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Incidence, prevalence, and global burden of ADHD from 1990 to 2019 across 204 countries: data, with critical re-analysis, from the Global Burden of Disease study

Molecular Psychiatry volume 28, pages 4823–4830 (2023)Cite this article

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Abstract

Data on incidence, prevalence and burden of ADHD are crucial for clinicians, patients, and stakeholders. We present the incidence, prevalence, and burden of ADHD globally and across countries from 1990 to 2019 from the Global Burden of Disease (GBD) study. We also: (1) calculated the ADHD prevalence based on data actually collected as opposed to the prevalence estimated by the GBD with data imputation for countries without prevalence data; (2) discussed the GBD estimated ADHD burden in the light of recent meta-analytic evidence on ADHD-related mortality. In 2019, GBD estimated global age-standardized incidence and prevalence of ADHD across the lifespan at 0.061% (95%UI = 0.040–0.087) and 1.13% (95%UI = 0.831–1.494), respectively. ADHD accounted for 0.8% of the global mental disorder DALYs, with mortality set at zero by the GBD. From 1990 to 2019 there was a decrease of −8.75% in the global age-standardized prevalence and of −4.77% in the global age-standardized incidence. The largest increase in incidence, prevalence, and burden from 1990 to 2019 was observed in the USA; the largest decrease occurred in Finland. Incidence, prevalence, and DALYs remained approximately 2.5 times higher in males than females from 1990 to 2019. Incidence peaked at age 5–9 years, and prevalence and DALYs at age 10–14 years. Our re-analysis of data prior to 2013 showed a prevalence in children/adolescents two-fold higher (5.41%, 95% CI: 4.67–6.15%) compared to the corresponding GBD estimated prevalence (2.68%, 1.83–3.72%), with no significant differences between low- and middle- and high-income countries. We also found meta-analytic evidence of significantly increased ADHD-related mortality due to unnatural causes. While it provides the most detailed evidence on temporal trends, as well as on geographic and sex variations in incidence, prevalence, and burden of ADHD, the GBD may have underestimated the ADHD prevalence and burden. Given the influence of the GBD on research and policies, methodological issues should be addressed in its future editions.

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Fig. 1: Age standardized prevalence and DALY rates.
Fig. 2: Temporal trends.
Fig. 3: Age patterns.

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References

  1. Faraone SV, Banaschewski T, Coghill D, Zheng Y, Biederman J, Bellgrove MA, et al. The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder. Neurosci Biobehav Rev. 2021;128:789–818.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Sibley MH, Mitchell JT, Becker SP. Method of adult diagnosis influences estimated persistence of childhood ADHD: a systematic review of longitudinal studies. Lancet Psychiatry. 2016;3:1157–65.

    Article  PubMed  Google Scholar 

  3. Erskine HE, Ferrari AJ, Polanczyk GV, Moffitt TE, Murray CJ, Vos T, et al. The global burden of conduct disorder and attention-deficit/hyperactivity disorder in 2010. J Child Psychol Psychiatry. 2014;55:328–36.

    Article  PubMed  Google Scholar 

  4. Erskine HE, Ferrari AJ, Nelson P, Polanczyk GV, Flaxman AD, Vos T, et al. Epidemiological modelling of attention-deficit/hyperactivity disorder and conduct disorder for the Global Burden of Disease Study 2010. J Child Psychol Psychiatry. 2013;54:1263–74.

    Article  PubMed  Google Scholar 

  5. GBD 2019 Mental Disorders Collaborators. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019.Lancet Psychiatry. 2022;9:137–50.

    Article  PubMed Central  Google Scholar 

  6. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2163–96.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Cortese S, Faraone SV, Bernardi S, Wang S, Blanco C. Gender differences in adult attention-deficit/hyperactivity disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). J Clin Psychiatry. 2016;77:e421–428.

    Article  PubMed  Google Scholar 

  8. Abdelnour E, Jansen MO, Gold JA. ADHD diagnostic trends: increased recognition or overdiagnosis? Mo Med. 2022;119:467–73.

