ADHD diagnoses on the rise among working-age adults in the United States

New research published in the Journal of Attention Disorders reveals a significant increase in the number of working-age adults in the United States who report having ever been diagnosed with attention-deficit/hyperactivity disorder, or ADHD. The study found that nearly 14% of adults between the ages of 18 and 64 reported a past diagnosis, a figure substantially higher than estimates from just over a decade ago. Researchers also uncovered notable differences in diagnosis rates across various demographic groups, including sex, age, race, education level, and where people live.

For years, researchers have suspected that the number of adults diagnosed with ADHD has been climbing. However, solid data on this trend has been lacking. While studies have examined ADHD prevalence in adults using older data or data from other countries, up-to-date, nationally representative information for working-age adults in the U.S. has been scarce. It’s important to focus on this age group because ADHD can significantly affect many aspects of their lives, such as job performance, financial stability, relationships, overall health, and even risky behaviors.

To address this knowledge gap, researchers turned to a newly available resource: the 2023 National Wellbeing Survey. This survey offered a unique opportunity to get a current snapshot of self-reported ADHD diagnoses in this population. Around the time this study was being prepared for publication, another research group released similar estimates using a different data source. This led the researchers to compare their findings with these new estimates to provide a more complete picture of the current situation.

“There were several reasons to believe that the percentage of working-age adults who have been diagnosed with ADHD by a health care provider has increased over time. However, there is limited population-representative data to test that idea,” said study author Andrew S. London, associate dean for Maxwell Programs in DC and professor of sociology at Syracuse University.

“At the time we began this paper, we believed the National Wellbeing Survey was the only recent national data set that would allow such estimates to be made. While the paper was in review, another set of estimates became available. Hence, at the Editor’s and Reviewers’ suggestion, we spent considerable time in this paper talking about similarities and differences in the estimates obtained from the two studies. This research fills a major gap in the literature.”

The 2023 National Wellbeing Survey included responses from 7,053 working-age adults across the United States. This survey is conducted online annually and aims to represent the non-institutionalized adult population between 18 and 64 years old who can read English. Participants are recruited from online panels managed by a company called Qualtrics Panels. For the 2023 survey, a large number of panel members were contacted, and nearly 15,000 completed the survey.

To ensure the quality of the data, responses were checked for issues like rushing through the survey or giving the same answer repeatedly, and some responses were removed from the final dataset due to quality concerns. While online surveys often have lower response rates than traditional mail or phone surveys, the response rate for this survey was comparable to other national online surveys.

In the survey, participants were asked if a healthcare professional had ever told them they had any of a list of medical conditions, including “ADHD or Attention Deficit Disorder (ADD).” The researchers then analyzed the percentage of people who answered “yes” to this question. They looked at the overall percentage and also broke it down by different demographic characteristics such as sex (male or female), age group (18-29, 30-39, 40-49, and 50-64 years), race and ethnicity (White, Black/African American, Hispanic, Asian/Pacific Islander, and other/multiple race), whether they were born in the U.S. or not, education level (less than high school, high school graduate, some college, bachelor’s degree or higher), and urban or rural residence.

To ensure the survey results accurately reflected the U.S. working-age population, the researchers used statistical weights. These weights adjusted the sample to match the known demographics of this population in terms of sex, age, race, education, and urban/rural location.

Interestingly, the researchers noticed that the survey sample initially appeared less healthy than what is typically seen in national health surveys. Because health status can be related to ADHD, they made an additional adjustment to the weights to ensure the sample’s health profile was more in line with national averages, specifically matching the self-rated health distribution from the 2023 National Health Interview Survey. They then calculated the percentages of self-reported ADHD diagnoses using both the original weights and these adjusted weights.

The study’s primary finding was that 13.9% of working-age adults in the U.S. reported having ever received an ADHD diagnosis from a healthcare professional. This number is considerably higher than a 2012 estimate of 4.25% for a similar population and also higher than a recent estimate of 7.8% for all adults aged 18 and older in 2023 from the other study.

“It was somewhat surprising that the levels were as high as they were,” London told PsyPost. “That said, they seem consistent with rates of diagnosis in childhood plus the growth in new adult diagnoses. Thus, they seem plausible. The increase over time may reflect changes in diagnostic criteria for children and adults, greater acceptance of adult diagnosis, over- and mis-diagnosis, and methodological issues.”

The researchers found that diagnosis rates varied across all the demographic factors they examined. Women were more likely to report a diagnosis than men, although the difference was relatively small. Younger adults had much higher rates of diagnosis compared to older adults, with the highest rates in the 18-29 age group and the lowest in the 50-64 group. Non-Hispanic White adults had higher rates than other racial and ethnic groups. U.S.-born adults reported diagnoses more frequently than those born outside the U.S.

Individuals with less education were more likely to report an ADHD diagnosis than those with higher education levels. Finally, people living in mid-sized metropolitan areas (with populations between 250,000 and 1 million) had the highest rates, compared to those in the largest metropolitan areas (over 1 million population).

To put their findings in perspective, the researchers also analyzed data from the 2023 National Center for Health Statistics Rapid Surveys System, the same data source used in the other recent study. Using this dataset and focusing on working-age adults, they estimated a slightly lower prevalence of 9.6%. While this is still a substantial figure and higher than previous estimates, it is lower than the 13.9% found in the National Wellbeing Survey. The researchers point out that the difference might be due to variations in the specific online panels used for each survey, subtle differences in survey methods, and how quality control was handled in each study.

The researchers acknowledge that their study has some limitations. The National Wellbeing Survey, even with adjustments, may not perfectly represent the overall health of the U.S. population.

“The sample was drawn from an online panel and weighted to make it demographically representative of the population,” London noted. “We also adjusted the weight to enhance sample generalizability. There are better methodologies—gold-standard methodologies—for drawing probability samples of populations. Such samples are better for generalizing results to the population level.”

“While we have confidence in our estimates, we would like to see surveys that use the gold-standard sampling approach collect data on lifetime and current ADHD, as well as symptoms. This would allow for potentially more-precise estimates, validation of our estimates, and research on factors that are associated with ADHD. We are doing some of the work on factors association with ADHD now with the National Wellbeing Survey.”

Despite these limitations, this study offers valuable, up-to-date estimates of self-reported ADHD diagnoses among working-age adults in the U.S. These findings highlight a potential increase in diagnoses and significant demographic variations. The researchers hope their work will encourage further research to confirm these trends and better understand the reasons behind them.

“We would like to contribute current research on adult ADHD and its consequences across a range of life-course domains—health, substance use, marriage/family outcomes, etc,” London said. “The National Wellbeing Survey allows for that in a way that no other national, population-representative survey does. We hope this research will raise awareness, stimulate more data collection, and encourage others to do research in this area.”

The study, “Self-Reported ADHD Diagnosis Status Among Working-Age Adults in the United States: Evidence From the 2023 National Wellbeing Survey,” was authored by Andrew S. London, Shannon M. Monnat, and Iliya Gutin.