Mental Health (ADHD) Attention Deficit Hyperactivity Disorder I need a 2-3 page paper to include statistics, a separate cover page and reference page

Mental Health (ADHD) Attention Deficit Hyperactivity Disorder
I need a 2-3 page paper to include statistics, a separate cover page and reference page. on topic: Diagnostic Experiences of Children With Attention-Deficit/Hyperactivity Disorder (Article and RUA attached). I need all the yellow highlighted areas on the RUA addressed in the paper. I like to have completed by Friday 8/14/20 12pm.

National Health Statistics Reports
Number 81 September 3, 2015

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention

National Center for Health Statistics

Diagnostic Experiences of Children With
Attention-Deficit/Hyperactivity Disorder

by Susanna N. Visser, Dr.P.H., M.S., National Center on Birth Defects and Developmental Disabilities;
Benjamin Zablotsky, Ph.D., National Center for Health Statistics; and Joseph R. Holbrook, Ph.D., M.P.H.,

Melissa L. Danielson, M.S.P.H., and Rebecca H. Bitsko, Ph.D., National Center on Birth Defects and
Developmental Disabilities

Abstract
ObjectivesThis report describes the diagnostic experiences of a sample of

children in the United States diagnosed with attention-deficit/hyperactivity disorder
(ADHD) as of 20112012.

Data sourcesData were drawn from the 2014 National Survey of the Diagnosis
and Treatment of Attention-Deficit/Hyperactivity Disorder and Tourette Syndrome, a
follow-up to the 20112012 National Survey of Childrens Health.

ResultsThe 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 childs 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 childs doctor during the ADHD assessment.

Keywords: ADHD NSDATA national survey

Introduction
Parental reports indicate that more

than 1 in 10 school-aged children (11%;
6.4 million children) in the United States
have received a diagnosis of attention-
deficit/hyperactivity disorder (ADHD)
from a health care provider (1). The
percentage of children diagnosed with
ADHD increased steadily from 1997 to
2006 (2), and increased 42% from
20032004 to 20112012 (1). Reports

of these increases in the diagnosed
prevalence of ADHD have resulted in
discussions about the validity of ADHD
diagnoses in the United States more
generally (3). Describing the diagnostic
experiences of a representative sample of
U.S. children with ADHD is an important
step toward understanding how children
are diagnosed with ADHD in the United
States and helps to inform efforts that
seek to ensure that best practices are used

in the evaluation and diagnosis of the
disorder.

Recommendations for the evaluation
and diagnosis of ADHD are similar
across the American Academy of
Pediatrics (AAP) immediate past and
current clinical guidelines for ADHD
(4,5). These best practices guidelines
recommend performing a diagnostic
evaluation for ADHD using criteria from
the Diagnostic and Statistical Manual of
Mental Disorders (6,7) and assessing the
extent of the childs impairment and the
pervasiveness of the impairment across
multiple settings, while collecting
information from multiple informants
(e.g., parents, teachers, and other adults
involved in the childs care). The most
recent guidelines also include the
recommendation to involve the child as
an informant in the evaluation process, as
appropriate (5).

This report presents a national
description of the ADHD diagnostic
experience as reported by U.S. parents,
with a focus on assessing the alignment
between parent-reported characteristics
of the diagnostic experience and AAPs
recommendations for the evaluation and
diagnosis of ADHD. Comparisons are
made between the experiences of children
diagnosed before and after the age most
children enter school, given the special
considerations for diagnosing a child
under age 6 (5).

Page 2 National Health Statistics Reports Number 81 September 3, 2015

Methods
The data source for this report is the

2014 National Survey of the Diagnosis
and Treatment of ADHD and Tourette
Syndrome (NSDATA), a follow-up
to the 20112012 National Survey of
Childrens Health (NSCH). NSCH was
a nationally representative, random-
digit-dial telephone (both landline
and cell phone) survey of households
with children aged 017 in the United
States, which examined the physical
and emotional health of children.
NSDATA was a follow-up telephone
survey conducted 23 years later and
designed to collect information on
the early experiences associated with
the emergence and ultimate diagnosis
and treatment of ADHD and Tourette
syndrome (TS). NSCH and NSDATA
were conducted by the Centers for
Disease Control and Preventions (CDC)
National Center for Health Statistics
(NCHS) as modules of the State and
Local Area Integrated Telephone Survey
(SLAITS). NSDATA was sponsored by
CDCs National Center on Birth Defects
and Developmental Disabilities and by
NCHS.