    PubMed  PubMed Central  Google Scholar 

  9. Vigo D, Thornicroft G, Atun R. Estimating the true global burden of mental illness. Lancet Psychiatry. 2016;3:171–8.

    Article  PubMed  Google Scholar 

  10. Stanton AV, Leroy F, Elliott C, Mann N, Wall P, De Smet S. 36-fold higher estimate of deaths attributable to red meat intake in GBD 2019: is this reliable? Lancet. 2022;399:e23–e26.

    Article  PubMed  Google Scholar 

  11. Dalsgaard S, Østergaard SD, Leckman JF, Mortensen PB, Pedersen MG. Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: a nationwide cohort study. Lancet. 2015;385:2190–6.

    Article  PubMed  Google Scholar 

  12. GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396:1204–22.

    Article  Google Scholar 

  13. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1545–602.

    Article  Google Scholar 

  14. Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA. The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry. 2007;164:942–8.

    Article  PubMed  Google Scholar 

  15. Polanczyk GV, Willcutt EG, Salum GA, Kieling C, Rohde LA. ADHD prevalence estimates across three decades: an updated systematic review and meta-regression analysis. Int J Epidemiol. 2014;43:434–42.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Thomas R, Sanders S, Doust J, Beller E, Glasziou P. Prevalence of attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Pediatrics. 2015;135:e994–1001.

    Article  PubMed  Google Scholar 

  17. Catalá-López F, Hutton B, Page MJ, Driver JA, Ridao M, Alonso-Arroyo A, et al. Mortality in persons with autism spectrum disorder or attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. JAMA Pediatr. 2022;176:e216401.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Song P, Zha M, Yang Q, Zhang Y, Li X, Rudan I. The prevalence of adult attention-deficit hyperactivity disorder: a global systematic review and meta-analysis. J Glob Health. 2021;11:04009.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Döpfner M, Breuer D, Wille N, Erhart M, Ravens-Sieberer U. How often do children meet ICD-10/DSM-IV criteria of attention deficit-/hyperactivity disorder and hyperkinetic disorder? Parent-based prevalence rates in a national sample-results of the BELLA study. Eur Child Adolesc Psychiatry. 2008;17:59–70.

    Article  PubMed  Google Scholar 

  20. Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006;163:716–23.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Nielsen B. Imitations and transformations. on side effects of the ADHD Epidemic. Med Anthropol. 2017;36:246–59.

    Article  PubMed  Google Scholar 

  22. Faraone SV, Sergeant J, Gillberg C, Biederman J. The worldwide prevalence of ADHD: is it an American condition? World Psychiatry. 2003;2:104–13.

    PubMed  PubMed Central  Google Scholar 

  23. Gershon J. A meta-analytic review of gender differences in ADHD. J Atten Disord. 2002;5:143–54.

    Article  CAS  PubMed  Google Scholar 

  24. Staller J, Faraone SV. Attention-deficit hyperactivity disorder in girls: epidemiology and management. CNS Drugs. 2006;20:107–23.

    Article  CAS  PubMed  Google Scholar 

  25. Lenzi F, Cortese S, Harris J, Masi G. Pharmacotherapy of emotional dysregulation in adults with ADHD: a systematic review and meta-analysis. Neurosci Biobehav Rev. 2018;84:359–67.

    Article  CAS  PubMed  Google Scholar 

  26. Shaw P, Stringaris A, Nigg J, Leibenluft E. Emotion dysregulation in attention deficit hyperactivity disorder. Am J Psychiatry. 2014;171:276–93.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Ezpeleta L, Keeler G, Erkanli A, Costello EJ, Angold A. Epidemiology of psychiatric disability in childhood and adolescence. J Child Psychol Psychiatry. 2001;42:901–14.

    Article  CAS  PubMed  Google Scholar 

  28. Sibley MH, Arnold LE, Swanson JM, Hechtman LT, Kennedy TM, Owens E, et al. Variable patterns of remission From ADHD in the multimodal treatment study of ADHD. Am J Psychiatry. 2022;179:142–51.

