New York Times
by Alan Schwarz and Sarah Cohen
31 Mar 13
Nearly one in five high school age boys in the United States and 11 percent of school-age children over all 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 A.D.H.D. diagnosis and its medication are overused in American children.
The figures showed that an estimated 6.4 million children ages 4 through 17 had received an A.D.H.D. diagnosis at some point in their lives, a 16 percent increase since 2007 and a 41 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 A.D.H.D. but can also lead to addiction, anxiety and occasionally psychosis.
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And even more teenagers are likely to be prescribed medication in the near future because the American Psychiatric Association plans to change the definition of A.D.H.D. to allow more people to receive the diagnosis and treatment.
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the new rates suggest that millions of children may be taking medication merely to calm behavior or to do better in school.
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“There’s no way that one in five high-school boys has A.D.H.D.,” said James Swanson, a professor of psychiatry at Florida International University and one of the primary A.D.H.D. 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 A.D.H.D. 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 C.D.C. data, have among the highest rates of A.D.H.D. diagnoses: 14 percent for school-age children, about one-third higher than the rest of the population.
Several doctors mentioned that advertising from the pharmaceutical industry that played off parents’ fears — showing children struggling in school or left without friends — encouraged parents and doctors to call even minor symptoms A.D.H.D. and try stimulant treatment. For example, a pamphlet for Vyvanse from its manufacturer, Shire, shows a parent looking at her son and saying, “I want to do all I can to help him succeed.”
Sales of stimulants to treat A.D.H.D. have more than doubled to $9 billion in 2012 from $4 billion in 2007, according to the health care information company IMS Health.
Criteria for the proper diagnosis of A.D.H.D., 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, according to several people involved in the discussions.
The final wording has not been released, but most proposed changes would lead to higher rates of diagnosis: the requirement that symptoms appeared before age 12 rather than 7; illustrations, like repeatedly losing one’s cellphone or losing focus during paperwork, that emphasize that A.D.H.D. is not just a young child’s disorder; and the requirement that symptoms merely “impact” daily activities, rather than cause “impairment.”
An analysis of the proposed changes published in January by the Journal of Learning Disabilities concluded: “These wording changes newly diagnose individuals who display symptoms of A.D.H.D. but continue to function acceptably in their daily lives.
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