The Prevalence of Attention Deficit/Hyperactivity Disorder among Chinese Children and Adolescents

Anni Liu, Yunwen Xu, Qiong Yan, Lian Tong, Anni Liu, Yunwen Xu, Qiong Yan, Lian Tong

Abstract

Updating the worldwide prevalence estimates of attention-deficit hyperactivity disorder (ADHD) has significant applications for the further study of ADHD. However, previous reviews included few samples of Chinese children and adolescents. To conduct a systematic review of ADHD prevalence in Mainland China, Hong Kong, and Taiwan to determine the possible causes of the varied estimates in Chinese samples and to offer a reference for computing the worldwide pooled prevalence. We searched for PubMed, Embase, PsycINFO, Web of Science, China National Knowledge Infrastructure, VIP, WANFANG DATA, and China Science Periodical Database databases with time and language restrictions. A total of 67 studies covering 642,266 Chinese children and adolescents were included. The prevalence estimates of ADHD in Mainland China, Hong Kong, and Taiwan were 6.5%, 6.4%, and 4.2%, respectively, with a pooled estimate of 6.3%. Multivariate meta-regression analyses indicated that the year of data collection, age, and family socioeconomic status of the participants were significantly associated with the prevalence estimates. Our findings suggest that geographic location plays a limited role in the large variability of ADHD prevalence estimates. Instead, the variability may be explained primarily by the years of data collection, and children's socioeconomic backgrounds, and methodological characteristics of studies.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Study selection flowchart.
Figure 2
Figure 2
Forest plot of subgroup prevalence estimates among children and adolescents in three regions. aData was not available in some studies.
Figure 3
Figure 3
Begg’s and Egger’s funnel plots for analysis of publication bias.

References

    1. Thapar A, Cooper M. Attention deficit hyperactivity disorder. Lancet. 2016;387:1240–1250. doi: 10.1016/S0140-6736(15)00238-X.
    1. American Psychiatric Association. Diagnostic and statistical manual of mental diseases (DSM-IV), 4th ed. (American Psychiatric Publishing, 1994).
    1. World Health Organization (WHO). The ICD-10 classification of mental and behavioral disorders: diagnosticcriteria for research. (WHO, 1993)
    1. Centers for Disease Control and Prevention (CDC). Attention deficit/hyperactivity disorder: a public health research agenda, (2017).
    1. Dulcan M. Practice parameters for the assessment and treatment of children, adolescents, and adults with attention-deficit/hyperactivity disorder. American Academy of Child and Adolescent Psychiatry. Journal of the American Academy of Child and Adolescent Psychiatry. 1997;36:85s–121s. doi: 10.1097/00004583-199710001-00007.
    1. Swanson JM, et al. Attention-deficit hyperactivity disorder and hyperkinetic disorder. Lancet. 1998;351:429–433. doi: 10.1016/S0140-6736(97)11450-7.
    1. National Institutes of Health Consensus Development Conference Statement: diagnosis and treatment of attention-deficit/hyperactivity disorder (ADHD). Journal of the American Academy of Child and Adolescent Psychiatry39, 182–193 (2000).
    1. Singh I. Beyond polemics: science and ethics of ADHD. Nature reviews. Neuroscience. 2008;9:957–964. doi: 10.1038/nrn2514.
    1. Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA. Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. Journal of child psychology and psychiatry, and allied disciplines. 2015;56:345–365. doi: 10.1111/jcpp.12381.
    1. Meltzer H, Gatward R, Goodman R, Ford T. Mental health of children and adolescents in Great Britain. International review of psychiatry (Abingdon, England) 2003;15:185–187. doi: 10.1080/0954026021000046155.
    1. Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA. The worldwide prevalence of ADHD: a systematic review and metaregression analysis. The American journal of psychiatry. 2007;164:942–948. doi: 10.1176/ajp.2007.164.6.942.
