determine the accuracy of

parent reports of either diagnosed

ADHD or LD.

Additionally, information about the

severity and duration of a child’s

condition(s) was not collected in NHIS.

Moreover, because of the cross-sectional

design of NHIS, identifying how

particular factors influence the diagnosis

of ADHD, LD, or both conditions was

not possible. NHIS includes only a few

questions about health care and

educational services utilized by children.

More detailed information about current

and past service use, including specific

types of prescription medication, forms
Series 10, Number 237 [ Page 9

of behavioral treatment, and providers of

these treatments, would improve the

description of service use. Information

about other mental disorders of children

with ADHD, LD, or both conditions

could also enhance the understanding of

the health care and educational needs of

these children.

Conclusion

Given the substantial burden

associated with ADHD and LD for

children, their families, and society,

there remains a continuing need to

monitor the national prevalence of these

conditions. This study provides an

overview of the number, characteristics,

health conditions, and service use of

school-aged children who had parent

reports of diagnosed ADHD and LD in

2004–2006. This report contains

information that may help educators,

health planners, and health professionals

assess the service needs of children with

diagnosed ADHD and LD.

References

1.	 Federal Interagency Forum on Child

and Family Statistics. America’s

children: Key national indicators of

well-being, 2007. Washington, DC.

2007.

2.	 New Freedom Commission on Mental

Health. Achieving the promise:

Transforming mental health care in

America. Final report. DHHS pub no

SMA–03–3832. Rockville, MD. 2003.

3.	 U.S. Department of Education, Office

of Special Education and Rehabilitative

Services, Office of Special Education

Programs. 2005 Report to Congress on

the implementation of the Individuals

with Disabilities Education Act; vol. 1.

Washington, DC. 2007.

4.	 Kelleher KJ, McInerny TK, Gardner

WP, Childs GE, Wasserman RC.

Increasing identification of

psychosocial problems: 1979–1996.

Pediatrics 105(6):1313–21. 2000.

5.	 Grupp-Phelan J, Harman JS, Kelleher

KJ. Trends in mental health and

chronic condition visits by children

presenting for care at U.S. emergency

departments. Public Health Rep

122:55–61. 2007.

6.	 Wagner M, Blackorby J. Disability

profiles of elementary and middle

school students with disabilities. Menlo

Park, CA: SRI International. 2002.

7.	 Wagner M, Kutash K, Duchnowski AJ,

Epstein MH, Sumi WC. The children

and youth we serve: A national picture

of the characteristics of students with

emotional disturbances receiving

special education. Journal of Emotional

and Behavioral Disorders 13:79–96.

2005.

8.	 Thomas CP, Conrad P, Casler R,

Goodman E. Trends in the use of

psychotropic medications among

adolescents, 1994 to 2001. Psychiatr

Serv 57:63–9. 2006.

9.	 Pastor PN, Reuben CA. Attention

deficit disorder and learning disability:

United States, 1997–98. National

Center for Health Statistics. Vital

Health Stat 10(206). 2002.

10.	 Shah BV, Barnwell BG, Bieler GS.

SUDAAN user’s manual, release 7.5.

Research Triangle Park, North

Carolina: Research Triangle Institute.

1997.

11.	 Bloom B, Cohen RA. Summary health

statistics for U.S. children: National

Health Interview Survey, 2006.

National Center for Health Statistics.

Vital Health Stat 10(234). 2007.

12.	 Pelham WE, Foster M, Robb JA. The

economic impact of attention-deficit/

hyperactivity disorder in children and

adolescents. J Pediatric Psychol

32(6):711–27. 2007.

13.	 Schnoes C, Reid R, Wagner M, Marder

C. ADHD among students receiving

special education services: A national

survey. Exceptional Children

72:483–96. 2006.

14.	 Visser SN, Lesesne CA, Perou R.

National estimates and factors

associated with medication treatment

for childhood attention-deficit/

hyperactivity disorder. Pediatrics

119:S99–106. 2007.

15.	 Braun JM, Kahn RS, Froehlich T,

Auinger P, Lanphear BP. Exposures to

environmental toxicants and attention

deficit hyperactivity disorder in U.S.

children. Environ Health Perspect

114:1904–9. 2006.

16.	 Froehlich TE, Lanphear BP, Epstein

JN, Barbaresi WJ, Katusic SK, Kahn

RS. Prevalence, recognition, and

treatment of attention-deficit/

hyperactivity disorder in a national

sample of US children. Arch Pediatr

Adolesc 161:857–64. 2007.

17.	 Altarac M, Saroha E. Lifetime

prevalence of learning disability among

US children. Pediatrics 119:S77–83.

2007.