Households eligible to be recontacted
for NSDATA had children aged 215
at the time of NSCH whose parents
or guardians (hereafter referred to as
parents) completed NSCH and reported
that they had once been told by a doctor
or other health care provider that their
child had ADHD or TS. Respondents for
NSDATA had to be currently living in
the same household as the sampled child
and be knowledgeable about the childs
health, but they did not need to be the
NSCH respondent. NSDATA consists of
two interview modules: one administered
to parents of children ever having ADHD,
and the other administered to parents
of children ever having TS. Parents
whose children had both conditions were
administered both interview modules.
A total of 2,976 ADHD and 115 TS
interviews were completed from January
to June 2014. The present report explores
data from the ADHD module.

The ADHD module included
questions about the diagnostic experience
of when the sample child was first
diagnosed with the disorder, presence
of co-occurring disorders, medication

and behavioral treatment for ADHD,
medication management and adherence,
and presence of ADHD symptoms and
impairment. Specific questions examined
in the present report include age at
diagnosis, type of diagnosing provider,
first individual concerned about the
sample childs behavior, and individuals
involved in the childs diagnostic
experience.

The sampled childs ADHD
diagnosis was confirmed during the
NSDATA screener (initial screening
portion of the interview), when parents
were asked, Has a doctor or other health
care provider ever told you that your
child had ADHD or ADD? If a parent
could not confirm the ADHD diagnosis,
the child was not eligible for NSDATA.
This screener question mirrored the
phrasing of the 20112012 NSCH
question when parents were asked,
Please tell me if a doctor or other health
care provider ever told you that your
child had Attention Deficit Disorder or
Attention-Deficit/Hyperactivity Disorder,
that is ADD or ADHD, even if he or she
does not have the condition now.

Estimates in this statistical analysis
are weighted by the NSDATA sampling
weight, which is based on the NSCH
sampling weight with adjustments
for known survey response biases
and further adjustments to ensure that
weighted estimates match demographic
control totals of the noninstitutionalized
population of children ever diagnosed
with ADHD between ages 2 and 15
from the 20112012 NSCH. As such,
all weighted estimates shown in this
report are intended to produce national
estimates of the noninstitutionalized
population of U.S. children with ADHD
as of the 20112012 NSCH. Sampling
weights were adjusted to account for
differential probabilities of selection,
nonresponse, and noncoverage. All
differences between children diagnosed
with ADHD before age 6 and those
diagnosed at ages 6 and over were tested
using bivariate logistic regression. All
differences with a p value less than 0.05
were considered statistically significant.
Statistical analyses were conducted using
Stata 13.1 (8).

The NSDATA response rate was
47.2%. Accounting for the 23.0% overall
NSCH response rate, the overall

NSDATA response rate was 10.9%.
When only noncooperation among
successfully recontacted eligible
households was examined, more than
four out of five eligible households
(80.8%) completed the survey.

Estimates based on telephone
surveys with low response rates may
be unreliable due to selection biases
resulting from sampling, nonresponse,
lack of coverage of households without
telephones, and respondent classification
and reporting errors. However, sample
weights were calculated in accordance
with best practices for sample surveys,
which included adjustments for
known demographic correlates of
nonresponse that have been shown to
minimize the potential for nonresponse
bias. Furthermore, the demographic
composition of the population of children
ever diagnosed with ADHD based on
NSDATA was compared with that of
children ever diagnosed with the disorder
based on the 20112012 NSCH and the
2011 and 2012 National Health Interview
Survey, with no differences found
(estimates not shown).

In addition, a nonresponse bias
analysis was performed, which suggested
that, although the potential for bias
cannot be ruled out, nonresponse bias in
weighted estimates is likely smaller than
sampling error (for details, see Technical
Notes at the end of this report).

For more information on NSCH and
NSDATA, including sample design, data
collection procedures, and questionnaire
content, please visit: http://www.cdc.gov/
nchs/slaits.htm.

Results
Parents were asked how old their

child was when you were first told by a
doctor or other health care provider that
he/she had ADHD? The median age at
ADHD diagnosis was 7 years, and about
one in three children (30.7%) was
diagnosed before age 6 (Figure 1).
Approximately three out of four children
(76.1%) were diagnosed with ADHD
before age 9.

