The Prevalence of DSM-IV Attention-Deficit/Hyperactivity Disorder: A Meta-Analytic Review
Open accessAbstract
This article describes a comprehensive meta-analysis that was conducted to estimate the prevalence of attention-deficit/hyperactivity disorder (ADHD), as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). A systematic literature review identified 86 studies of children and adolescents (N = 163,688 individuals) and 11 studies of adults (N = 14,112 individuals) that met inclusion criteria for the meta-analysis, more than half of which were published after the only previous meta-analysis of the prevalence of ADHD was completed. Although prevalence estimates reported by individual studies varied widely, pooled results suggest that the prevalence of DSM-IV ADHD is similar, whether ADHD is defined by parent ratings, teacher ratings, or a best estimate diagnostic procedure in children and adolescents (5.9-7.1 %), or by self-report measures in young adults (5.0 %). Analyses of diagnostic subtypes indicated that the predominantly inattentive type is the most common subtype in the population, but individuals with the combined type are more likely to be referred for clinical services. Additional research is needed to determine the etiology of the higher prevalence of ADHD in males than females and to clarify whether the prevalence of ADHD varies as a function of socioeconomic status or ethnicity. Finally, there were no significant prevalent differences between countries or regions of the world after controlling for differences in the diagnostic algorithms used to define ADHD. These results provide important support for the diagnostic validity of ADHD, and argue against the hypothesis that ADHD is a cultural construct that is restricted to the United States or any other specific culture.
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Only one study documented the prevalence of ADHD in teenagers other than children.
“Only one study [76] documented the prevalence of ADHD in teenagers other than children, which is consistent with our findings.”
From The global prevalence of ADHD in children and adolescents: a systematic review and meta-analysis (2023) · cites this paper as [76]
Table 3 (Developmental Differences; page not available in our copy) reports ADHD prevalence for 13–18-year-olds from six samples, not one study. The Overall ADHD section likewise reports a prevalence estimate for adolescent samples. The citing authors’ statement about their own findings is not part of the attribution being judged. (LLM, conf=0.90)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredAmong youths, 5.9% satisfy diagnostic criteria for ADHD.
“A meta-analysis of 19 studies with over 55,000 participants found that 5.9% of youths meet diagnostic criteria for ADHD”
From The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder (2021) · cites this paper as Willcutt, 2012
The Overall ADHD section reports a 5.9% prevalence among children and adolescents when studies used best-estimate diagnoses. But Table 1 (under Summary and Conclusions) shows that the 19 studies with 55,125 participants used parent ratings and yielded 6.1%, not 5.9%; the citing sentence combines results from different analyses. Page numbers were not available in our copy. (LLM, conf=0.91)
Experimental — accuracy not yet measuredParents have been shown to have better diagnostic determination for ADHD than teachers, although a composite from multiple raters is better diagnostically than relying on one rater.
“Parents have been shown to have better diagnostic determination for ADHD than teachers (despite bias and reliability issues), although utilizing a composite from multiple raters is better diagnostically than relying on one rater (O’Neill, Schneiderman, Rajendran, Marks, & Halperin, 2014; Willcutt, 2012).”
From Sensitivity and Specificity of an Executive Function Screener at Identifying Children with ADHD and Reading Disability (2021) · cites this paper as Willcutt, 2012
The 'Diagnostic Algorithms Used by Studies Included in the Meta-Analysis' section (page unavailable) says parent and teacher raters identify partly nonoverlapping groups, supporting the value of considering more than one rater. The 'Algorithms to Combine Multiple Sources of Clinical Information' section (page unavailable) reports that one combined-rating rule had high positive predictive power, but missed many cases and concludes that no single algorithm is best for every purpose. The paper does not establish that parents are diagnostically better than teachers or that a multi-rater composite is generally better than one rater. (LLM, conf=0.84)
Experimental — accuracy not yet measuredSignificant heterogeneity across studies has previously been identified in systematic reviews and meta-analyses of ADHD prevalence in children and adults, mostly due to methodological differences.