18.	 Barkley RA. Attention-deficit

hyperactivity disorder. 2d ed. New

York: Guilford Press. 1998.

19.	 Smith BH, Barkley RA, Shapiro CJ.

Attention-deficit/hyperactivity disorder.

In: Mash EJ, Barkley RA, editors.

Treatment of childhood disorders. 3d

ed. New York, NY: Guilford Press.

2006.

20.	 Derks EM, Hudziak JJ, Boomsma DI.

Why more boys than girls with ADHD

receive treatment: A study of Dutch

twins. Twin Res Hum Genet

10:765–70. 2007.

21.	 Stein REK, Siegel MJ, Bauman LJ. Are

children of moderately low birth weight

at increased risk for poor health? A

new look at an old question. Pediatrics

118:217–23. 2006.

22.	 Stevens J, Harman JS, Kelleher KJ.

Ethnic and regional differences in

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Pediatr 25:318–25. 2004.

23.	 Social Security Administration.

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Security (Blue Book—June 2006).

Available from: http://www.ssa.gov/

disability/professionals/bluebook/. 2006.
Page 10 [ Series 10, Number 237

Table 1. Diagnosed attention deficit hyperactivity disorder

selected characterisitics: United States, 2004–2006

(ADHD) and learning disability (LD) among children 6–17 years of age, by

Characteristic

ADHD

without LD1

LD without

ADHD2 Both3 All ADHD4 All LD5

Total .....................

Sex

Boys .....................

Girls .....................

......................

Age

6–11 years .................

12–17 years ................

Birthweight

Low (less than 2,500 grams) ......

Not low (2,500 grams or more) .....

Race and ethnicity7

Non-Hispanic white ............

Non-Hispainc black ............

Hispanic ...................

Family structure8

Mother only .................

Mother and father .............

Health insurance coverage

at interview

Uninsured ..................

Medicaid9 ..................

Private10...................

Mother’s education

Less than high school graduate ....

High school graduate or GED11 ....

Some college. . . . . . . . . . . . . . . .

Bachelor degree or more ........

4.7

6.7

2.5

4.0

5.2

5.3

4.6

5.6

4.3

2.7

6.1

4.1

3.1

5.7

4.6

3.1

5.1

5.2

4.2

(0.2)

(0.5)

(0.2)

(0.3)

(0.3)

(0.6)

(0.2)

(0.3)

(0.4)

(0.3)

(0.4)

(0.2)

(0.4)

(0.4)

(0.2)

(0.4)

(0.4)

(0.3)

(0.3)

4.9

5.6

4.3

4.4

5.4

7.6

4.7

5.1

5.4

4.8

5.8

4.6

3.8

7.8

4.1

5.8

5.0

5.4

3.7

(0.2)

(0.3)

(0.3)

(0.3)

(0.3)

(0.8)

(0.2)

(0.3)

(0.5)

(0.3)

(0.4)

(0.2)

(0.4)

(0.5)

(0.2)

(0.5)

(0.3)

(0.4)

(0.3)

Percent (standard

3.7 (0.2)

5.1 (0.3)

2.3 (0.2)

2.9 (0.2)

4.4 (0.3)

6.5 (0.6)

3.5 (0.2)

4.1 (0.2)

4.3 (0.4)

2.6 (0.3)

5.1 (0.4)

3.1 (0.2)

2.6 (0.4)

5.9 (0.4)

3.1 (0.2)

3.3 (0.4)

4.2 (0.4)

4.3 (0.3)

2.3 (0.3)

error)6

8.4

11.8

4.8

7.1

9.6

11.7

8.1

9.8

8.6

5.3

11.2

7.1

5.7

11.6

7.7

6.4

9.2

9.5

6.5

(0.2)

(0.4)

(0.2)

(0.3)

(0.3)

(0.9)

(0.2)

(0.3)

(0.6)

(0.4)

(0.6)

(0.3)

(0.6)

(0.6)

(0.3)

(0.5)

(0.5)

(0.5)

(0.4)

8.7

10.7

6.6

7.4

9.9

14.1

8.1

9.3

9.6

7.4

11.0

7.7

6.4

13.7

7.2

9.1

9.2

9.7

6.0

(0.4)

(0.4)

(0.3)

(0.3)

(0.4)

(1.0)

(1.0)

(0.3)

(0.6)

(0.4)

(0.5)

(0.3)

(0.6)

(0.6)

(0.3)

(0.6)

(0.5)

(0.5)

(0.4)

1

‘‘ADHD without LD’’ includes children who have ever had a diagnosis of ADHD and have never had a diagnosis of LD.
 

2

‘‘LD without ADHD’’ includes children who have ever had a diagnosis of LD and have never had a diagnosis of ADHD.
 

