ADHD diagnoses up 53% this decade, CDC data show

Numbers raise fear children may be overmedicated

New York TimesApril 2, 2013 

ATTENTION DEFICIT STUDY

Dr. Ned Hallowell, a child psychiatrist and author of best-selling books on attention deficit hyperactivity disorder is concerned about the overdiagnosis of the disorder. Rates of ADHD diagnosis have increased noticeably in the past decade, coming at a time of concern that the diagnosis and its medication are overused among American children. (Robert Caplin/The New York Times)

ROBERT CAPLIN — NYT

  • Child psychiatrist reassesses his previous position

    Given that severe ADHD that goes untreated has been shown to increase a child’s risk for academic failure and substance abuse, doctors have historically focused on raising awareness of the disorder and reducing fears surrounding stimulant medication.

    A leading voice has been Dr. Ned Hallowell, a child psychiatrist and author of best-selling books on the disorder. But in a recent interview, Hallowell said that the new CDC data, combined with recent news reports of young people abusing stimulants, left him assessing his role.

    Whereas Hallowell for years reassured skeptical parents by telling them that Adderall and other stimulants were “safer than aspirin,” he said, “I regret the analogy” and that he “won’t be saying that again.” And while he still thinks that many children with ADHD continue to go unrecognized and untreated, he said the high rates demonstrate how the diagnosis is being given too freely.

    “I think now’s the time to call attention to the dangers that can be associated with making the diagnosis in a slipshod fashion,” he said. “That we have kids out there getting these drugs to use them as mental steroids – that’s dangerous, and I hate to think I have a hand in creating that problem.” New York Times

Nearly 1 in 5 high-school-age boys in the United States and 11 percent of school-age children overall have received a medical diagnosis of attention deficit hyperactivity disorder, according to new data from the federal Centers for Disease Control and Prevention.

These rates reflect a marked rise over the last decade and could fuel growing concern among many doctors that the ADHD diagnosis and its medication are overused in American children.

The figures showed that an estimated 6.4 million children ages 4-17 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 such as Ritalin or Adderall, which can drastically improve the lives of those with ADHD but can also lead to addiction, anxiety and occasionally psychosis.

“Those are astronomical numbers. I’m floored,” said Dr. William Graf, a pediatric neurologist in New Haven, Conn., and a professor at the Yale School of Medicine.

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.

The findings were part of a broader CDC study of children’s health issues, taken from February 2011 to June 2012. The agency interviewed more than 76,000 parents nationwide by both cellphone and landline and is currently compiling its reports. The New York Times obtained the raw data from the agency and compiled the results.

ADHD has historically been estimated to affect 3 percent 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.

The 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,” 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.

Fifteen percent of school-age boys have received an ADHD diagnosis, the data showed; 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.

Rates by state are less precise but vary widely. Southern states, such as Arkansas, Kentucky, Louisiana, South Carolina and Tennessee, showed about 23 percent of school-age boys receiving an ADHD diagnosis. The rates in Colorado and Nevada were less than 10 percent.

The medications – primarily Adderall, Ritalin, Concerta and Vyvanse – often afford those with severe ADHD the concentration and impulse control to lead relatively normal lives. Because the pills can vastly improve focus and drive among those with perhaps only traces of the disorder, an ADHD diagnosis has become a popular shortcut to better grades, some experts said, and many students are unaware of or disregard the medication’s health risks.

“There’s no way that 1 in 5 high school boys has ADHD,” said James Swanson, a professor of psychiatry at Florida International University and one of the primary ADHD researchers in the last 20 years. “If we start treating children who do not have the disorder with stimulants, a certain percentage are going to have problems that are predictable – some of them are going to end up with abuse and dependence. And with all those pills around, how much of that actually goes to friends? Some studies have said it’s about 30 percent.”

An ADHD diagnosis often results in a family’s paying for a child’s repeated visits to doctors for assessments or prescription renewals. Taxpayers assume this cost for children covered by Medicaid, who, according to the CDC data, have among the highest rates of ADHD diagnoses: 14 percent for school-age children, about one-third higher than the rest of the population.

Sales of stimulants to treat ADHD have more than doubled to $9 billion in 2012 from $4 billion in 2007, according to the health care information company IMS Health.

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