    Article  PubMed  Google Scholar 

  29. Faraone SV, Biederman J, Mick E. The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychol Med. 2006;36:159–65.

    Article  PubMed  Google Scholar 

  30. Faraone SV, Biederman J, Spencer T, Mick E, Murray K, Petty C, et al. Diagnosing adult attention deficit hyperactivity disorder: are late onset and subthreshold diagnoses valid? Am J Psychiatry. 2006;163:1720–9. quiz 1859

    Article  PubMed  Google Scholar 

  31. Faraone SV, Wilens TE, Petty C, Antshel K, Spencer T, Biederman J. Substance use among ADHD adults: implications of late onset and subthreshold diagnoses. Am J Addict. 2007;16:24–32. quiz 33-24

    Article  PubMed  Google Scholar 

  32. Ruiz-Goikoetxea M, Cortese S, Aznarez-Sanado M, Magallón S, Alvarez Zallo N, Luis EO, et al. Risk of unintentional injuries in children and adolescents with ADHD and the impact of ADHD medications: a systematic review and meta-analysis. Neurosci Biobehav Rev. 2018;84:63–71.

    Article  PubMed  Google Scholar 

  33. Kittel-Schneider S, Arteaga-Henriquez G, Vasquez AA, Asherson P, Banaschewski T, Brikell I, et al. Non-mental diseases associated with ADHD across the lifespan: Fidgety Philipp and Pippi Longstocking at risk of multimorbidity? Neurosci Biobehav Rev. 2022;132:1157–80.

    Article  PubMed  Google Scholar 

  34. Septier M, Stordeur C, Zhang J, Delorme R, Cortese S. Association between suicidal spectrum behaviors and attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Neurosci Biobehav Rev. 2019;103:109–18.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI22C1976; DKY) and National Research Foundation of Korea (NRF, MSIT; RS-2023-00248157; DKY). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Author information

Author notes

  1. These authors contributed equally: Samuele Cortese, Minjin Song, Luis C. Farhat, Dong Keon Yon, Seung Won Lee.

Authors and Affiliations

  1. Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK

    Samuele Cortese, Corentin J. Gosling & Marco Solmi

  2. Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK

    Samuele Cortese

  3. Solent NHS Trust, Southampton, UK

    Samuele Cortese

  4. Hassenfeld Children’s Hospital at NYU Langone, New York University Child Study Center, New York City, NY, USA

    Samuele Cortese

  5. Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK

    Samuele Cortese

  6. Yonsei University College of Medicine, Seoul, South Korea

    Minjin Song & Seoyeon Park

  7. Universidade de Sao Paulo, Sao Paulo, SP, Brazil

    Luis C. Farhat & Guilherme V. Polanczyk

  8. Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea

    Dong Keon Yon

  9. Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, South Korea

    Seung Won Lee

  10. Department of digital health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea

    Min Seo Kim

  11. Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Jae Won Oh & San Lee

  12. Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea

    San Lee

  13. Division of Child and Adolescent Psychiatry, Department of Psychiatry, Severance Hospital, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea

    Keun-Ah Cheon

  14. Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK

    Lee Smith

  15. DysCo Lab, Department of Psychology, Université Paris Nanterre, Nanterre, France

    Corentin J. Gosling

  16. Laboratoire de Psychopathologie et Processus de Santé, Université de Paris, Boulogne-Billancourt, France

    Corentin J. Gosling

  17. School of Medical Sciences, Örebro University, Faculty of Medicine and Health, Örebro, Sweden

    Henrik Larsson

  18. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

    Henrik Larsson

  19. ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clinica de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil

    Luis A. Rohde

  20. UNIEDUK, National Institute of Developmental Psychiatry, São Paulo, Brazil

    Luis A. Rohde

  21. Department of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA

    Stephen V. Faraone

  22. Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Barcelona, Spain

    Ai Koyanagi

  23. ICREA, Pg. Lluis Companys, Barcelona, Spain

    Ai Koyanagi

  24. Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden

    Elena Dragioti

  25. Institut d’Investigacions Biomediques August Pi i Sunyer, CIBERSAM, Instituto de Salud Carlos III, University of Barcelona, Barcelona, Spain