    1. H. R., B. The diagnostic classification, epidemiology and cross-cultural validity of ADHD, in attention deficit hyperactivity disorder: state of the science: bestpPractices. (Civic Research Institute, 2002).
    1. Faraone SV, Sergeant J, Gillberg C, Biederman J. The worldwide prevalence of ADHD: is it an American condition? World psychiatry: official journal of the World Psychiatric Association (WPA) 2003;2:104–113.
    1. Willcutt EG. The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics: the journal of the American Society for Experimental NeuroTherapeutics. 2012;9:490–499. doi: 10.1007/s13311-012-0135-8.
    1. Provincial Psychiatric Hospital An investigation report on minor brain dysfunction in five primary schools in Guiyang city. Guizhou Medical Journal. 1981;6:47–49.
    1. Zhang BC, et al. Survey of ADHD among primary and middle school students in urban area of Guiyang city. Maternal and Child Health Care of China. 2011;26:4892–4894.
    1. Zhang ML, Bai GL, Yang QL, Cao GH, Qiao YR. A survey of ADHD among children in Urban, & rural areas of Baotou. Inner Mongolia Medical Journal. 1995;15:114–115.
    1. Tong L, Shi H, Zang J. Prevalence of ADHD in children of China: a systematic review and meta analysis. Chinese Journal of Public Health. 2013;29:1279–1283.
    1. Rappley MD. Clinical practice. Attention deficit-hyperactivity disorder. The New England journal of medicine. 2005;352:165–173.
    1. Duan C, Lv L, Wang Z, Guo J. The survival and development status of floating children in China: an analysis of the sixth population census data. South China Population. 2013;4(44–55):80.
    1. Liu X, et al. Behavioral and emotional problems in Chinese adolescents: parent and teacher reports. Journal of the American Academy of Child and Adolescent Psychiatry. 2001;40:828–836. doi: 10.1097/00004583-200107000-00018.
    1. Xiaoli Y, et al. Prevalence of psychiatric disorders among children and adolescents in northeast China. PloS one. 2014;9:e111223. doi: 10.1371/journal.pone.0111223.
    1. Peng C, Ye C, Xie K. Analysis of relation between middle school student study stress and their parents. Guide of Science&Education. 2011;23:45–46.
    1. Liu Y, Lu Z. Chinese high school students’ academic stress and depressive symptoms: gender and school climate as moderators. Stress and health: journal of the International Society for the Investigation of Stress. 2012;28:340–346. doi: 10.1002/smi.2418.
    1. 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. doi: 10.1542/peds.2014-3482.
    1. Polanczyk GV, Willcutt EG, Salum GA, Kieling C, Rohde LA. ADHD prevalence estimates across three decades: an updated systematic review and meta-regression analysis. International journal of epidemiology. 2014;43:434–442. doi: 10.1093/ije/dyt261.
    1. Winterstein AG, et al. Utilization of pharmacologic treatment in youths with attention deficit/hyperactivity disorder in Medicaid database. The Annals of pharmacotherapy. 2008;42:24–31. doi: 10.1345/aph.1K143.
    1. Robison LM, Skaer TL, Sclar DA, Galin RS. Is attention deficit hyperactivity disorder increasing among girls in the US? Trends in diagnosis and the prescribing of stimulants. CNS drugs. 2002;16:129–137. doi: 10.2165/00023210-200216020-00005.
    1. Robison LM, Sclar DA, Skaer TL, Galin RS. National trends in the prevalence of attention-deficit/hyperactivity disorder and the prescribing of methylphenidate among school-age children: 1990-1995. Clinical pediatrics. 1999;38:209–217. doi: 10.1177/000992289903800402.
    1. Garfield CF, et al. Trends in attention deficit hyperactivity disorder ambulatory diagnosis and medical treatment in the United States, 2000-2010. Academic pediatrics. 2012;12:110–116. doi: 10.1016/j.acap.2012.01.003.
