Epidemiology

In the introduction to their book, Shaywitz and Shaywitz (193) say that ADD is now recognized as the most common neurobehavioral disorder of children. It affects children from earliest infancy through school and into adult life. According to this article, estimates for ADD with or without HYP range from 10 to 20% (194). DSM-IV estimates the prevalence of ADHD to be much lower (3-5% in school-age children). Shekim et al. (195) report that symptoms of ADD/ADHD persist into adulthood in one-third to one half of subjects who receive this diagnosis in childhood, and that the overwhelming majority of adult subjects have other co-occurring diagnoses.

A problem that Barkley (184) pointed out in discussing the limitations of DSM-IV was that of diagnosing ADD/ADHD reliably in the preschool years. However, Palfrey et al. (196) had earlier evaluated children at eight checkpoints between birth and age four, and the writers report that 13% of the children met criteria for possible ADD/ADHD at one or more checkpoints. However, only 5% of the group evidenced definite symptoms that persisted into kindergarten. The peak age for the identification of symptoms was 3.5 yr. It is obviously dangerous to make a diagnosis of ADD/ADHD in the preschool years, because many young children demonstrate behaviors associated with this condition, which is in fact normal for their age. We simply do not have reliable information on the prevalence of ADD/ADHD in preschool children.

It is clear that prevalence can be made very low by imposing restrictive criteria, but if this were done it might exclude many children who need help. There is an inverse relation between prevalence and the severity of restrictive diagnostic criteria. Moreover, the identification of ADHD or LD in families living in poverty or near poverty is problematic. Symptoms of restlessness and inattentiveness could occur in children who are not adequately prepared for school, particularly if they have been reared in an environment in which the importance of learning has not been emphasized.

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