Apr 01 / Simcha

11% of American Children Struggle with ADHD…. Really?? (Schwarz & Cohen)

Image:  PsychologyToday.com
Image: PsychologyToday

According to the findings of a 2011-2012 CDC (Center for Disease Control) study of some 76,000 families, one in five high-school age boys in the United States and 11 percent of school-age children have received a medical diagnosis of Attention Deficit Hyperactivity Disorder (ADHD). ADHD is described by most experts as resulting from abnormal chemical levels in the brain that impair a person’s impulse control and attention skills.

Criteria for the proper diagnosis of ADHD, to be released next month in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, have been changed specifically to allow more adolescents and adults to qualify for a diagnosis.  Should we be concerned we are over-diagnosing and over-medicating our children?  The follow is a selection from a report by Alan Schwarz and Sara Cohen (New York Times, 31.3.2013).

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The figures showed that an estimated 6.4 million children ages 4 through 17 had received an ADHD diagnosis at some point in their lives, a 16 percent increase since 2007 and a 53 percent rise in the past decade. About two-thirds of those with a current diagnosis receive prescriptions for stimulants like Ritalin or Adderall, which can drastically improve the lives of those with ADHD but can also lead to addiction, anxiety and occasionally psychosis.  Fifteen percent of school-age boys have received an ADHD diagnosis; the rate for girls was 7 percent. Diagnoses among those of high-school age — 14 to 17 — were particularly high, 10 percent for girls and 19 percent for boys. About one in 10 high-school boys currently takes ADHD medication, the data showed.

“Those are astronomical numbers. I’m floored,” said Dr. William Graf, a pediatric neurologist in New Haven and a professor at the Yale School of Medicine. He added, “Mild symptoms are being diagnosed so readily, which goes well beyond the disorder and beyond the zone of ambiguity to pure enhancement of children who are otherwise healthy.”

While some doctors and patient advocates have welcomed rising diagnosis rates as evidence that the disorder is being better recognized and accepted, others said the new rates suggest that millions of children may be taking medication merely to calm behavior or to do better in school. Pills that are shared with or sold to classmates — diversion long tolerated in college settings and gaining traction in high-achieving high schools — are particularly dangerous, doctors say, because of their health risks when abused.

ADHD has historically been estimated to affect 3 to 7 percent of children. The disorder has no definitive test and is determined only by speaking extensively with patients, parents and teachers, and ruling out other possible causes — a subjective process that is often skipped under time constraints and pressure from parents. It is considered a chronic condition that is often carried into adulthood.

CDC director, Dr. Thomas R. Frieden likened the rising rates of stimulant prescriptions among children to the overuse of pain medications and antibiotics in adults.  “We need to ensure balance,” Dr. Frieden said. “The right medications for ADHD, given to the right people, can make a huge difference. Unfortunately, misuse appears to be growing at an alarming rate.”

Experts cited several factors in the rising rates. Some doctors are hastily viewing any complaints of inattention as full-blown ADHD, they said, while pharmaceutical advertising emphasizes how medication can substantially improve a child’s life. Moreover, they said, some parents are pressuring doctors to help with their children’s troublesome behavior and slipping grades.

“There’s a tremendous push where if the kid’s behavior is thought to be quote-unquote abnormal — if they’re not sitting quietly at their desk — that’s pathological, instead of just childhood,” said Dr. Jerome Groopman, a professor of medicine at Harvard Medical School and the author of How Doctors Think.

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Editor:  Over-haste to diagnose and medicate poses not only health risks but, in many cases, misses the opportunity to pick up and treat trauma, emotional distress or personal struggles that may be largely contributing to the child or teen’s behavior.

See also:  The Pathologization of Human Emotion