3

‘‘Both’’ includes children who have ever had a diagnosis of both ADHD and LD.
 

4

‘‘All ADHD’’ includes children who have ever been diagnosed with ADHD. The category includes children with ADHD with and without LD.
 

5

‘‘All LD’’ includes children who have ever been diagnosed with LD. The category includes children with LD with and without ADHD.
 

6

Unknowns for the variables of interest are not included in denominators used for the calculation of percentages and standard errors.
 

7

Data are not shown for non-Hispanic children of other races because of small sample size.
 

8

Mother and father refer to biological, adoptive, step, and foster parents. Data are not shown for children in other family types because of small s

9

Medicaid includes children insured only by Medicaid.
 

10Private includes children covered by private insurance, those with non-Medicaid public insurance, and those with both private and public insurance.

11GED is General Educational Development high school equivalency diploma.
 

SOURCE: CDC/NCHS, National Health Interview Survey.

ample size. 
 


 
hyperactivity disorder (ADHD) and learning disability (LD) among children 6–17 years of age, by sex, age group, and selected characteristics:

Boys Girls 6–11 years of age 12–17 year of age

ADHD

thout LD1

LD without

ADHD2 Both3

ADHD

without LD1

LD without

ADHD2 Both3

ADHD LD without

without LD1 ADHD2 Both3

ADHD LD without

without LD1 ADHD2 Both3

.7

.5.7

 

.0 .6 .0 .5 .6 .7 .5 .5 

.8 .9 .4 .1

(0.3)

(1.0)(0.3)(0.4)(0.7)

 (0.5) (0.7) (0.4) (0.7) (0.8) (0.4) (0.6) (0.6) (0.6) (0.6)

5.6

7.95.35.56.65.5

 7.1 5.1 4.7 8.2 4.8 6.5 5.4 6.0 4.7

(0.3)

(1.0)(0.3)(0.3)(0.7)(0.5)(0.6)(0.4)

 (0.7) (0.7) (0.3) (0.7) (0.5) (0.5) (0.5)

5.1

8.94.75.65.93.77.54.1

 3.9 8.3 4.2 4.8 5.6 5.7 3.4

(0.3)

(1.0)(0.3)(0.4)(0.7)(0.4)(0.7)(0.3)(0.7)(0.7)

 

(0.3) 

(0.6)(0.6)(0.6)(0.4)

2.5

3.02.53.12.01.32.82.41.42.92.6

 1.4 3.1 2.9 2.1

(0.2)

(0.7)(0.2)(0.3)(0.3)(0.2)(0.4)(0.2)(0.3)(0.4)(0.2)

(0.3)

 (0.4) (0.4) (0.4)

4.3

7.44.04.74.14.04.74.12.87.33.4

5.14.64.82.7 

(0.3)

(1.2)(0.3)(0.4)(0.6)(0.4)(0.5)(0.3)(0.5)(0.7)(0.3)

(0.6)(0.5)(0.5)(0.4) 

Percent (standard error)4

2.3 (0.2) 4.4 (0.3)

4.0 (0.7) 5.6 (0.9)2.1 (0.2) 4.2 (0.3)2.5 (0.2) 5.1 (0.4)2.7 (0.5) 4.5 (0.6)1.5 (0.3) 2.7 (0.4)2.9 (0.4) 6.3 (0.6)1.9 (0.2) 3.7 (0.3)1.3 (0.4) 2.5 (0.6)3.6 (0.4) 6.1 (0.6)2.0 (0.2) 3.9 (0.3)

1.9 (0.4) 3.1 (0.5)2.7 (0.4) 5.3 (0.6)2.8 (0.4) 5.7 (0.5)1.1 (0.2) 2.5 (0.4) 

 

 

 

4.6

8.44.24.65.14.85.44.12.97.43.7

5.14.54.63.9 

(0.3)

(1.2)(0.3)(0.4)(0.7)(0.4)(0.5)(0.3)(0.5)(0.7)(0.3)

(0.6)(0.5)(0.5)(0.5) 

2.8

5.62.53.03.42.24.52.12.44.32.2

2.63.23.31.5 

(0.3)

(0.9)(0.2)(0.3)(0.5)(0.3)(0.5)(0.2)(0.6)(0.4)(0.2)

(0.4)(0.4)(0.4)(0.3)

5.0

4.95.06.14.22.75.84.43.55.25.2

3.14.94.7

 6.0

 

 

(0.2)

(0.8)(0.3)(0.4)(0.5)(0.4)(0.2)(0.3)(0.6)(0.5)(0.3)

(0.5)(0.5)(0.4)(0.6) 

5.3

6.95.15.65.64.76.25.14.58.24.5

6.55.46.23.6 

(0.3)

