Geographic Analysis of Diagnosis of Attention-Deficit/Hyperactivity Disorder in Children: Eastern Wisconsin, USA

Objective: To perform a novel geographic analysis of Attention-Deficit/Hyperactivity Disorder (ADHD) diagnosis in Midwest United States. Method: Primary care children age 5–17 with ADHD diagnosis (N = 6833; 13.5%) were compared to those receiving well child care without ADHD diagnosis (N = 43,630) in a Wisconsin integrated medical system. Street addresses, demographic, and block group level U.S. Census 2000 data were mapped and analyzed using ArcGIS, CrimeStat III, and SaTScan. Lead levels from a State database were linked to 2,837 subjects. Univariate analysis was done by chi-square test or Mann-Whitney U test, multivariate analysis by logistic regression. Results: ADHD cases were 74% male (p = 0.0001), and more frequently diagnosed in White children (17.3%) than Blacks (10.6%), Hispanics (9.4%), or Asians (3.7%; all p values < 0.001). Overall, male gender, white race, lower block group median household income and population density, and greater distance to nearest park and airport were more predictive of ADHD (p values < 0.001). In urban Milwaukee County (865 cases/10,493 controls) male gender, white race, suburban residence, and younger age were more predictive of ADHD (p values < 0.01). Among children with ADHD diagnosis and linked lifetime lead values, those with a maximum level of 10 μg/dl or more differed significantly from controls (9.3% vs. 5.6%; p = 0.003); elevated lead remained a significant predictor of ADHD diagnosis in multivariate analysis. Conclusions: Further studies are needed to determine if geographic distribution of ADHD diagnosis can be partially explained by differential efficiency of referral for diagnosis by school districts, by race/ethnicity, and/or built environment.

[1]  A. Malone,et al.  The use of methylphenidate in Michigan. , 1996, Archives of pediatrics & adolescent medicine.

[2]  M. Kulldorff.  A spatial scan statistic , 1997 .

[3]  R. Bussing,et al.  Knowledge and information about ADHD: evidence of cultural differences among African-American and white parents. , 1998, Social science & medicine.

[4]  T. Belin,et al.  Differential access to care for children with ADHD in special education programs. , 1998, Psychiatric services.

[5]  L. Scahill,et al.  Epidemiology of ADHD in school-age children. , 2000, Child and adolescent psychiatric clinics of North America.

[6]  B. Crouse,et al.  Diagnosing childhood attention-deficit/hyperactivity disorder. Do family practitioners and pediatricians make the same call? , 2000, Minnesota medicine.

[7]  K. Gadow,et al.  Teacher reports of DSM-IV ADHD, ODD, and CD symptoms in schoolchildren. , 2001, Journal of the American Academy of Child and Adolescent Psychiatry.

[8]  J. Kendall,et al.  Racism as a source of health disparity in families with children with attention deficit hyperactivity disorder. , 2002, ANS. Advances in nursing science.

[9]  A. Erkanli,et al.  Psychiatric disorder, impairment, and service use in rural African American and white youth. , 2002, Archives of general psychiatry.

[10]  A. Rowland,et al.  The epidemiology of attention-deficit/hyperactivity disorder (ADHD): a public health view. , 2002, Mental retardation and developmental disabilities research reviews.

[11]  J. Rushton,et al.  Coding of pediatric behavioral and mental disorders. , 2002, Pediatrics.

[12]  F. Gary,et al.  Parental explanatory models of ADHD: gender and cultural variations. , 2003 .

[13]  F. E. Kuo,et al.  A potential natural treatment for attention-deficit/hyperactivity disorder: evidence from a national study. , 2004, American journal of public health.

[14]  S. Timimi,et al.  ADHD is best understood as a cultural construct , 2004, British Journal of Psychiatry.

[15]  Ethnic differences in ADHD and the mad/bad debate. , 2004, The American journal of psychiatry.

[16]  A. Pomerantz,et al.  How Does Clients' Method of Payment Influence Psychologists' Diagnostic Decisions? , 2004, Ethics & behavior.

[17]  S. Clark,et al.  Use of practice guidelines in the primary care of children with attention-deficit/hyperactivity disorder. , 2004, Pediatrics.

[18]  S. Timimi,et al.  A Critique of the International Consensus Statement on ADHD , 2004, Clinical child and family psychology review.

