Chronic School Absenteeism Among Children With Selected Developmental Disabilities: National Health Interview Survey, 2014–2016

September 26, 2018

Lindsey Black, NCHS Health Statistician

Questions for Lindsey Black, Health Statistician and Lead Author of “Chronic School Absenteeism Among Children With Selected Developmental Disabilities: National Health Interview Survey, 2014–2016

Q: Why did you decide to focus on chronic school absenteeism among U.S. children with developmental disabilities for this report?

LB: DDs encompass a range of conditions that may have lifelong impacts on the functioning and wellbeing of children. In particular, developmental disabilities (DDs) can affect school adjustment, attendance and academic performance. Previous research has explored the relationships of DDs and school outcomes but have generally been limited in sample size and use aggregate mental health measures, rather than specific conditions.

This study aims to describe chronic school absenteeism among a nationally representative sample of children with selected DDs of autism spectrum disorder, intellectual disability, other developmental delay and attention-deficit/hyperactivity disorder (ADHD), in order to identify groups that may need additional supports.


Q: What is meant by chronic school absenteeism?

LB:  School absenteeism was categorized based on the survey question, “During the past 12 months, about how many days did (sample child) miss school because of illness or injury?” Responses of 15 or more days were categorized as chronic school absenteeism based on the U.S. Department of Education definition.


Q: How did the findings vary among the selected developmental disabilities?

LB: In this nationally representative sample of children aged 5–17 years, children with ADHD, autism spectrum disorder, and intellectual disability were more likely to have had chronic school absenteeism compared with children who did not have these conditions even after controlling for demographic and selected physical health conditions.

Similarly, as the number of DDs increased, the DDs of chronic school absenteeism increased. These findings show that both the type and number of DDs are associated with school attendance.


Q: What methods did you use to conduct this analysis?

LB: We calculated the weighted percentage of children who had chronic school absenteeism for each of the selected developmental disability groups. Next, separate unadjusted logistic regressions for each of the selected DDs as the dependent variable (and chronic absenteeism as the outcome) were calculated. Multivariate logistic regressions were also used to assess the association between children with selected DDs and chronic school absenteeism, adjusted by selected demographic characteristics and co-occurring physical health conditions.


Q: Is there any comparable trend data on this topic from previous National Health Interview Service data?

LB: This is the first report that specifically looks at chronic school absenteeism among developmental disabilities.  Data on number of school days missed due to illness or injury has been collected among children consistently since 1997.


Q: What is the take home message in this report?

LB: Children with DDs had higher chronic school absenteeism. Associations remained, controlling for demographics and co-occurring physical health conditions.

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QuickStats: Percentage of Children and Teens Aged 4–17 Years Ever Diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD), by Sex and Urbanization of County of Residence

June 19, 2017

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During 2013−2015, the percentage of children and teens aged 4–17 years who had ever received a diagnosis of ADHD was significantly higher among boys than among girls within all urbanization levels.

Among boys, those living in small metro and nonmetro micropolitan areas were more likely to have received a diagnosis of ADHD (17.4% and 16.4%, respectively) than were those living in large central (11.4%) and large fringe (12.7%) metropolitan areas.

Among girls, those living in large central areas were less likely to have received a diagnosis of ADHD (4.4%) than those living in each of the other five types of urban/rural areas.

Source: https://www.cdc.gov/mmwr/volumes/66/wr/mm6623a7.htm


Physician Office Visits for ADHD in Children and Adolescents Aged 4–17 Years: United States, 2012–2013

January 25, 2017

Questions for Michael Albert, Medical Officer and Lead Author on “Physician Office Visits for Attention-deficit/Hyperactivity Disorder in Children and Adolescents Aged 4–17 Years: United States, 2012–2013

Q: Did we learn anything new from this new report about the problem of Attention-deficit/Hyperactivity Disorder (ADHD) among children?

MA: Yes, this report provides a snapshot of health care utilization related to ADHD among children aged 4-17 years. Specifically, it looks at visits to physician offices and uses nationally representative data from the 2012-13 National Ambulatory Medical Care Survey.  Based on a sample of 946 visits by children aged 4-17 years with a primary diagnosis of ADHD, an estimated annual average of 6.1 million physician office visits were made by this age group during 2012-13, corresponding to a visit rate of 105 visits per 1,000 children.