(0.9)(0.3)(0.3)(0.6)(0.5)(0.5)(0.3)(0.6)(0.7)(0.3)

(0.7)(0.5)(0.5)(0.4) 

4.6

7.34.45.25.13.15.74.02.87.83.9

4.15.05.23.2 

(0.3)

(0.9)(0.3)(0.3)(0.7)(0.4)(0.6)(0.3)(0.6)(0.7)(0.3)

(0.6)(0.5)(0.5)(0.4) 


 


 


 


 


 


 
 

ver had a diagnosis of ADHD and have never had a diagnosis of LD.

ver had a diagnosis of LD and have never had a diagnosis of ADHD.

gnosis of both ADHD and LD.

uded in denominators used for the calculation of percentages and standard

ther races because of small sample size.

p, and foster parents. Data are not shown for children in other family types

aid.

ance, those with non-Medicaid public insurance, and those with both private

hool equivalency diploma.

Survey.

errors.
 

because of

and public

small sample size.

insurance.
 


 

Series 10, Number 237[ Page 11
Page 12 [ Series 10, Number 237

Table 3. Selected health conditions among children 6–17 years of age, by diagnostic group, sex, and age group: United States, 2004–2006

Neither1 ADHD without LD2 LD without ADHD3 Both4

Health conditions (N = 19,973) (N = 1,032) (N = 1,124) (N = 840)

All youth

Mental retardation or other developmental delay6 . . .

Hearing or vision problems7 ................

Allergies8 ............................

Asthma9 ............................

Other chronic health conditons10 .............

Boys

Mental retardation or other developmental delay6 . . .

Hearing or vision problems7 ................

Allergies8 ............................

Asthma9 ............................

Other chronic health conditons10 .............

Girls

Mental retardation or other developmental delay6 . . .

Hearing or vision problems7 ................

Allergies8 ............................

Asthma9 ............................

Other chronic health conditons10 .............

6–11 years of age

Mental retardation or other developmental delay6 . . .

Hearing or vision problems7 ................

Allergies8 ............................

Asthma9 ............................

Other chronic health conditons10 .............

12–17 years of age

Mental retardation or other developmental delay6 . . .

Hearing or vision problems7 ................

Allergies8 ............................

Asthma9 ............................

Other chronic health conditons10 .............

1.2

2.8

26.8

13.7

3.6

1.6

2.8

27.4

15.9

3.3

0.9

2.6

26.2

11.5

3.9

1.5

2.4

27.1

13.1

3.1

1.0

3.0

26.5

14.2

4.2

(0.1)

(0.2)

(0.4)

(0.3)

(0.2)

(0.2)

(0.2)

(0.6)

(0.5)

(0.2)

(0.1)

(0.2)

(0.5)

(0.4)

(0.2)

(0.2)

(0.2)

(0.6)

(0.4)

(0.2)

(0.1)

(0.2)

(0.5)

(0.4)

(0.2)

6.5

4.5

36.8

22.0

5.7

6.8

4.7

36.8

22.8

5.3

5.8

4.1

36.7

19.7

6.8

8.9

3.3

40.5

22.5

6.0

4.5

5.6

33.8

21.6

5.5

Percent

(0.9)

(0.8)

(1.8)

(1.6)

(0.9)

(1.0)

(1.0)

(2.2)

(1.9)

(1.1)

(1.9)

(1.4)

(3.5)

(3.1)

(1.7)

(1.5)

(1.0)

(2.8)

(2.4)

(1.3)

(1.0)

(1.3)

(2.3)

(2.1)

(1.2)

(standard error)5

36.6

6.3

39.1

20.8

12.6

37.1

6.4

40.5

23.1

13.3

35.9

6.3

37.1

17.6

11.7

41.2

5.6

37.6

21.3

13.1

32.8

6.9

40.3

20.3

12.2

(1.9)

(0.9)

(1.8)

(1.4)

(1.2)

(2.3)

(1.2)

(2.3)

(1.9)

(1.6)

(3.0)

(1.3)

(2.9)

(2.2)

(1.9)

(2.8)

(1.3)

(2.7)

(2.1)

(1.9)

(2.5)

(1.2)

(2.4)

(2.0)

(1.6)

30.8

9.6

42.8

22.2

12.4

29.9

8.5

40.4

24.1

11.5

32.8

12.2

48.3

17.6

14.3

34.4

10.3

48.4

21.5

14.1

28.7

9.2

39.6

22.5

11.4

(2.1)

(1.3)

(2.1)

(1.9)

(1.4)

(2.4)

(1.5)

(2.5)

(2.4)

(1.6)

(3.7)

(2.6)

(3.9)

(2.7)

(2.9)

(3.4)

(2.1)

(3.6)

(2.8)

(2.6)

(2.6)

(1.6)

(2.7)

(2.5)

(1.7)

1

‘‘Neither’’ includes children who have never had a diagnosis of either ADHD or LD.