Parents were instructed to think
about a time before their childs ADHD
diagnosis in order to provide
information on the first person who was
concerned with their childs behavior,

Figure 1. Childs age when parent was first told that child had ADHD, among children who
were aged 215 years in 20112012 and had a diagnosis of ADHD: United States, 2014

Aged 4 years
and under

16.1%

Aged 5 years
14.6%

Aged 6 years
17.1%

Aged 7 years
14.4%

Aged 8 years
13.9%

Aged 9 years
and over
23.9%

NOTES: ADHD is attention-deficit/hyperactivity disorder. Due to the age of eligible participants, the oldest age of
diagnosis that could be reported was 15 years.
SOURCE: CDC/NCHS, National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome, 2014.

http://www.cdc.gov/nchs/slaits.htm

http://www.cdc.gov/nchs/slaits.htm

National Health Statistics Reports Number 81 September 3, 2015 Page 3

NSDATA response rate was 10.9%.
When only noncooperation among
successfully recontacted eligible
households was examined, more than
four out of five eligible households
(80.8%) completed the survey.

Estimates based on telephone
surveys with low response rates may
be unreliable due to selection biases
resulting from sampling, nonresponse,
lack of coverage of households without
telephones, and respondent classification
and reporting errors. However, sample
weights were calculated in accordance
with best practices for sample surveys,
which included adjustments for
known demographic correlates of
nonresponse that have been shown to
minimize the potential for nonresponse
bias. Furthermore, the demographic
composition of the population of children
ever diagnosed with ADHD based on
NSDATA was compared with that of
children ever diagnosed with the disorder
based on the 20112012 NSCH and the
2011 and 2012 National Health Interview
Survey, with no differences found
(estimates not shown).

In addition, a nonresponse bias
analysis was performed, which suggested
that, although the potential for bias
cannot be ruled out, nonresponse bias in
weighted estimates is likely smaller than
sampling error (for details, see Technical
Notes at the end of this report).

For more information on NSCH and
NSDATA, including sample design, data
collection procedures, and questionnaire
content, please visit: http://www.cdc.gov/
nchs/slaits.htm.

Results
Parents were asked how old their

child was when you were first told by a
doctor or other health care provider that
he/she had ADHD? The median age at
ADHD diagnosis was 7 years, and about
one in three children (30.7%) was
diagnosed before age 6 (Figure 1).
Approximately three out of four children
(76.1%) were diagnosed with ADHD
before age 9.

Parents were instructed to think
about a time before their childs ADHD
diagnosis in order to provide
information on the first person who was
concerned with their childs behavior,

Figure 1. Childs age when parent was first told that child had ADHD, among children who
were aged 215 years in 20112012 and had a diagnosis of ADHD: United States, 2014

Aged 4 years
and under

16.1%

Aged 5 years
14.6%

Aged 6 years
17.1%

Aged 7 years
14.4%

Aged 8 years
13.9%

Aged 9 years
and over
23.9%

NOTES: ADHD is attention-deficit/hyperactivity disorder. Due to the age of eligible participants, the oldest age of
diagnosis that could be reported was 15 years.
SOURCE: CDC/NCHS, National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome, 2014.

