County-level prevalence estimates of ADHD in children in the United States

•Attention-deficit/hyperactivity disorder (ADHD) is a childhood disorder characterized by impairments in family, academic, and social settings. Most U.S. studies of childhood ADHD prevalence focus on national or subpopulation rates, but no recent studies provide U.S.-wide county-level prevalence estimates.•We applied small-area estimation to national survey data to estimate area-level ADHD rates in U.S. children. Findings showed elevated ADHD prevalence in the New England, South Atlantic, East South Central, and West South Central census divisions.•Study results can be used by policymakers and public health officials to determine which geographic areas and sociodemographic groups need additional programming, funding, or other resources (e.g., strategic plans, trainings, or toolkits) to systematically assess and treat children with ADHD. Attention-deficit/hyperactivity disorder (ADHD) is a common childhood disorder often characterized by long-term impairments in family, academic, and social settings. Measuring the prevalence of ADHD is important as treatment options increase around the U.S. Prevalence data helps inform decisions by care providers, policymakers, and public health officials about allocating resources for ADHD. In addition, measuring geographic variation in prevalence estimates can facilitate hypothesis generation for future analytic work. Most U.S. studies of ADHD prevalence among children focus on national or demographic group rates. Using a small area estimation approach and data from the 2016 to 2018 National Survey of Children's Health, we estimated childhood ADHD prevalence estimates at the census regional division, state, and county levels. The sample included approximately 70,000 children aged 5–17 years. The national ADHD rate was estimated to be 12.9% (95% Confidence Interval: 11.5%, 14.4%). Counties in the West South Central, East South Central, New England, and South Atlantic divisions had higher estimated rates of childhood ADHD (55.1%, 53.6%, 49.3%, and 46.2% of the counties had rates of 16% or greater, respectively) compared to counties in the Mountain, Mid Atlantic, West North Central, Pacific, and East North Central divisions (2.1%, 4%, 5.8%, 6.9%, and 11.7% of the counties had rates of 16% or greater, respectively). These local-level rates are useful for decision-makers to target programs and direct sufficient ADHD resources based on communities’ needs.