2

‘‘ADHD without LD’’ includes children who have ever had a diagnosis of ADHD and have never had a diagnosis of LD.

3

‘‘LD without ADHD’’ includes children who have ever had a diagnosis of LD and have never had a diagnosis of ADHD.

4

‘‘Both’’ includes children who have ever had a diagnosis of both ADHD and LD.

5

Unknowns for the variables of interest are not included in denominators used for the calculation of percentages and standard errors.

6

Parental report of diagnosed mental retardation, other developmental delay, autism, or Down syndrome.

7

Parental report of blindness, deafness, or serious difficulty seeing or hearing.

8

Parental report of a digestive allergy, skin allergy, hay fever, respiratory allergy, or frequent ear infections (three or more) during the past 12

9

Parental report of ever having a diagnosis of asthma.

10Parental report of diagnosed cerebral palsy, muscular dystrophy, cystic fibrosis, sickle cell anemia, diabetes, arthritis, or heart disease; also

seizures during the past 12 months.

NOTES: ADHD is attention deficit hyperactivity disorder. LD is learning disability. N is sample size.

SOURCE: CDC/NCHS, National Health Interview Survey.

months.

a parental report of frequent diarrhea or colitis, anemia, or
Series 10, Number 237 [ Page 13

Table 4. Use of selected educational and health care services among children 6–17 years of age, by diagnostic group, sex, and age group:

United States, 2004–2006

Neither1 ADHD without LD2 LD without ADHD3 Both4

Educational and health care services (N = 19,973) (N = 1,032) (N = 1,124) (N = 840)

All children Percent (standard error)5

Received special education .......................... 2.4 (0.1) 14.6 (1.3) 56.1 (1.9) 59.3 (2.1)

Received special education for emotional behavioral problem6 .... †

0.3 (0.0) 9.4 (1.0) 9.1 (1.1) 31.0 (2.0)

Contacted a mental health professional7 .................. 4.0 (0.2) 31.7 (1.8) 19.7 (1.4) 46.2 (2.2)

Used prescription medication8

......................... 10.6 (0.3) 56.9 (1.9) 24.7 (1.6) 62.7 (2.0)

Contacted a medical specialist9........................ 12.3 (0.3) 18.7 (1.5) 25.7 (1.7) 30.4 (2.0)

Contacted a therapist10............................. 4.4 (0.2) 7.6 (1.1) 25.5 (1.7) 22.7 (1.7)

Had four or more health care visits11 .................... 21.7 (0.4) 47.7 (1.9) 41.4 (1.8) 56.7 (2.1)

Saw a general doctor for an emotional or behavioral problem12 .... 1.8 (0.1) 25.8 (1.7) 11.4 (1.2) 33.7 (2.2)

Boys

Received special education .......................... 2.9 (0.2) 16.4 (1.6) 55.2 (2.4) 59.4 (2.5)

Received special education for emotional behavioral problem6 .... 0.4 (0.1) 11.0 (1.3) 9.8 (1.3) 32.3 (2.5)

Contacted a mental health professional7 .................. 3.4 (0.2) 33.3 (2.1) 19.7 (1.8) 46.0 (2.7)

Used prescription medication8

......................... 10.5 (0.4) 58.0 (2.2) 25.2 (2.1) 63.9 (2.4)

Contacted a medical specialist9........................ 12.5 (0.4) 20.5 (1.8) 27.8 (2.1) 27.8 (2.3)

Contacted a therapist10............................. 4.9 (0.4) 8.1 (1.3) 26.6 (2.0) 22.3 (2.1)

Had four or more health care visits11 .................... 20.0 (0.5) 45.6 (2.3) 39.3 (2.2) 56.8 (2.6)

Saw a general doctor for an emotional or behavioral problem12 .... 1.8 (0.2) 26.8 (2.0) 10.8 (1.5) 34.2 (2.6)

Girls

Received special education .......................... 1.9 (0.2) 9.5 (1.9) 57.3 (2.9) 59.1 (3.8)

Received special education for emotional behavioral problem6 .... ‡

0.2 (0.1) 4.8 (1.3) 8.2 (1.8) 28.0 (3.4)

Contacted a mental health professional7 .................. 4.5 (0.3) 27.1 (3.2) 19.6 (2.3) 46.8 (3.9)

Used prescription medication8

......................... 10.7 (0.4) 53.9 (3.6) 23.9 (2.5) 59.8 (3.8)

