Children in foster care are three times more likely to be diagnosed with attention deficit hyperactivity disorder (ADHD) than others, a new Centers for Disease Control and Prevention’s study finds.

Symptoms of ADHD include difficulty staying focused and paying attention, difficulty controlling behavior, and over-activity. The percentage of American children diagnosed with ADHD increased steadily from 1997 to 2006, and increased 42 percent from 2003–2004 to 2011–2012, Melissa Danielson, a statistician with the National Center on Birth Defects and Developmental Disabilities, and her colleagues explained in a previous study. Reports indicate that 11 percent of school-aged children in the United States (6.4 million children total) have received a diagnosis of ADHD from a health care provider. And, among children enrolled in Medicaid, ADHD is the most common behavioral health diagnosis.

For the current study, Danielson and her colleagues examined 2011 Medicaid outpatient and prescription drug claims from multiple states and uncovered a subset of children within Medicaid who suffer most from ADHD.

Psychological Help

More than a quarter of all children between the ages of 2 and 17 who were in foster care had received an ADHD diagnosis, compared to about one in 14 of all other children in Medicaid. Roughly half of the ADHD foster care children had also been diagnosed with another condition (such as depression or anxiety) in comparison to just one in three of the children diagnosed with ADHD in Medicaid.

The positives? About three quarters of the children with ADHD in foster care received some psychological care in 2011. In fact, they were as likely as others to be treated with medication yet even more likely to have received psychological services. This high proportion who already receive psychological services appears promising, since behavior therapy is recommended as the first-line treatment for preschoolers with ADHD, the researchers noted. (In school aged children, both medication and psychological therapy are recommended.)

In her previous more general investigation of ADHD among children, Danielson and her colleagues perused data from the 2014 National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome (NS–DATA) and a follow-up to the 2011–2012 National Survey of Children’s Health (NSCH). They found the median age at which children with ADHD were first diagnosed with the disorder was 7 years old, with one-third diagnosed before age 6 — “an age at which there are few valid diagnostic tools to support diagnosis,” wrote the researchers.

Most commonly, a family member (64.7 percent) expressed initial concern about a child with ADHD, but in almost one-third of the cases, someone from school or daycare discussed the issue first. For 18.1 percent of the children, only family members provided information to the child’s doctor during the assessment. Overall, in a majority of cases (53.1 percent), primary care physicians had been first to diagnose the child, though among kids diagnosed before age 6, a psychiatrist was more likely to have assessed the condition.

Source: Danielson M, Visser S, Loeb R. The Diagnosis and Treatment of ADHD Among Children in Foster Care Using Medicaid Claims Data, 2011. AAP. 2015.