“Significant heterogeneity across studies has previously been identified in systematic reviews and meta-analyses of ADHD prevalence in children and adults, mostly due to methodological differences (Polanczyk et al., 2007;Simon et al., 2009;Willcutt, 2012).”
From Prevalence of attention-deficit/hyperactivity disorder in older adults: a systematic review and meta-analysis (2020) · cites this paper as Willcutt, 2012
The Abstract (page unavailable) reports wide variation across studies of children and adolescents and says methodological factors accounted for a portion of that heterogeneity. The Summary and Conclusions (page unavailable) also notes widely varying estimates across the studies reviewed, including adult studies. Neither passage establishes that methodological differences explain most of the heterogeneity in both children and adults. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe prevalence of ADHD in children aged 6 to 12 years was 11.4% and in youngsters aged 12 to 18 years was 8% in a 2012 study.
“According to the findings of a 2012 study, the prevalence of ADHD in children aged 6 to 12 years was 11.4%, and in youngsters aged 12 to 18 years was 8%, which was slightly higher than our findings.”
From The global prevalence of ADHD in children and adolescents: a systematic review and meta-analysis (2023) · cites this paper as [76]
Table 3 (Developmental Differences in the Prevalence of DSM-IV ADHD; page not provided) reports 11.4% for ages 6–12 and 8.0% for ages 13–18. The quoted percentages match, but the source's older age group begins at 13, not 12. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Studies that require both a childhood-onset and adult symptoms report lower prevalence estimates than those that do not.
“Given the fact that studies that require both a childhood-onset and adult symptoms (persistent adult ADHD) report lower prevalence estimates than those that do not (symptomatic adult ADHD), it is necessary to separately provide prevalence estimates for those two distinct groups.”
From The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis (2021) · cites this paper as [16]
The sections “Estimated Prevalence Based Only on Symptom Criteria” and “Age-of-Onset by 7 Years of Age” show that adding diagnostic criteria, including childhood onset, reduces prevalence estimates among children. They do not compare persistent adult ADHD with symptomatic adult ADHD; the age-of-onset section explicitly says the community sample is not informative about cases emerging in adolescence or adulthood. Page numbers were not available in our copy. (LLM, conf=0.78)
Experimental — accuracy not yet measuredDefinitions of adult ADHD in epidemiological studies varied significantly.
“As indicated in the previous two systematic reviews of adult ADHD, the definitions of adult ADHD in epidemiological studies varied significantly.”
From The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis (2021) · cites this paper as [16]
The Abstract says ADHD diagnostic criteria changed significantly over time, and The Current Review describes studies using different criteria to define ADHD. But the passages do not establish that definitions varied significantly specifically among epidemiological studies of adults; the review’s detailed examples of differing methods largely concern children and adolescents. Page numbers are unavailable in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measuredEG Willcutt estimated that the pooled prevalence of adult ADHD was 5.0% based on 11 studies published between 1996 and 2011 when defining adult ADHD with DSM-IV criteria.
“When defining adult ADHD with the DSM-IV criteria, EG Willcutt estimated that the pooled prevalence of adult ADHD was 5.0% based on 11 studies published between 1996 and 2011 [15,16].”
From The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis (2021) · cites this paper as [16]
The Overall ADHD section reports a 5.0% prevalence estimate from 11 studies of people older than 18 using DSM-IV symptom thresholds. The Overview of the Literature Search and Meta-Analysis says the search covered studies published between 1994 and 2010, not 1996 and 2011; the claimed publication-year range is not supported by our copy. Page numbers are unavailable. (LLM, conf=0.88)
Experimental — accuracy not yet measuredImpaired executive functions are commonly observed in autism spectrum disorder and attention-deficit/hyperactivity disorder.
“Impaired EFs are commonly observed in two prevalent neurodevelopmental disorders8: autism spectrum disorder (ASD, 1 in 68 children diagnosed with ASD9) and attention-deficit/hyperactivity disorder (ADHD, up to 1 in 15 children diagnosed with ADHD10).”