Contacted a medical specialist9........................ 12.2 (0.4) 13.4 (2.5) 22.8 (2.7) 36.3 (3.8)

Contacted a therapist10............................. 3.9 (0.2) 6.3 (2.0) 24.1 (2.9) 23.7 (3.4)

Had four or more health care visits11 .................... 23.3 (0.6) 53.5 (3.5) 44.4 (3.0) 56.5 (3.8)

Saw a general doctor for an emotional or behavioral problem12 .... 1.8 (0.2) 22.8 (3.1) 12.3 (1.9) 32.6 (3.9)

6–11 years of age

Received special education .......................... 3.1 (0.2) 14.9 (1.8) 58.6 (2.8) 60.0 (3.5)

Received special education for emotional behavioral problem6 .... ‡

0.3 (0.1) 10.6 (1.6) 9.3 (1.4) 33.1 (3.4)

Contacted a mental health professional7 .................. 3.4 (0.2) 35.5 (2.7) 19.9 (2.1) 53.7 (3.4)

Used prescription medication8

......................... 9.6 (0.4) 65.9 (2.9) 23.4 (2.4) 66.4 (3.3)

Contacted a medical specialist9........................ 11.0 (0.4) 17.0 (2.0) 26.5 (2.6) 30.2 (3.2)

Contacted a therapist10............................. 4.7 (0.3) 9.8 (1.7) 36.1 (2.9) 32.8 (3.3)

Had four or more health care visits11 .................... 21.9 (0.5) 54.9 (3.0) 43.9 (2.8) 59.7 (3.5)

Saw a general doctor for an emotional or behavioral problem12 .... 1.8 (0.2) 34.0 (2.7) 12.0 (1.7) 38.3 (3.5)

12–17 years of age

Received special education .......................... 1.6 (0.2) 14.4 (1.8) 54.0 (2.5) 58.8 (2.7)

Received special education for emotional behavioral problem6 .... ‡

0.3 (0.1) 8.4 (1.4) 8.9 (1.6) 29.8 (2.6)

Contacted a mental health professional7 .................. 4.5 (0.3) 28.4 (2.2) 19.5 (1.9) 41.9 (2.8)

Used prescription medication8

......................... 11.6 (0.4) 49.4 (2.6) 25.7 (2.1) 60.5 (2.6)

Contacted a medical specialist9........................ 13.6 (0.4) 20.1 (2.0) 25.1 (2.4) 30.5 (2.5)

Contacted a therapist10............................. 4.1 (0.2) 5.8 (1.3) 16.9 (1.8) 16.9 (2.0)

Had four or more health care visits11 .................... 21.5 (0.5) 41.6 (2.5) 39.4 (2.4) 55.0 (2.7)

Saw a general doctor for an emotional or behavioral problem12 .... 1.8 (0.2) 18.9 (2.0) 11.0 (1.6) 31.0 (2.6)

† The standard error is 0.04.

‡ Estimate meets standards of reliability and precision. When expressed to two decimal places the relative standard error of the estimates is 30% or less.
 

1

‘‘Neither’’ includes children who have never had a diagnosis of either ADHD or LD.
 

2

‘‘ADHD without LD’’ includes children who have ever had a diagnosis of ADHD and have never had a diagnosis of LD.
 

3

‘‘LD without ADHD’’ includes children who have ever had a diagnosis of LD and have never had a diagnosis of ADHD.
 

4

‘‘Both’’ includes children who have ever had a diagnosis of both ADHD and LD.
 

5

Unknowns for the variables of interest are not included in denominators used for the calculation of percentages and standard errors.
 

6

Received special education services because of an emotional or behavioral problem.
 

7

Saw or spoke to a mental health professional such as a psychiatrist, psychologist, psychiatric nurse, or clinical social worker during the past 12 months.
 

8

Has a condition for which prescription medication had been taken regularly for at least 3 months.
 

9

Saw or spoke to a medical specialist (other than a gynecologist, psychiatrist, or opthamologist) during the past 12 months.
 

10Saw or spoke to a physical therapist, speech therapist, respiratory therapist, audiologist, or occupational therapist.
 

11Four or more visits to a doctor or other health professional during the past 12 months; overnight hospitalizations, emergency room visits, home visits, or telephone calls are not included.
 

12Saw or spoke to a general doctor because of an emotional or behavioral problem during the past 12 months.
 

NOTES: ADHD is attention deficit hyperactivity disorder. LD is learning disability. N is sample size.

