Rise in ADHD may reflect lax assessments

April 3, 2013 

The latest numbers on the rising rate of Attention Deficit Hyperactivity Disorder, or ADHD, suggest a crisis enveloping America’s children.

The New York Times reported this week that data collected by the federal Centers for Disease Control show nearly one in five high school-age boys and 11 percent of all school-age children have received a medical diagnosis of ADHD. The rate of ADHD found in children 4 through 17 has jumped 53 percent in the past decade.

But the numbers may be saying something much different than they suggest. Rather than a sharp rise in the number of children who have serious problems with concentrating and controlling their impulses, the problem may lie with adults – parents, teachers and doctors – who are not paying proper attention. Parents may have become passive about accepting the increasingly common diagnosis. Teachers may be too quick to suggest ADHD – and the drugs such as Ritalin and Adderall that go with it – to control disruptive or difficult students. And doctors may be less than rigorous in making the assessment.

Arthur D. Anastopoulos, a psychology professor and director of the AD/HD Clinic at the University of North Carolina at Greensboro, said the numbers in The Times report were stunning, but likely inflated by flawed diagnoses. Anastopoulos, who founded the UNC-G clinic in 1996, said his clinic does extensive assessments and he is not seeing a sharp rise in ADHD cases. If a sample was taken of children who have been properly diagnosed, he said, “You would find that rates would be what they’ve always been, 5 to 7 or 8 percent.”

The problem, Anastopoulos and other psychologists and doctors suggest, is that many of their colleagues have become too relaxed about concluding that a restless or easily distracted child suffers from ADHD. Doctors and psychologists can go down a list of 18 symptoms, Anastopoulos said, and if six get checked off, they conclude it’s ADHD. He said several matches point to concentration issues that could be related to a thyroid problem or depression or a number of other causes. If diagnosis is based only on a checklist, he said, “You’ll catch a lot of people in that same net that don’t have ADHD.”

But even if skeptics are correct that the rise in ADHD is a mirage, the higher rate reflects real problems and real hazards. It shows the expanding treatment of behavior and moods with drugs, treatment that has spread to children. Often therapy and instruction are ignored in favor of swallowing a pill. In the case of children who have become a challenge to manage or teach, drugs are too easy and too common an answer.

“In general, whether it’s parents or teachers, there is sometimes a desire to take a short cut,” Anastopoulos said. “And medication is thought of as a panacea. Most practitioners don’t recommend that you use only medication.”

Wider treatment of ADHD – real or imagined – is exposing more children to drugs. The Times reports that sales of drugs that treat ADHD – primarily Ritalin, Adderall, Concerta and Vyvanse – have more than doubled to $9 billion in 2012 from $4 billion in 2007. Drug makers are encouraging the trend with ads that suggest the drug will lead to academic success.

The drugs are not harmless. They can reduce appetite and raise blood pressure and heart rate. And their proliferation in school settings has led to the pills being shared with or sold to students without ADHD who want the amphetamine lift or think it enhances their ability to study and take tests. The abuse of the drugs by children and teens can create dependency and lead to use of illegal drugs.

Advances in the diagnosis and treatment of ADHD have helped many children who would otherwise struggle in school and social situations. But the cure is becoming a disease if one in five high school boys is being diagnosed with ADHD and stimulants have become a basic part of school environments. Diagnostic standards need to be made more rigorous, drug companies’ marketing tactics and claims should be reviewed by regulators and parents and teachers must become less willing to change a challenging child with a pill.

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