Recently released data from the federal Centers for Disease Control and Prevention found that nearly 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). One of the most common childhood disorders, ADHD symptoms can last through adulthood, and include difficulty staying focused and paying attention, difficulty controlling behavior and hyperactivity (over-activity).
These figures, which estimate that 6.4 million children aged four through 17 have an ADHD diagnosis, show a 16 percent increase since 2007 and a 53 percent increase in the past decade.
“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.
Concerning for many medical professionals like Graf is that the data may prove ADHD is overdiagnosed, and even more concerning is that doctors may be prescribing ADHD-related medication to children too frequently as well.
“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,” said Graf.
As the New York Times reported, about two-thirds of children diagnosed with ADHD receive a prescription for a psychostimulant drug like methylphenidate (Ritalin) or Adderall, which can help some of the symptoms of ADHD, but at the expense of problems with addiction, anxiety and occasionally psychosis.
Side effects of Ritalin include fast, pounding or uneven heartbeats; fever, sore throat, and headache with a severe blistering, peeling, and red skin rash; aggression, restlessness, hallucinations, unusual behavior, motor tics (twitches); and dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure), to name a few.
Long-term effects of these drugs are not yet fully known, as researchers haven’t focused on the long-term impact a drug like Ritalin has on a person, specifically an adult who has been taking the drug since childhood.
L. Alan Sroufe is a professor emeritus of psychology at the University of Minnesota’s Institute of Child Development, who has been studying the development of troubled children for more than 40 years. He wrote an opinion piece last year for the New York Times, and wrote that “attention-deficit drugs increase concentration in the short term, which is why they work so well for college students cramming for exams. But when given to children over long periods of time, they neither improve school achievement nor reduce behavior problems. The drugs can also have serious side effects, including stunting growth.”
While some doctors and patient advocates view the increase in the amount of people diagnosed with ADHD as a result of medical professionals becoming more familiar with symptoms of ADHD, others argue the increase shows millions of children may be unnecessarily taking pills to calm their behavior or do better in school.
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.”
Expanding ADHD definition
Those concerned about the high diagnosis rate also point out that the numbers will only continue to grow in the future unless something is done, as the American Psychiatric Association announced plans to change the definition of the condition to a more generic one, allowing more persons to fit the definition of an ADHD diagnosis so they can receive treatment.
Final wording on what the new ADHD entry will look like in the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders has not been released yet, but is expected to reflect the following changes: “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 ADHD is not just a young child’s disorder; and the requirement that symptoms merely ‘impact’ daily activities, rather than cause ‘impairment.’”
Currently ADHD is described by experts as abnormal chemical levels in the brain, impairing a person’s impulse control and attention skills.
Historically, ADHD affects about 3 to 7 percent of all children, and can only be diagnosed through a subjective process: talking extensively with patients, parents and teachers and ruling out other possible causes.
But some doctors say they are receive extensive pressure from parents to diagnose a child with ADHD in the hope the medication would help with 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.”
Popping pills to stay focused
Forgetting that kids are kids and need to move around is probably why boys, who are stereotypically more active than girls, are diagnosed with ADHD at about twice the rate as females. The data from the CDC found 15 percent of school-age boys have received an ADHD diagnosis, compared with 7 percent of girls.
Rates also vary by state, with southern states like Arkansas, Kentucky, Louisiana, South Carolina and Tennessee, showing rates of about 23 percent of school-age boys being diagnosed with ADHD, compared with less than 10 percent in states like Colorado and Nevada.
“There’s no way that one in five 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.”
Dr. Ned Hallowell is a child psychiatrist and author of best-selling books on the disorder, and until recently was a proponent of prescribing stimulants to children until recently. Talking with the New York Times, Hallowell said that after reviewing the CDC’s data, along with reading news reports about young people abusing stimulants, he regrets telling parents that stimulants often prescribed for ADHD like Adderall were “safer than aspirin.”
“I regret the analogy and won’t be saying that again,” he said, adding that while he believes many children with ADHD are not treated, he thinks the high diagnosis rates demonstrate how the diagnosis is being handed out 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.”