SOURCE: CDC/NCHS, National Health Interview Survey.
Page 14 [ Series 10, Number 237

Appendix I
 

Technical Notes

Source of data

NHIS is a cross-sectional household

interview survey with a complex survey

design. Each week a probability sample

of the civilian noninstitutionalized U.S.

population is interviewed by personnel

of the U.S. Census Bureau. Data are

collected continuously throughout the

year from households throughout the

contiguous United States, Hawaii, and

Alaska. Excluded from the sample are

persons residing in nursing homes or

other institutionalized settings, members

of the Armed Forces, and U.S. nationals

living aboard. Information is obtained

by self-report or proxy report about the

health, use of health care services, and

other characteristics of each household

member. For sample children, a family

member knowledgeable about the health

of the child is selected as the respondent

for the child.

In 1997, NHIS was redesigned, and

virtually all aspects of the questionnaire

were changed. A ‘‘Basic Module’’ was

developed consisting of five

questionnaire components—Household

Composition, Family Core, Sample

Adult Core, Sample Child Core, and

Recontact Information. This report uses

data collected for the sample child from

each household and draws upon results

from the following sections of the

Sample Child Core questionnaire:

conditions, limitation of activity and

health status, access to health care, and

health care provider contacts.

Information on the sociodemographic

characteristics of sample children used

in this report is from the Family Core

section of the NHIS questionnaire.

Precision of estimates

The relative standard error (RSE) of

an estimate was used as the criterion of

precision. The RSE was calculated by

dividing the standard error of each

estimate by the estimate itself and

multiplying this fraction by 100.

Estimates with a RSE of greater than

30% are shown in the tables of this

report with an asterisk (*), indicating

that these estimates do not meet the

NCHS standard of adequate precision

and stability. Standard errors in this

report were calculated using the

statistical package, SUDAAN, which

takes into account the complex

multistage sampling design.

Tests of significance

The test statistic used to determine

if the difference between two point

estimates was significantly different

from zero was

Z = |Xa – Xb

|

�(Sa

2 + Sb2

) .

Here Xa and Xb represent two point

imates, and Sa and Sb est are the standard

errors for these estimates. The critical

value indicating significance at the 0.05

level was 1.96. No adjustments were

made for multiple comparisons.

Percentages and standard errors rounded

to the second decimal place were used

in the tests of significance.

Definition of terms

Age—The child’s age in years at

last birthday.

ADHD—Parent report of a

diagnosis of attention deficit

hyperactivity disorder by a doctor or

health professional (also called attention

deficit disorder or ADD). A condition

characterized by problems with

attention, impulsiveness, hyperactivity,

school problems, and sometimes

aggression.

ADHD without LD—Parent report

of a diagnosis of attention deficit

hyperactivity disorder without a

diagnosis of learning disability.

Both—Parent report of a diagnosis

of attention deficit hyperactivity disorder

and learning disability.

Contact with health care

provider—Consultation with a

physician, nurse, or other person acting

under a physician’s supervision. The

consultation may be either in person or

by phone and for the purpose of

examination, diagnosis, treatment, or

advice.

Developmental delay—Significant

delay in one of several areas: physical

development, cognitive (mental)

development, social or emotional

development, or adaptive development.

DSM—The Diagnostic and

Statistical Manual of Mental Disorders

is the standard manual for diagnosis of

mental disorders in the United States.

DSM-IV—Fourth edition of The

Diagnostic and Statistical Manual of

Mental Disorders.

Family—All people within a

household related to one another by

blood, marriage, or adoption. Mother

and father refer to biological, adoptive,

step, or foster parents.

Health care visit—Visits to a health

care professional; does not include

overnight hospitalization, emergency

room visits, home visits, or telephone

calls.

LD—Parent report of a diagnosis of

learning disability by a representative

from a school or a health professional.

LD without ADHD—Parent report

of a diagnosis of learning disability

without a diagnosis of attention deficit

hyperactivity disorder.

Medicaid—Health insurance at the

time of interview reported as Medicaid

or coverage under a state-sponsored

health program.

Mental retardation—Intellectual

functioning that is significantly below

average and results in problems with

adaptive behavior.

Neither—Parent report of a

diagnosis of neither attention deficit

hyperactivity disorder nor learning

disability.

NHANES—National Health and

Nutrition Examination Survey.

NHIS—National Health Interview

Survey.

NSCH—National Survey of

Children’s Health.

Special education—Special

education refers to special education

services paid for by the public school

system that may take place at a regular

school, special school, private school,

home, or hospital.
Vital and Health Statistics

series descriptions

SERIES 1.	 Programs and Collection Procedures—These reports

describe the data collection programs of the National Center

for Health Statistics. They include descriptions of the methods

used to collect and process the data, definitions, and other

material necessary for understanding the data.