    Joaquim Radua

  26. IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Australia

    Andre F. Carvalho

  27. Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea

    Jae Il Shin

  28. Severance Underwood Meta-research Center, Institute of Convergence Science, Yonsei University, Seoul, Republic of Korea

    Jae Il Shin

  29. Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada

    Marco Solmi

  30. Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada

    Marco Solmi

  31. School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada

    Marco Solmi

  32. Ottawa Hospital Research Institute (OHRI), Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada

    Marco Solmi

  33. Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany

    Marco Solmi

  34. Research Laboratory Psychology of Patients, Families and Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece

    Elena Dragioti

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  1. Samuele Cortese
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  2. Minjin Song
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Contributions

All authors contributed and approved the study’s protocol. SC created the first draft of the manuscript. MS, LCF, DKY, SWL, MSK, SP, JWO, SL, and KAC extracted and analysed data. SC, MS, and JIS provided overall guidance. Finally, all authors read, edited, and approved the final version of the manuscript.

Corresponding authors

Correspondence to Samuele Cortese or Jae Il Shin.

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Competing interests

Dr. Cortese declares honoraria and reimbursement for travel and accommodation expenses for lectures from the following non- profit associations: Association for Child and Adolescent Central Health (ACAMH), Canadian ADHD Alliance Resource (CADDRA), British Association of Pharmacology (BAP), and from Healthcare Convention for educational activity on ADHD. Dr. Faraone received income, potential income, travel expenses continuing education support and/or research support from Aardvark, Aardwolf, Tris, Otsuka, Ironshore, KemPharm/Corium, Akili, Supernus, Atentiv, Noven, Sky Therapeutics, Axsome, Johnson & Johnson and Genomind. With his institution, he has US patent US20130217707 A1 for the use of sodium-hydrogen exchange inhibitors in the treatment of ADHD. He also receives royalties from books published by Guilford Press: Straight Talk about Your Child’s Mental Health, Oxford University Press: Schizophrenia: The Facts and Elsevier: ADHD: Non-Pharmacologic Interventions. He is Program Director of www.adhdinadults.com and www.ADHDEvidence.org. Dr. Larsson reports receiving grants from Shire Pharmaceuticals; personal fees from and serving as a speaker for Medice, Shire/Takeda Pharmaceuticals and Evolan Pharma AB; and sponsorship for a conference on attention-deficit/hyperactivity disorder from Shire/Takeda Pharmaceuticals and Evolan Pharma AB, all outside the submitted work. Dr. Polanczyk has served as a consultant/speaker to Abbott, Ache, Medice, Novo Nordisk, and Takeda, and has received royalties from Editora Manole. Dr. Rohde has received grant or research support from, served as a consultant to, and served on the speakers’ bureau of Abbott, Aché, Bial, Medice, Novartis/Sandoz, Pfizer/Upjohn, and Shire/Takeda in the last three years. The ADHD and Juvenile Bipolar Disorder Outpatient Programs chaired by Dr Rohde have received unrestricted educational and research support from the following pharmaceutical companies in the last three years: Novartis/Sandoz and Shire/Takeda. Dr Rohde has received authorship royalties from Oxford Press and ArtMed. Dr. Solmi received honoraria/has been a consultant for AbbVie, Angelina, Lundbeck, Otsuka.

Ethics approval

We followed the standard procedure recommended to register additional publication from GBD2019 project after publication of capstone paper. Our study was also approved by the Institutional Review Board at Yonsei University Health System for the data use.

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Cortese, S., Song, M., Farhat, L.C. et al. Incidence, prevalence, and global burden of ADHD from 1990 to 2019 across 204 countries: data, with critical re-analysis, from the Global Burden of Disease study. Mol Psychiatry 28, 4823–4830 (2023). https://doi.org/10.1038/s41380-023-02228-3

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