The news last month from the Centers for Disease Control and Prevention (CDC) was widely reported: Nearly 1 in 5 high-school age U.S. boys and more than 1 in 10 of all school-age children have been diagnosed with attention deficit hyperactivity disorder (ADHD).
ADHD generally is thought to result from abnormal chemical levels in the brain that impair the ability to pay attention and compromise impulse control.
The New York Times was among the media outlets that reported the significant increase of the diagnosis, and the concern about overprescribing the drugs used to treat it. We, too, have questioned the practice.
More than 6 million children 4 to 17 have been diagnosed with ADHD; their numbers have increased 16 percent since 2007, and more than doubled in a decade. More than 2 in 3 currently diagnosed take Ritalin or Adderall, stimulants that certainly help the afflicted, but, according to the The Times, also can cause addiction, anxiety and even psychosis.
Sales of stimulants to treat ADHD, The Times says, have more than doubled to $9 billion in 2012 from $4 billion in 2007.
Some people legitimately need these drugs, but experts estimate that only 3 to 7 in 100 children suffer from ADHD, and that the meds are being given to people with mild symptoms who shouldn’t be taking them.
As The Times puts it, “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.”
Kids often share or sell their meds to classmates, so the boom in ADHD opens the door to drug abuse and its consequent health risks. CDC Director Thomas R. Frieden compared the rising rates of stimulant prescriptions among children to the overuse of pain medications and antibiotics in adults.
One heartbreaking illustration of this scenario was presented last week in a commentary in the New York Times. The writer, Ted Gup, told the story of his son David, who was diagnosed with ADHD as a first-grader and told by one psychiatrist that he wouldn’t even see the child until he was medicated.
Gup resisted, but after a year of David’s “rambunctious” behavior, he started taking Ritalin, then Adderall.
As a 21-year-old college senior, he was found on the floor of his room, dead from a fatal mix of alcohol and drugs. The date was Oct. 18, 2011.
No one made him take the heroin and alcohol, and yet I cannot help but hold myself and others to account. I had unknowingly colluded with a system that devalues talking therapy and rushes to medicate, inadvertently sending a message that self-medication, too, is perfectly acceptable.
My son … was known to trade in Adderall, to create a submarket in the drug among his classmates who were themselves all too eager to get their hands on it. What he did cannot be excused, but it should be understood. What he did was to create a market that perfectly mirrored the society in which he grew up, a culture where Big Pharma itself prospers from the off-label uses of drugs, often not tested in children and not approved for the many uses to which they are put.
Stories like David’s are likely to repeat. As The Times points out, the American Psychiatric Association is planning to broaden the definition of ADHD in the upcoming edition of the Diagnostic and Statistical Manual of Mental Disorders (see our blog, “Controversy Swirls as Psychiatry Manual Gets an Update.”)
That invites more people to be diagnosed and be medicated, possibly many for whom other treatments are more appropriate.
Pharmaceutical company marketing enables any parent seeking to help a kid who’s misbehaving and whose grades are falling. The Times noted that the brochure for Vyvanse, an ADHD drug, shows a parent looking at her son and saying, “I want to do all I can to help him succeed.”
Dr. Jerome Groopman, professor of medicine at Harvard Medical School, told The Times, “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.”
Diagnosing ADHD is a difficult judgment call. As The Times notes, there’s no definitive test for it—it’s determined only by extensive communication with patients, parents and teachers, and by ruling out other possible causes for its behavioral symptoms. The process is subjective and made more difficult when parents pressure doctors for a diagnosis. ADHD is a chronic condition that often endures in adulthood.
More than twice as many boys as girls have been diagnosed with ADHD—15 in 100 versus 7 in 100. The rates were highest among high-schoolers—1 in 10 girls, and nearly twice as many boys. About 1 in 10 high-school boys takes ADHD medication.
Before yours becomes one of them, find out if your kid truly is suffering from a mental disorder. Explore other treatment options, such as counseling, and causes for unacceptable behavior that might be social (bullying?) instead of chemical. Drugs can be lifesavers, but they also can harm.