    1. McCarthy S, et al. The epidemiology of pharmacologically treated attention deficit hyperactivity disorder (ADHD) in children, adolescents and adults in UK primary care. BMC pediatrics. 2012;12:78. doi: 10.1186/1471-2431-12-78.
    1. Brault MC, Lacourse E. Prevalence of prescribed attention-deficit hyperactivity disorder medications and diagnosis among Canadian preschoolers and school-age children: 1994-2007. Canadian journal of psychiatry. Revue canadienne de psychiatrie. 2012;57:93–101. doi: 10.1177/070674371205700206.
    1. Russell G, Ford T, Rosenberg R, Kelly S. The association of attention deficit hyperactivity disorder with socioeconomic disadvantage: alternative explanations and evidence. Journal of child psychology and psychiatry, and allied disciplines. 2014;55:436–445. doi: 10.1111/jcpp.12170.
    1. Russell AE, Ford T, Williams R, Russell G. The Association Between Socioeconomic Disadvantage and Attention Deficit/Hyperactivity Disorder (ADHD): A Systematic Review. Child psychiatry and human development. 2016;47:440–458. doi: 10.1007/s10578-015-0578-3.
    1. Hoy D, et al. Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement. Journal of clinical epidemiology. 2012;65:934–939. doi: 10.1016/j.jclinepi.2011.11.014.
    1. Freeman MF, Tukey JW. Transformations related to the angular and the square root. The Annals of Mathematical Statistics. 1950;21:607–611. doi: 10.1214/aoms/1177729756.
    1. Hayashino Y, Noguchi Y, Fukui T. Systematic evaluation and comparison of statistical tests for publication bias. Journal of epidemiology. 2005;15:235–243. doi: 10.2188/jea.15.235.
    1. Duval S, Tweedie R. Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000;56:455–463. doi: 10.1111/j.0006-341X.2000.00455.x.
    1. Hunter JP, et al. In meta-analyses of proportion studies, funnel plots were found to be an inaccurate method of assessing publication bias. Journal of Clinical Epidemiology. 2014;67(8):897–903. doi: 10.1016/j.jclinepi.2014.03.003.
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ (Clinical research ed.) 2003;327:557–560. doi: 10.1136/bmj.327.7414.557.
    1. Wang RC, et al. A survey of children with hyperkinetic syndrome in Baoding city. Hebei Medical Journal. 1987;9:122.
    1. Tang WB, et al. Prevalence study of ADHD among children in Hexi district, Tianjin city. Chinese Journal of Public Health. 1993;9:90.
    1. Wang LM, et al. An epidemiological survey on childhood hyperkinetic syndrome among aged 7-10 in Dongli district of Harbin, Harbin city. Chinese Journal of Behavioral Medical Science. 1997;6:284–286.
    1. Tang JP, Tu J, Cao HG, Yang LC, Que XH. Investigation and analysis of children’s attention deficit disorder in part of preschools, primary schools and secondary schools in Changsha city. Hunan Medical Journal. 1998;15:185–186.
    1. Lin YL, Zhuang HC, Zheng YT. Investigation and analysis of ADHD among school age children in Putian county. Fujian Medical Journal. 1999;21:105–107.
    1. Zhang JP, Yu AP. Investigation on prevalence of ADHD among children aged 6-11 in Hefei city. Literature and information on preventive medicine. 2000;6:309–310.
    1. Jiang H, et al. Investigation and analysis of ADHD among pupils in Pudong New Area. Chinese Journal of School Health. 2000;21:189–190.
    1. Jiang L, Chang WJ, Su Y, Liu WH, Cao GW. Epidemiological survey of attention-deficit hyperactivity disorder in pupils of urban districts in Zhenjiang. Academic Journal of Second Military Medical University. 2004;25:1238–1240.
    1. Wang XL, et al. Epidemiological investigation and analysis of information with ADHD of school age children in Xiamen. Chinese Journal of Child Health. 2007;15(479-480):483.