[19]  F. Gary,et al.  Barriers to detection, help-seeking, and service use for children with ADHD symptoms , 2003, The Journal of Behavioral Health Services & Research.

[20]  Patricia N. Pastor,et al.  Racial and Ethnic Differences in ADHD and LD in Young School-Age Children: Parental Reports in the National Health Interview Survey , 2005, Public health reports.

[21]  F. Gary,et al.  Exploring Help‐Seeking for ADHD Symptoms: A Mixed‐Methods Approach , 2005, Harvard review of psychiatry.

[22]  M. Rappley,et al.  Clinical practice. Attention deficit-hyperactivity disorder. , 2005, The New England journal of medicine.

[23]  Mental health in the United States. Prevalence of diagnosis and medication treatment for attention-deficit/hyperactivity disorder--United States, 2003. , 2005, MMWR. Morbidity and mortality weekly report.

[24]  L. Rohde,et al.  Attention-Deficit/Hyperactivity Disorder in a Diverse Culture: Do Research and Clinical Findings Support the Notion of a Cultural Construct for the Disorder? , 2005, Biological Psychiatry.

[25]  S. Faraone,et al.  Attention-deficit hyperactivity disorder , 2005, The Lancet.

[26]  S. Cha,et al.  Assessment and diagnosis of attention-deficit/hyperactivity disorder by family physicians. , 2006, Minnesota medicine.

[27]  P. Auinger,et al.  Exposures to Environmental Toxicants and Attention Deficit Hyperactivity Disorder in U.S. Children , 2006, Environmental health perspectives.

[28]  Jason S. Lanham.  The Evaluation of Attention Deficit/ Hyperactivity Disorder in Family Medicine Residency Programs , 2006, Southern medical journal.

[29]  T. Selden.  Compliance With Well-Child Visit Recommendations: Evidence From the Medical Expenditure Panel Survey, 2000–2002 , 2006, Pediatrics.

[30]  P. Remington,et al.  Health disparities in Milwaukee by socioeconomic status. , 2007, WMJ : official publication of the State Medical Society of Wisconsin.

[31]  B. J. Casey,et al.  Etiologic Subtypes of Attention-Deficit/Hyperactivity Disorder: Brain Imaging, Molecular Genetic and Environmental Factors and the Dopamine Hypothesis , 2007, Neuropsychology Review.

[32]  F. Middleton,et al.  Environmental risk factors for attention‐deficit hyperactivity disorder , 2007, Acta paediatrica.

[33]  B. Horta,et al.  The worldwide prevalence of ADHD: a systematic review and metaregression analysis. , 2007, The American journal of psychiatry.

[34]  Joseph Biederman,et al.  Attention-deficit/hyperactivity disorder: diagnosis, lifespan, comorbidities, and neurobiology. , 2007, Journal of pediatric psychology.

[35]  J Gordon Millichap,et al.  Etiologic Classification of Attention-Deficit/Hyperactivity Disorder , 2008, Pediatrics.

[36]  J. Nigg.  ADHD, lead exposure and prevention: how much lead or how much evidence is needed? , 2008, Expert review of neurotherapeutics.

[37]  W. Fremont,et al.  Comfort Level of Pediatricians and Family Medicine Physicians Diagnosing and Treating Child and Adolescent Psychiatric Disorders , 2008, International journal of psychiatry in medicine.

[38]  J. Nigg,et al.  Low Blood Lead Levels Associated with Clinically Diagnosed Attention-Deficit/Hyperactivity Disorder and Mediated by Weak Cognitive Control , 2008, Biological Psychiatry.

[39]  Nancy L Day,et al.  Developmental consequences of prenatal tobacco exposure , 2009, Current opinion in neurology.

[40]  C. Morley,et al.  Children, ADHD, and Citizenship , 2009, The Journal of medicine and philosophy.

[41]  R. Hornung,et al.  Association of Tobacco and Lead Exposures With Attention-Deficit/Hyperactivity Disorder , 2009, Pediatrics.

[42]  G. Salmon,et al.  Attention deficit hyperactivity disorder. , 2018, British journal of hospital medicine.

[43]  C. Morley.  The effects of patient characteristics on ADHD diagnosis and treatment: a factorial study of family physicians , 2010, BMC family practice.