SERIES 2.	 Data Evaluation and Methods Research—These reports

are studies of new statistical methods and include analytical

techniques, objective evaluations of reliability of collected

data, and contributions to statistical theory. These studies

also include experimental tests of new survey methods and

comparisons of U.S. methodology with those of other

countries.

SERIES 3.	 Analytical and Epidemiological Studies—These reports

present analytical or interpretive studies based on vital and

health statistics. These reports carry the analyses further than

the expository types of reports in the other series.

SERIES 4.	 Documents and Committee Reports—These are final

reports of major committees concerned with vital and health

statistics and documents such as recommended model vital

registration laws and revised birth and death certificates.

SERIES 5.	 International Vital and Health Statistics Reports—These

reports are analytical or descriptive reports that compare U.S.

vital and health statistics with those of other countries or

present other international data of relevance to the health

statistics system of the United States.

SERIES 6.	 Cognition and Survey Measurement—These reports are

from the National Laboratory for Collaborative Research in

Cognition and Survey Measurement. They use methods of

cognitive science to design, evaluate, and test survey

instruments.

SERIES 10.	 Data From the National Health Interview Survey—These

reports contain statistics on illness; unintentional injuries;

disability; use of hospital, medical, and other health services;

and a wide range of special current health topics covering

many aspects of health behaviors, health status, and health

care utilization. They are based on data collected in a

continuing national household interview survey.

SERIES 11.	 Data From the National Health Examination Survey, the

National Health and Nutrition Examination Surveys, and

the Hispanic Health and Nutrition Examination Survey—

Data from direct examination, testing, and measurement on

representative samples of the civilian noninstitutionalized

population provide the basis for (1) medically defined total

prevalence of specific diseases or conditions in the United

States and the distributions of the population with respect to

physical, physiological, and psychological characteristics, and

(2) analyses of trends and relationships among various

measurements and between survey periods.

SERIES 12.	 Data From the Institutionalized Population Surveys—

Discontinued in 1975. Reports from these surveys are

included in Series 13.

SERIES 13.	 Data From the National Health Care Survey—These

reports contain statistics on health resources and the public’s

use of health care resources including ambulatory, hospital,

and long-term care services based on data collected directly

from health care providers and provider records.

SERIES 14.	 Data on Health Resources: Manpower and Facilities—

Discontinued in 1990. Reports on the numbers, geographic

distribution, and characteristics of health resources are now

included in Series 13.

SERIES 15.	 Data From Special Surveys—These reports contain

statistics on health and health-related topics collected in

special surveys that are not part of the continuing data

systems of the National Center for Health Statistics.

SERIES 16.	 Compilations of Advance Data From Vital and Health

Statistics—Advance Data Reports provide early release of

information from the National Center for Health Statistics’

health and demographic surveys. They are compiled in the

order in which they are published. Some of these releases

may be followed by detailed reports in Series 10–13.

SERIES 20.	 Data on Mortality—These reports contain statistics on

mortality that are not included in regular, annual, or monthly

reports. Special analyses by cause of death, age, other

demographic variables, and geographic and trend analyses

are included.

SERIES 21.	 Data on Natality, Marriage, and Divorce—These reports

contain statistics on natality, marriage, and divorce that are

not included in regular, annual, or monthly reports. Special

analyses by health and demographic variables and

geographic and trend analyses are included.

SERIES 22.	 Data From the National Mortality and Natality Surveys—

Discontinued in 1975. Reports from these sample surveys,

based on vital records, are now published in Series 20 or 21.

SERIES 23.	 Data From the National Survey of Family Growth—These

reports contain statistics on factors that affect birth rates,

including contraception, infertility, cohabitation, marriage,

divorce, and remarriage; adoption; use of medical care for

family planning and infertility; and related maternal and infant

health topics. These statistics are based on national surveys

of women of childbearing age.

SERIES 24.	 Compilations of Data on Natality, Mortality, Marriage, and

Divorce—These include advance reports of births, deaths,

marriages, and divorces based on final data from the National

Vital Statistics System that were published as National Vital

Statistics Reports (NVSR), formerly Monthly Vital Statistics

Report. These reports provide highlights and summaries of

detailed data subsequently published in Vital Statistics of the

United States. Other special reports published here provide

selected findings based on final data from the National Vital

Statistics System and may be followed by detailed reports in

Series 20 or 21.

For answers to questions about this report or for a list of reports published

in these series, contact:

Information Dissemination Staff

National Center for Health Statistics

Centers for Disease Control and Prevention

3311 Toledo Road, Room 5412

Hyattsville, MD 20782

1-800-232-4636
 

E-mail: cdcinfo@cdc.gov
 

Internet: www.cdc.gov/nchs
 
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DHHS Publication No. (PHS) 2008–1565, Series 10, No. 237