    1. Sun XY, et al. Investigation on the incidence of ADHD among children in Zibo City. Chinese Mental Health Journal. 2003;17:453.
    1. Chen SZ, et al. Incidence and related factors of ADHD in children of Guilin city. Chinese Journal of Clinical Psychology. 2004;12(370):386–387.
    1. Ying WG, Zhu XY. Prevalence study of ADHD among children in a primary school, Mudan district, Heze city. Preventive Medicine Tribune. 2006;12:762.
    1. Kulibahan, Li DM, Yeerken, Ruo M, Panggejiapu Investigation of attention deficit hyperactivity disorder among the ethnic Han and Kazakh students from Kuntun city of Xinjiang. Chinese Journal of Contemporary Pediatrics. 2005;7:366–368.
    1. Huangfu ZM. Study on epidemic and family factors of children with attention deficit hyperactivity disorder in Foshan city. China Journal of Modern Medicine. 2006;16(149-150):153.
    1. Liu L, Wen J, Du Y, Hai JJ, Ma XB. A cross-sectional study of ADHD among children in part regions of Ningxia. Journal of Ningxia Medical College. 2006;28:415–417.
    1. Zhang W, Liu XP, Gu Q, Liao R, Ran LW. An epidemiological investigation of ADHD in six cities. Chinese Journal of Clinical Psychology. 2007;15:23–25.
    1. Yang BF, Song HM, Liu XH, Lin R, Wang BB. Prevalence of ADHD and its influencing factors in Jining city. Journal of Public Health and Preventive Medcine. 2008;19:34–37.
    1. Ba JF, Huo BY, Hu BT. An Epidemiological Survey Of Attention Deficit Hyperactivity Disorder Among School-age Children In Huaibei. Henan Journal of Preventive medicine. 2008;19:252–253.
    1. Sun D, Yang Y, Song Y, Yu SC. An epidemiological survey of ADHD among pupils in Mudanjiang city. Sichuan Mental Health. 2008;21:164–166.
    1. Sun DF, Yi MJ, Li M, Li YL. An investigation of ADHD and family environment in 8235 school children aged 4-16 years in Northern Shandong. Chinese Journal of Nervous and Mental Diseases. 2009;35:650–654.
    1. Jiang H, et al. An epidemiological survey on ADHD in school age children of Weihai. Journal of Psychiatry. 2010;23:116–118.
    1. Chang XL, Zhang Y, Wang HY. An epidemiological survey of attention deficit hyperactivity disorder among preschool children in Zhenjiang. China Journal of Health Psychology. 2011;19:1350–1352.
    1. Han LT, Han JY, Huang GY, Li JW. An epidemiological investigation of children with attention deficit hyperactivity disorder and related factors in Liaoyang city, Liaoning province. Medical Journal of Chinese People’s Health. 2011;23:883–887.
    1. Wang HM, Zhang HQ, Liang YY, Zhang PY. An epidemiological investigation of ADHD among children in Taiyuan city. Chinese Mental Health Journal. 1997;11(47):54.
    1. Zhao PF, Xie H. An epidemiological investigation of children’s attention deficit hyperactivity disorder in Shaodong county. Practical Preventive Medicine. 2005;12:368.
    1. Xu M. An investigation of children’s attention deficit hyperactivity disorder in Fuan city. Chinese Journal of School Doctor. 2005;19:587–588.
    1. Liang D, Wang Y, Li CH. An epidemiological survey of attention deficit hyperactivity disorder among students aged 6-18 years old in Central Districts, Changchun city. Maternal and Child Health Care of China. 2009;24:522–524.
    1. Tang SW, Shao H. A survey of attention deficit hyperactivity disorder among preschool children in Urumqi. Chinese Journal of Misdiagnostics. 2008;8:3517–3518.
    1. Shi ST, et al. An epidemiological survey of attention deficit hyperactivity disorder in four ethnic groups in Yunnan. Chinese Journal of Child Health Care. 2008;16:204–206.