From Heterogeneity of executive functions among comorbid neurodevelopmental disorders (2016) · cites this paper as [10]
In youths, the male-to-female ADHD ratio is about 2:1.
“A meta-analysis of parent ratings of symptoms in 29 studies with over 42,000 participants, and teacher ratings in 24 studies with over 56,000 participants, found a roughly two-to-one male/female ratio in youth”
From The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder (2021) · cites this paper as Willcutt, 2012
Males are more frequently affected by ADHD than females.
“ADHD occurs throughout the developed and developing world and is more common in males compared with females.”
From The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder (2021) · cites this paper as Willcutt, 2012
There is still reason to suspect that females are missed or delayed in diagnosis more often than males.
“Notwithstanding the biological evidence suggesting a male majority in ASD similar to other developmental conditions such as ADHD (Willcutt 2012), there is still reason to suspect that females are missed or delayed in diagnosis more often than males.”
From The Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond (2021) · cites this paper as Willcutt 2012
Hyperactivity is more observable in children than in adults.
“This reflects the findings on the development of ADHD symptoms from childhood to adulthood, demonstrating that hyperactivity is more observable in children than in adults [14, 83, 84].”
From Assessing ADHD symptoms in children and adults: evaluating the role of objective measures (2018) · cites this paper as [14]
These estimates are lower than previously identified pooled prevalence estimates based on validated scales: 2.5% in adults with mean age 34 and 5.0% in young adults.
“These estimates are lower than previously identified pooled prevalence estimates based on validated scales: 2.5 % (95 % CI = 2.1, 3.1) in adults with the mean age of 34, (Simon et al., 2009) and 5.0 % (95 % CI = 4.1, 6.2) in young adults (Willcutt, 2012).”
From Prevalence of attention-deficit/hyperactivity disorder in older adults: a systematic review and meta-analysis (2020) · cites this paper as Willcutt, 2012
V Simon and colleagues estimated that the pooled prevalence of adult ADHD was 2.5% based on six studies published between 1996 and 2005.
“Through a systematic review and meta-analysis of six studies published between 1996 and 2005, V Simon and colleagues estimated that the pooled prevalence of adult ADHD was 2.5%.”
From The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis (2021) · cites this paper as [16]
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- Authors
- Willcutt, E. G.
- Affiliations
- University of Colorado Boulder (US)
- Corresponding author
- Willcutt, Erik G.
- ORCID
- Willcutt, Erik G.
- Venue
- Neurotherapeutics
- Publisher
- Elsevier BV
- Published
- 2012-07
- Volume
- 9
- Issue
- 3
- Pages
- 490-499
- ISSN
- 1878-7479 (ISSN-L)
- PMC
- PMC3441936
- OpenAlex
- W2102388069
- Semantic Scholar
- 3dc62515c876d6d3779838891645696284acfdaf
- Cited by
- 2,160
- References
- 35
- Citations by year
- 2026: 93 · 2025: 157 · 2024: 153 · 2023: 199 · 2022: 173 · 2021: 180 · 2020: 245 · 2019: 141 · 2018: 169 · 2017: 161 · 2016: 200 · 2015: 140 · 2014: 99 · 2013: 44 · 2012: 3
- FWCI
- 12.35
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Neurotherapeutics (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Institute of Mental Health (P50MH079485, P50MH79485, R01MH063207, R01MH63941, R01 MH62120, R01MH063941, R01MH062120, R01 MH 63207, R01MH070037)
- National Institute on Drug Abuse (R01 DA 24002, R01DA024002)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD068728, R01HD047264, P50-HD27802, R01 HD 68728, R01 HD 47264, R24HD075460, P50HD027802)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Keywords
- attention deficit hyperactivity disorder, ADHD prevalence, DSM-IV diagnostic criteria, children and adolescents, adults, predominantly inattentive type, combined type, sex differences, socioeconomic status, ethnicity, cross-cultural validity, diagnostic validity, parent and teacher ratings
- MeSH terms
- Algorithms, Attention Deficit Disorder with Hyperactivity, Humans, Prevalence, Databases, Factual, Diagnostic and Statistical Manual of Mental Disorders
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