attention or performance. For about two
out of three children diagnosed with
ADHD overall (64.7%), and for three out
of four diagnosed before age 6 (74.5%),
the first individual concerned about the
childs behavior, attention, or
performance was a family member,
which could include a parent (Figure 2).
Relative to children diagnosed at younger
ages, those diagnosed at older ages were
more likely to have had concern first
expressed by someone at school or
daycare (35.3%; p < 0.001), but less likely to have had concern expressed first by a family member (60.5%; p < 0.001) or other individual (4.2%; p < 0.05). The type of health care provider who first told parents that their child had ADHD was also examined (Figure 3). Approximately one-half of children with ADHD were first diagnosed by a primary care provider, including a pediatrician (39.0%) or general health physician (14.1%). Approximately one in four children diagnosed with ADHD before age 6 (23.7%) was first diagnosed by a psychiatrist; when diagnosed at an older age, children were less likely to be diagnosed by a psychiatrist Figure 2. Individual first concerned about childs behavior, attention, or performance, among children who were aged 215 years in 20112012 and had a diagnosis of ADHD, by childs age at diagnosis: United States, 2014 64.7 30.1 5.2 74.5 18.1 7.4 60.5 35.3 4.2 0 20 40 60 80 100 Family member1 Someone at school or daycare1 Other1 P er ce nt All children diagnosed with ADHD Diagnosed at ages 05 Diagnosed at ages 615 1 Significantly different by age at ADHD diagnosis (p < 0.05). NOTE: ADHD is attention-deficit/hyperactivity disorder. SOURCE: CDC/NCHS, National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome, 2014. (15.6%; p < 0.01). Approximately one in six children diagnosed at ages 6 and over (15.7%) was first diagnosed by a psychologist; when diagnosed at a younger age, children were less likely to be diagnosed by a psychologist (10.8%; p < 0.05). Children were equally likely to be diagnosed by a pediatrician, general health physician, or neurologist, regardless of age at ADHD diagnosis. Parents were asked a series of questions about the methods used by the diagnosing provider to assess their child for ADHD. They were also asked to recall whether a series of tools or methods were used by the diagnosing provider to ask about symptoms of ADHD and their impact on the child (Figure 4). Behavior rating scales or checklists were used for about 9 out of 10 children assessed for ADHD (89.9%), and this did not differ by age at diagnosis. For nearly all children, the diagnostic process included a conversation with a parent about their childs behavior (96.3%). These conversations were used less frequently among children diagnosed at ages 6 and over (p < 0.01), although the difference was small. Page 4 National Health Statistics Reports Number 81 September 3, 2015 Figure 3. Type of health care provider who first told parent that child had ADHD, among children who were aged 215 years in 20112012 and had a diagnosis of ADHD, by childs age at diagnosis: United States, 2014 39.0 37.4 39.7 14.1 12.2 15.0 14.2 10.8 15.7 18.0 23.7 15.6 4.9 6.7 4.1 19.7 9.2 9.9 0 20 40 60 80 100 Pediatrician General health physician Psychologist, outside school2 Psychiatrist 2 Neurologist Other All children diagnosed with ADHD Diagnosed at ages 05 Diagnosed at ages 615 P er ce nt 1Includes a small percentage of children (2.8%) who were first diagnosed by a school professional (i.e., school psychologist, school nurse, school counselor, or teacher). 2Significantly different by age at ADHD diagnosis (p < 0.05). NOTE: ADHD is attention-deficit/hyperactivity disorder. SOURCE: CDC/NCHS, National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome, 2014. The majority of children diagnosed with ADHD (68.0%) had undergone neuropsychological testing. More than three-quarters of children diagnosed before age 6 (76.4%), and nearly two-thirds diagnosed at ages 6 and over (64.3%), had received these psychological tests. Neuropsychological testing and medical tests were used significantly less frequently among children diagnosed at ages 6 and over, compared with those diagnosed at younger ages. Approximately one in three children (30.0%) received neurological imaging or laboratory tests as part of the diagnostic assessment, and this was more common among children diagnosed before age 6 (41.8%, compared with 25.0% for those aged 6 and over; p < 0.001). Parents were also asked a series of questions about which individuals the diagnosing provider collected information from in order to assess the child for ADHD (Figure 5). This could include individuals from the family, as well as those who were part of the childs community. Children were Figure 4. Methods used to assess for ADHD, among children who were aged 215 years in 20112012 and had a diagnosis of ADHD, by childs age at diagnosis: United States, 2014 89.9 96.3 68.0 30.0 91.5 98.5 76.4 41.8 89.2 95.3 64.3 25.0 0 20 40 60 80 100 Behavior rating scale or checklist Conversation with parent about behavior1 Neuropsychological testing1 Neurological imaging or laboratory tests1 P er ce nt 1 Significantly different by age at ADHD diagnosis (p < 0.05). NOTE: ADHD is attention-deficit/hyperactivity disorder. SOURCE: CDC/NCHS, National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome, 2014. All children diagnosed with ADHD Diagnosed at ages 05 Diagnosed at ages 615 National Health Statistics Reports Number 81 September 3, 2015 Page 5 Figure 5. Individuals from whom information was collected to assess child for ADHD, among children who were aged 215 years in 20112012 and had a diagnosis of ADHD, by childs age at diagnosis: United States, 2014 84.5 79.4 22.9 8.9 81.981.3 72.7 39.3 12.6 78.6 85.9 82.4 15.7 7.3 83.4 0 20 40 60 80 100 Child Teachers or school