Q:  Does your research back up the notion that boys are more commonly afflicted with ADHD than girls?

MA: Our analysis did find that among children aged 4-17 years with a primary diagnosis of ADHD, the visit rate was more than twice as high for boys as girls.


Q: Is it true that medication is very often involved in the treatment of ADHD?

MA: Central nervous system stimulant medications were provided, prescribed, or continued at approximately 80% of these ADHD visits.  A total of 29% of ADHD visits included a diagnostic code for an additional mental health disorder.  In terms of what specialty of physician provided care at these visits, it was a pediatrician at 48%, psychiatrist at 36%, and general and family medicine physician at 12%.


Q: Was it surprising that 80% of office visits for ADHD involve medication?

MA: It is important to interpret this finding carefully.  Because the National Ambulatory Medical Care Survey is a visit-based survey, as opposed to population based, estimates of persons cannot be made.  Thus, the finding should not be interpreted as indicating that 80% of children aged 4-17 years with ADHD are taking CNS stimulant medications. It is possible that patients taking CNS stimulant medications tend to make more physician office visits than those not taking these medications.  This might be in order to monitor the medication, or for other reasons such as differences in the severity of disease between those who take medication and those who do not.  Although the use of medication in children with ADHD in our survey cannot be directly compared with population-based surveys, there is evidence from the latter that medication is frequently used.  An analysis of parent-reported data from the National Survey of Children’s Health found that among children aged 4-17 years, 69% of children with current ADHD were taking medication for their ADHD (the specific medication was not identified).


Q: Anything else you’d like to address about the report?

MA: Again, we think the significance of this report lies in providing a snapshot of health care utilization related to ADHD in children that is nationally representative.  We chose to investigate several variables to in our analysis that are of interest and provide important information.


Diagnostic Experiences of Children With Attention-Deficit/Hyperactivity Disorder

September 4, 2015

A new NCHS report describes the diagnostic experiences of a sample of children in the United States diagnosed with attention-deficit/hyperactivity disorder (ADHD) as of 2011–2012.

Key Findings from the Report:

  • The median age at which children with ADHD were first diagnosed with the disorder was 7 years; one-third were diagnosed before age 6. Children with ADHD were diagnosed by a wide variety of health care providers, including primary care physicians and specialists.
  • Regardless of age at diagnosis, the majority of children (53.1%) were first diagnosed by primary care physicians. Notable differences were found by age at diagnosis for two types of specialists.
  • Children diagnosed before age 6 were more likely to have been diagnosed by a psychiatrist, and those diagnosed at ages 6 and over were more likely to have been diagnosed by a psychologist.
  • Among children diagnosed with ADHD, the initial concern about a child’s behavior was most commonly expressed by a family member (64.7%), but someone from school or daycare first expressed concern for about one-third of children later diagnosed with ADHD (30.1%).
  • For approximately one out of five children (18.1%), only family members provided information to the child’s doctor during the ADHD assessment.

 


Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4–17 Years: United States, 2011–2013

May 14, 2015

Attention deficit hyperactivity disorder (ADHD) is the most common neurobehavioral disorder diagnosed in U.S. children. While this disorder is most often diagnosed in children when they are in elementary school, it is increasingly being identified in preschool children.

A new NCHS report describes the prevalence of diagnosed ADHD among children aged 4–17 years using parent-reported data collected in a large, nationally representative health survey. Differences in the prevalence of diagnosed ADHD are examined by selected demographic and socioeconomic variables: the child’s sex, race and Hispanic ethnicity, health insurance coverage, and poverty status for all children aged 4–17 and among age groups 4–5, 6–11, and 12–17.

Key Findings from the Report:

  • In 2011–2013, 9.5% of children aged 4–17 years were ever diagnosed with attention deficit hyperactivity disorder (ADHD). For those aged 4–5, prevalence was 2.7%, 9.5% for those aged 6–11, and 11.8% for those aged 12–17.
  • Among all age groups, prevalence of ever diagnosed ADHD was more than twice as high in boys as girls.
  • Among those aged 6–17, prevalence was highest among non-Hispanic white children and lowest among Hispanic children.
  • Among all age groups, prevalence was higher among children with public insurance compared with children with private insurance.
  • Among children aged 4–11, prevalence was higher for children with family income less than 200% of the federal poverty threshold than for children with family income at 200% or more of the poverty threshold.