Understanding ADHD in Children And Adolescents

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Understanding ADHD in Children and Adolescents

Steering Committee

October 01, 2024

The Centers for Disease Control (CDC) recently released the Youth Risk Behavior Survey (YRBS) for 2021-2023 that also includes trends report from 2013-2023 1. This report provides information on the health behaviors and experiences of high school students in the United States. The survey covers six main areas of health-risk behaviors:

The Substance Abuse and Mental Health Services Administration (SAMHSA) conducts the National Survey on Drug Use and Health (NSDUH) annually. This survey gives us an opportunity to see trends in substance use and abuse from year to year. The NSDUH has been conducted by the federal government since 1971 and is a primary source of statistical information on substance use and mental health of the civilian, non-institutionalized population 12 years of age or older in the United States (US).

  1. Unintentional injuries and violence
    • Including substance use and bullying
  2. Sexual behaviors
    • Leading to unintended pregnancies and sexually transmitted infections
  3. Substance use
    • Alcohol, tobacco, and other drugs
  4. Dietary behaviors
  5. Physical activity
  6. Mental health

Here’s a summary of the 2021-2023 findings across key areas:

  1. Mental Health
    • A significant rise in poor mental health was observed among students.
    • Over 40% of students reported feeling persistently sad or hopeless.
    • Rates of suicidal thoughts and behaviors increased, particularly among females and LGBTQ+ students.
  2. Substance Use
    • Decreases in traditional tobacco use, such as smoking cigarettes, continued.
    • E-cigarette use (vaping) remained common, with around 14-15% of high school students reporting regular vaping.
  3. Violence and Bullying
    • Bullying (both in person and online) remained a significant concern.
    • Approximately 15-20% of students experienced bullying on school property, with more females reporting being bullied than males.
    • Incidences of physical violence, including weapon carrying on school grounds, also remained a risk for many students.
  4. Sexual Behaviors
      5. The number of sexually active high school students declined.
      Condom use decreased though, raising concerns about risks for sexually transmitted infections (STIs).
  5. Physical Activity and Diet
      6. Fewer students reported being physically active for 60 minutes or more per day.
      There was also a concerning rise in poor dietary habits, such as skipping meals or not consuming enough fruits and vegetables, contributing to overall health risks.
  6. LGBTQ+ Youth
      7. LGBTQ+ students reported significantly higher rates of mental health challenges, including depression, suicidal ideation, and bullying.
      LGBTQ+ students are particularly vulnerable to violence, discrimination, and victimization in both school and social environments.

The YRBS 2021-2023 highlighted persistent challenges related to mental health, particularly among marginalized groups, and ongoing concerns about substance use and other risky behaviors. There are also areas of improvement in some risk behaviors, such as reductions in cigarette smoking and sexual activity, but new concerns have emerged with rising mental health crises and disparities in student well-being.

Here’s a summary of the key trends from 2013 to 2023 in major risk behavior categories:

  1. Mental Health
    • Increase Mental health Challenges:
      • From 2013 to 2023, mental health issues, particularly feelings of persistent sadness, hopelessness, and suicidal ideation, increased sharply.
      • From 2013 to 2023, mental health issues, particularly feelings of persistent sadness, hopelessness, and suicidal ideation, increased sharply.
      • Suicidal thoughts and attempts have risen significantly among female students and LGBTQ+ youth, with LGBTQ+ students reporting particularly high rates of emotional distress.
  2. Substance Use
    • Declining Cigarette Use:
      • There has been a dramatic decline in cigarette smoking.
      • In 2013, about 15.7% of high school students smoked cigarettes.
      • In 2023, this number dropped to under 6%.
    • Vaping Surge, Then Stabilization:
      • Vaping surged in popularity from 2015 to 2019, with rates reaching as high as 28%.
      • After 2019, the rate stabilized but remained relatively high, with about 14-15% of students still vaping in 2023.
    • Alcohol and Other Drug Use:
      • Alcohol consumption and marijuana use have both decreased since 2013.
      • Strained relationships with family and friends due to changes in behavior and priorities.
      • Increased likelihood of engaging in risky behaviors that can lead to legal issues.
  3. Violence and Bullying
    • Bullying and Cyberbullying:
      • There was a decrease in students reporting weapon carrying at school and being involved in physical fights, suggesting schools have become somewhat safer.
      • Despite this, the risk of violence remains significant, especially for certain subgroups like LGBTQ+ students.
  4. Sexual Behavior
    • Declining Sexual Activity
      • Fewer students have reported being sexually active over time.
      • In 2013, about 34% of students were sexually active, but this fell to around 27% by 2023.
    • Decreasing Condom Use:
      • This decline in condom use, from 60% in 2013 to under 50% in 2023, raises concerns about protection against sexually transmitted infections (STIs).
  5. LGBTQ+ Youth Trends
    • Mental Health Disparities:
      1. LGBTQ+ students have consistently reported worse mental health outcomes compared to their heterosexual peers.
        • This trend has worsened from 2013 to 2023, with higher rates of bullying, discrimination, and suicidal ideation among this group.
      • Increased Violence and Victimization:
        1. LGBTQ+ students are more likely to face violence, including physical attacks and bullying.
          • This trend has remained alarmingly high over the past decade, with little progress in improving their school safety and mental well-being.

      From 2013 to 2023, trends in youth risk behavior show both positive and concerning shifts. The positive trends include declines in cigarette smoking, alcohol use, and physical fighting. The concerning trends include rising mental health issues, particularly among female and LGBTQ+ students, persistent vaping, and declining condom use among those youth reporting sexual activity. Efforts to address mental health needs, reduce substance use, and improve sexual health education and school safety, are critical to reversing some of these worrying trends.

      Schools are uniquely positioned to reach many youths with strategies that can lessen the impact of negative experiences and improve their health and well-being. Therefore, schools can play a crucial role in addressing youth risk behaviors and promoting the health and well-being of students through education, prevention, and early intervention efforts. If your school or district is already using the Multitiered Systems of Support (MTSS) model, the following suggested strategies from the CDC should enhance any work your district and/or school has already started.

      The CDC has identified six school-based strategies and associated approaches2 to help alleviate any mental health challenges your students may be facing and promote the positive behavioral and mental health of your students. These strategies and approaches include:

      References:

      1. Centers for Disease Control and Prevention Youth Risk Behavior Survey Data Summary and Trends Report: 2013–2023 U S Department of Health and Human Services; 2024.
      2. Promoting Mental Health and Well-Being in Schools
      3. Promoting Mental Health and Well-Being in Schools

      Resources: