New Study Shows Alarming Rise in the Diagnosis of ADHD in Children
Based on a survey conducted by the U.S. Center for Disease Control (CDC), a recent article in the New York Times (March 31) reported that according to this study 11% of school children have received a diagnosis of Attention deficit hyperactivity disorder (ADHD).They also found that nearly 20% of high school age boys were diagnosed with ADHD.
This dramatic increase in this diagnosis has resulted in the doubling of prescriptions for ADHD medications from 2007 to 2012. Last year, $9 billion was spent on stimulant medications!
This striking growth in the diagnosis of ADHD has physicians, researchers, and parents alarmed. Some of the increase may be due to greater awareness of the disorder, more knowledge about the symptoms, and better access to healthcare. But many experts wonder—Is this condition being over diagnosed? Are children being over treated?
There are a number of important issues to consider. There are no stand alone reliable or valid tests for ADHD. Typically a diagnosis is made by a medical or mental health professional based on:
- Taking a complete social and medical history
- Ruling out other conditions which can cause similar symptoms (e.g. hearing loss, thyroid disorder, sleep problem, drug use, etc.)
- Reviewing paper and pencil questionnaires completed by parents and teachers
- Administering psychometric tests that may be indicated to assess associated learning disabilities.
Jeanne Bourget, ARNP, pediatric nurse practitioner and Director of The Everett Clinic’s Attention Evaluation Clinic observes—“ADHD is diagnosis of exclusion: one must be certain that symptoms are not due to something else...”
When younger children are severely hyperactive, their parents make a bee line to their child’s pediatrician or nurse practitioner. These children can be a handful, even in their provider’s office! Their activity level is so far from what is normal for their age; it’s not hard to see that they are hyperactive. But this is relatively rare.
More commonly, children are referred in the third or fourth grade for evaluation by their teachers, not by their parents. In those grades, children are required to sit for longer periods of time and stay on task longer. At home, many parents have been able to adapt to their child’s behavioral problems. But in a classroom of thirty children, kids with ADHD can be a handful for teachers and disruptive to other students. They may be unable to sit for extended periods of time, keep their hands to themselves, or stay on task. Teachers may recommend that these youngsters be evaluated.
And then some kids who are not hyperactive (and therefore didn’t disrupt the class in the lower grades) but are inattentive, might only be recognized in later grades. They can sit still but as the academic and intellectual bar rises in high school, they have trouble staying on point. They become easily distracted and have significant problems with low interest and low satisfaction tasks. These kids, less frequently, may end up being sent for evaluation.
The concern? ---so much of the diagnosis depends on the eye of the observers, who may not be completely objective. The pressure for children to succeed and perform in earlier grades and the increasing size of elementary school classes can conspire to influence how parents and teachers view children. It can muddy the water.
The challenges of high school, the pressure to do well to get into college, and the expectations of parents can result in a rush to find an explanation for why a high school student is doing poorly. Parents wonder if their youngster has ADHD. But there can be other causes— e.g. drug abuse that parents don’t know about. Furthermore, many high school kids are chronically sleep deprived—texting friends until midnight and getting up at 6 a.m. to go school. No wonder they look half asleep!
So why are so many kids being diagnosed? My guess—youngsters with more mild attentional problems are struggling with the increased academic demands of this era. Rather than try to find educational resources to help these children succeed—teachers, parents, and health professionals alike are hoping for a quick fix. It’s much easier and less costly to give a kid a pill and hope that his performance in school improves.
A more extended evaluation, referral to a mental health professional, or for tutoring and other help is more time consuming and expensive. Sometimes looking for the quick fix causes other unanticipated problems.
What do you think?