staff1 Childcare providers1 Other community members1 At least one adult outside the family P er ce nt 1 Significantly different by age at ADHD diagnosis (p < 0.05). NOTE: ADHD is attention-deficit/hyperactivity disorder. SOURCE: CDC/NCHS, National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome, 2014. All children diagnosed with ADHD Diagnosed at ages 05 Diagnosed at ages 615 typically included in this diagnostic process, including both children diagnosed before age 6 (81.3%) and those diagnosed at ages 6 and over (85.9%). Children first diagnosed before age 6 were more likely than those diagnosed at ages 6 and over to have childcare providers (39.3%; p < 0.001) or other community members (12.6%; p < 0.05) involved in the diagnostic process, whereas children first diagnosed at ages 6 and over were more likely to have teachers or school staff involved in the diagnostic process (82.4%; p < 0.01). For approximately four out of five children overall diagnosed with ADHD, and for children diagnosed before age 6 (78.6%) and at ages 6 and over (83.4%), adults outside the family provided input to the diagnostic process; this difference by age at diagnosis was not statistically significant. Children were equally likely to be involved in the diagnostic process, regardless of age at ADHD diagnosis. Summary and Discussion This report has presented a set of indicators related to the diagnosis of ADHD in a representative sample of U.S. children diagnosed with the disorder as of 20112012. According to data from NSDATA, the median age at ADHD diagnosis was 7 years. About one in three children was diagnosed before age 6an age at which there are few valid diagnostic tools to support diagnosis (5,9). Parents indicated that the first individual concerned about the childs behavior, attention, or performance was most often a family member, with someone at school or daycare being the first person concerned for approximately one-third of children with ADHD in this study. A variety of health care providers were involved in the ADHD diagnostic process, including pediatricians and general health physicians, psychiatrists, neurologists, and psychologists. About one-half of children with ADHD were first diagnosed by either a pediatrician or a general health physician, with the single largest group being those diagnosed by a pediatrician. The age at diagnosis was related to the type of diagnosing provider. Children diagnosed at ages 6 and over were less likely than those diagnosed before age 6 to be diagnosed by a psychiatrist; these children were more likely to be diagnosed by a psychologist than younger children with ADHD. Consistent with best practices (5), behavior rating scales were used for the vast majority of children (about 9 out of 10) assessed for ADHD. Additionally, more than three-quarters diagnosed before age 6 and nearly two-thirds diagnosed at ages 6 and over had undergone neuropsychological testing. For the majority of children (81.9%), at least one adult outside the family was involved in the diagnostic process. This suggests that one out of five children had a diagnosing provider who relied only on information collected from family members, which is inconsistent with the AAP guideline to collect information Page 6 National Health Statistics Reports Number 81 September 3, 2015 from individuals across multiple settings, including outside the home. This report characterizes select components of the ADHD diagnostic process among a national sample of children diagnosed with the disorder, including methods of assessment and assessment across multiple informants. These findings may be used to inform assessments of the alignment between clinical practice and the 2011 AAP clinical practice guidelines for ADHD (5). Study findings do suggest that among children diagnosed with ADHD as of 20112012, diagnosing providers regularly used behavior rating scales and checklists. Strengths and limitations This study used data from the largest national survey to date dedicated to the diagnostic and treatment experiences of children diagnosed with ADHD. Because of its size and breadth, the survey data allowed for the presentation of a set of diagnostic indicators as a function of age at diagnosis. Despite these strengths, the data and results presented in this report are subject to several limitations. One set of limitations is related to the time that elapsed between the identification of sample children who have ever received an ADHD diagnosis in the 20112012 NSCH and the time of the follow-up interview in 2014 (median was 29 months). As a result, only children who had received an ADHD diagnosis as of 20112012 were included in the eligible population; children who had received a diagnosis more recently are not represented in this followback survey population. Additionally, parents were reporting on a diagnostic experience that took place a minimum of 2 years earlier and thus may be subject to some degree of recall bias. Other limitations are that the parent-reported information has not been validated against medical records or clinical notes, and the results are limited to the noninstitutionalized population of children with ADHD, excluding any children living in psychiatric hospitals, juvenile justice centers, and other institutions. A final limitation is the surveys low response rate; for more information, please refer to the Technical Notes. References 1. Visser SN, Danielson ML, Bitsko RH, Holbrook JR, Kogan MD, Ghandour RM, et al. Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 20032011. J Am Acad Child Adolesc Psychiatry 53(1): 3446.e2. 2014. 2. Pastor PN, Reuben CA. Diagnosed attention deficit hyperactivity disorder and learning disability: United States, 20042006. National Center for Health Statistics. Vital Health Stat 10(237). 