    1. Guo M, et al. Study and logistic analysis on attention deficit hyperactivity disorder among 633 pupils. Modern Preventive Medicine. 2009;36:3651–3653.
    1. Guan BQ, et al. Prevalence of psychiatric disorders in primary and middle school students in Hunan Province. Chinese Journal of Contemporary Pediatrics. 2010;12:123–127.
    1. Guo HL, Chen G. An investigation on related factors of attention deficit hyperactivity disorder among children aged 6–16 years in Binzhou area. Shandong Medical Journal. 2011;51:77–78.
    1. Wang, S. Y. et al. Prevalence of attention deficit hyperactivity disorder and its related factors among 6–13-year-old school children in Lanzhou city. Practical Clinical Medicine16, 90–95, 101 (2015).
    1. Xu GQ. Investigation and Analysis on related factors of children’s attention deficit hyperactivity disorder in Cixi city. Modern Practical Medicine. 2014;26:68–69.
    1. Liu F, Liao LH, Jiang ZS. Analysis of related factors of attention deficit hyperactivity disorder among children between 6 and 12 years old in Liuzhou. Contemporary Medicine Forum. 2014;12:179–181.
    1. Yu L, He C, Zhou Y, Luo HY. Epidemiological investigation and model study of correction and interference on children’s attention deficit hyperactivity disorder in Huizhou city’s primary school students. Chinese Journal of Practical Neruous Diseases. 2013;16:19–21.
    1. Wang LZ, Liu J, Wei YR. Relationship between attention deficit hyperactivity disorder in preschool children and child neglect. Chinese Journal of Woman and Child Health Research. 2013;24:144–146.
    1. Zhang HY, Lu GL. Preliminary exploration of children attention deficit hyperactivity disorder and sleep disorders. China Practical Medical. 2013;8:43–45.
    1. Li Y, Huang MX, Yu Q, Zhao B. Investigation of children and adolescents with attention defict hyperactivity disorder combinded with conduct disorder. Journal of International Psychiatry. 2015;42:32–35.
    1. Jiang, H. J. & Lu, H. Y. Analysis of influencing factors of children’s attention deficit hyperactivity disorder in Dongyang city. Chinese Journal of Public Health Management31, 594–595, 600 (2015).
    1. Shi L, Wang F. Epidemiological survey of attention deficit hyperactivity disorder among children aged 4-9 years old in Leshan city, Sichuan Province. Maternal and Child Health Care of China. 2014;29:1734–1735.
    1. Zhang CJ, Ai R, Deng B. ADHD among preschool students in Guiyang kindergartens. Chinese Journal of School Health. 2014;35:60–61.
    1. Wang AP, Wang D, Luo XP, He XZ. An investigation of influencing factors of children’s attention deficit and hyperactivity disorder in Yiwu city. Maternal and Child Health Care of China. 2013;28:996–998.
    1. Meng LP, Zhao ZH, Zheng FL, Jiang YR, Huo KM. Epidemiological study of attention deficit hyperactivity disorder of the children in Jiaozuo. Henan Medical Research. 1999;8:364–365.
    1. Shen P. Survey report on 2397 students’ attention deficit hyperactivity disorder. Jiangsu Education Research. 2013;4:35–38.
    1. Wang CR, Min PC, Lin XW. Investigation and treatment report of mild brain dysfunction in 3804 pupils in Hengyang city. Journal of Hengyang Medical College. 1987;15:314–315.
    1. Li XL, Maihefulaiti K. Epidemiology of attention defict hyperactivity disorder among Urumqi children aged 6 to 14. Chinese Journal of School Health. 2014;35(1204-1205):1208.
    1. Luo Z, Xu FZ. The analysis of risk factors of preschool children with ADHD in industrially developed rural areas. Chinese Journal of General Practice. 2013;11:1756–1757.
    1. He M, Su Z, Peng RC, Fan YQ. Prevalence survey analysis of preschoolers obstructive sleep apnea syndrome and attention deficit hyperactivity disorder in liwan district of Guangzhou city. Chinese Community Doctors. 2014;30:136–138.
