Introduction. Attention Deficit/Hyperactivity Disorder (AD/HD) was significantly revised in DSM-IV, and therefore, it is important to determine how the changes affect the prevalence.

Objectives. This study repeated a previous survey of teacher-reported prevalence rates of Attention Deficit Hyperactivity Disorder(AD/HD) based on DSM-IV criteria in a suburban Tennessee county in the subsequent academic year.

Methods. Teachers completed questionnaires on all their students consisting of the DSM -IV symptoms for Disruptive Behavior Disorders except for 9 Conduct Disorder symptoms, and also included 7 symptoms screening for anxiety or depression. This constituted children kindergarten through fifth grade in a Middle TN County during the 1994-95 academic year (10 schools, 214 teachers and 4323 children). Also included were ratings of academic and behavioral performance, questions about the children's diagnosis of AD/HD, treatment with stimulants, and the presence of behavior or academic problems.

Results. The prevalence rates were 16.1 for AD/HD-total (TOT), 8.8 for AD/HD-inattentive type (AD), 2.6 for AD/HD-hyperactive/impulsive type(HI), and 4.7 for AD/HD-combined type (CT). Prevalence rates when impairment was taken into consideration were: 12.4, 6.6, 0.9 & 4.9 respectively. Factor analysis identified 6 factors: opposition/defiance-conduct, inattention, hyperactivity/impulsivity, anxiety/depression, conduct disorder, and truancy/depression. The rates of problems differed mostly between AD/HD-AD and AD/HD-HI (30% vs. 68%) for behavior and (56% vs. 16%) for academics). Few(11-33%) had an AD/HD diagnosis or were receiving stimulant medication treatment (8-26%). For 243 children traked for both years only 52% meeting criteria for AD/HD in the first year also met criteria in the second year.

Conclusion. DSM-IV criteria are likely to increase the prevalence but may better characterize heterogeneity of this disorder. Impairment is an important diagnostic, and there is some lack of consistency in the reports across teachers over time.