2008. Available from: http://www.cdc.gov/nchs/ data/series/sr_10/Sr10_237.pdf. 3. Walkup JT, Stossel L, Rendleman R. Beyond rising rates: Personalized medicine and public health approaches to the diagnosis and treatment of attention- deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 53(1):146. 2014. 4. American Academy of Pediatrics. Clinical practice guideline: Diagnosis and evaluation of the child with attention- deficit/hyperactivity disorder. Pediatrics 105(5):115870. 2000. 5. American Academy of Pediatrics. ADHD: Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics 128(5):100722. 2011. 6. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed., text revision (DSMIVTR). Washington, DC: APA. 2000. 7. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed. (DSMV). Washington, DC: APA. 2013. 8. StataCorp LP. Stata/SE (Release 13.1) [computer software]. 2014. 9. McGoey K, DuPaul G, Haley E, Shelton T. Parent and teacher ratings of attention- deficit/hyperactivity disorder in preschool: The ADHD Rating ScaleIV preschool version. J Psychopathol Behav Assess 29(4):26976. 2007. http://www.cdc.gov/nchs/data/series/sr_10/Sr10_237.pdf http://www.cdc.gov/nchs/data/series/sr_10/Sr10_237.pdf National Health Statistics Reports Number 81 September 3, 2015 Page 7 Technical Notes Response rate and analysis of nonresponse The overall response rate for the 2014 National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome (NSDATA) is the product of the response rate for NSDATA and the response rate for the 20112012 National Survey of Childrens Health (NSCH). Individually, the response rate for NSDATA was 47.2%, while the response rate for NSCH was 23.0%, for a combined response rate for the two surveys of 10.9%. The low response rate is partly due to the inclusion of cell phone samples in both surveys, to provide better coverage of the population of children. When only noncooperation among successfully recontacted eligible households was examined, more than four out of five eligible households (80.8%) completed the survey. To reduce the potential for nonresponse bias, the sampling weights were adjusted for nonresponse and further adjusted to match external demographic control totals for the population of children with ADHD who were aged 215 in the 20112012 NSCH. Because data from NSCH were available for both NSDATA respondents and nonrespondents, it was possible to adjust the weights precisely by those characteristics that differentiated NSDATA respondents and nonrespondents. Nonresponse bias analysis was conducted to examine estimates before and after the nonresponse weighting adjustment. Results indicated that bias was found to greatly decrease after the weighting adjustment, and estimated biases using the final weights tended to be smaller than sampling error. These results indicate that differences between survey respondents and survey nonrespondents should not have had a major impact on the conclusions in this report; however, the potential for such impact cannot be ruled out completely. Definitions of terms Attention-deficit/hyperactivity disorder (ADHD) diagnosisChildren included in the current report as ever having ADHD had parents or guardians who answered in the affirmative to two survey questions. The first, which appeared in the 20112012 NSCH, asked respondents to Please tell me if a doctor or other health care provider ever told you that your child had Attention Deficit Disorder or Attention-Deficit/ Hyperactivity Disorder, that is ADD or ADHD, even if he or she does not have the condition now. The second question was part of the 2014 NSDATA screener and asked the respondent (who did not need to be the NSCH respondent), Has a doctor or other health care provider ever told you that your child had ADHD or ADD? Children whose parents or guardians refused to answer either question, or who said they did not know the answer to either question, were not identified as ever having had ADHD. Diagnosing health care professionalRespondents were asked, What type of doctor or other health care provider first told you that [your child] had ADHD? Responses were coded into 18 provider categories. For this report, providers were categorized in the following groups: (a) pediatricians, which include developmental or behavioral pediatricians; (b) general health physicians, which include family practice doctors; (c) psychologists outside of school; (d) psychiatrists (medical doctors); (e) neurologists; and (f) other providers, which include nurse practitioners, occupational therapists, physical therapists, speech therapists, team of professionals or multidisciplinary team, doctors of unknown specialty, school psychologists, school counselors, school nurses and teachers, and other health care professionals. Concerned individuals Respondents were instructed to Think about the time before [your child]s ADHD diagnosis and then were asked, Who was the first person who was concerned with [your child]s behavior, attention, or performance? Concerned individuals were categorized as follows: (a) you or another family member, (b) someone at your childs school or daycare, (c) a doctor or healthcare professional not at your childs school, and (d) someone else. In this report, responses c and d were grouped into one category. Diagnostic testing methods NSDATA contained a series of questions asking respondents whether specific methods had been used to assess for ADHD. These included (a) a rating scale or checklist about the childs behavior; (b) a conversation with you about the childs behavior; (c) a series of tests to better understand how the child learns, reads, understands and processes information, also known as psychological tests; and (d) medical tests, such as an EEG, CT scan, MRI, or blood tests to test for lead exposure. If necessary, respondents were provided a defin