    1. Jin W, Du Y, Zhong X, David C. Prevalence and contributing factors to attention deficit hyperactivity disorder: a study of five- to fifteen-year-old children in Zhabei District, Shanghai. Asia-Pacific psychiatry: official journal of the Pacific Rim College of Psychiatrists. 2014;6:397–404.
    1. Leung PW, et al. Prevalence of DSM-IV disorders in Chinese adolescents and the effects of an impairment criterion: a pilot community study in Hong Kong. European child & adolescent psychiatry. 2008;17:452–461. doi: 10.1007/s00787-008-0687-7.
    1. Gau SS, Chong MY, Chen TH, Cheng AT. A 3-year panel study of mental disorders among adolescents in Taiwan. The American journal of psychiatry. 2005;162:1344–1350. doi: 10.1176/appi.ajp.162.7.1344.
    1. Leung PW, et al. The diagnosis and prevalence of hyperactivity in Chinese schoolboys. The British journal of psychiatry: the journal of mental science. 1996;168:486–496. doi: 10.1192/bjp.168.4.486.
    1. Lu L, Shi QJ, Zhong YF, Wang ZM, Chen ZY. Attention deficit hyperactivity disorder and the related factors in children in Wuhan city: an analysis of 2199 questionnaries coming from 12 grades. Chinese Journal of Clinical Rehabilitation. 2005;9:116–118.
    1. Lam LT, Yang L, Zheng Y, Ruan C, Lei Z. Attention deficit and hyperactivity disorder tendency and unintentional injury among adolescents in China. Accident; analysis and prevention. 2006;38:1176–1182. doi: 10.1016/j.aap.2006.05.004.
    1. Chien IC, Lin CH, Chou YJ, Chou P. Prevalence, incidence, and stimulant use of attention-deficit hyperactivity disorder in Taiwan, 1996-2005: a national population-based study. Social psychiatry and psychiatric epidemiology. 2012;47:1885–1890. doi: 10.1007/s00127-012-0501-1.
    1. Shen YC, Wang YF, Yang XL. An epidemiological investigation of minimal brain dysfunction in six elementary schools in Beijing. Journal of child psychology and psychiatry, and allied disciplines. 1985;26:777–787. doi: 10.1111/j.1469-7610.1985.tb00591.x.
    1. Tseng WL, Kawabata Y, Gau SS, Crick NR. Symptoms of attention-deficit/hyperactivity disorder and peer functioning: a transactional model of development. Journal of abnormal child psychology. 2014;42:1353–1365. doi: 10.1007/s10802-014-9883-8.
    1. Qu Y, Jiang H, Zhang N, Wang D, Guo L. Prevalence of mental disorders in 6-16-year-old students in Sichuan province, China. International journal of environmental research and public health. 2015;12:5090–5107. doi: 10.3390/ijerph120505090.
    1. Ko WR, et al. Exposure to general anesthesia in early life and the risk of attention deficit/hyperactivity disorder development: a nationwide, retrospective matched-cohort study. Paediatric anaesthesia. 2014;24:741–748. doi: 10.1111/pan.12371.
    1. Xie YR, Wei XC, Zou BC. A survey of mild brain dysfunction among 2447 children in three primary schools in Xiufeng district, Guilin city. Guangxi Medical Journal. 1982;4:141–143.
    1. Chen MH, et al. Asthma and attention-deficit/hyperactivity disorder: a nationwide population-based prospective cohort study. Journal of child psychology and psychiatry, and allied disciplines. 2013;54:1208–1214. doi: 10.1111/jcpp.12087.
    1. Chen MH, et al. Association between psychiatric disorders and iron deficiency anemia among children and adolescents: a nationwide population-based study. BMC psychiatry. 2013;13:161. doi: 10.1186/1471-244X-13-161.

Source: PubMed

3
Abonnere