[Vision2020] More Diagnoses of A.D.H.D. in New C.D.C. Data

[Art Deco]

  [image: The New York Times] <http://www.nytimes.com/>

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March 31, 2013
More Diagnoses of A.D.H.D. in New C.D.C. Data By ALAN
SCHWARZ<http://topics.nytimes.com/top/reference/timestopics/people/s/alan_schwarz/index.html>and
SARAH
COHEN

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 53 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.<http://health.nytimes.com/health/guides/disease/attention-deficit-hyperactivity-disorder-adhd/overview.html?8qa>but
can also lead to addiction, anxiety and occasionally psychosis.

“Those are astronomical numbers. I’m floored,” said Dr. William
Graf<http://medicine.yale.edu/pediatrics/neurology/people/william_graf.profile>,
a pediatric neurologist in New Haven and a professor at the Yale School of
Medicine. He added, “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.”

And even more teenagers are likely to be prescribed medication in the near
future because the American Psychiatric Association
<http://www.psych.org/>plans to change the definition of A.D.H.D. to
allow more people to receive
the diagnosis and treatment. A.D.H.D. is described by most experts as
resulting from abnormal chemical levels in the brain that impair a person’s
impulse control and attention skills.

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.
Pills that are shared with or sold to classmates — diversion long tolerated
in college settings and gaining traction in high-achieving high schools —
are particularly dangerous, doctors say, because of their health risks when
abused.

The findings were part of a broader C.D.C.
study<http://www.cdc.gov/nchs/slaits/nsch.htm>of children’s health
issues, taken from February 2011 to June 2012. The
agency interviewed more than 76,000 parents nationwide by both cellphone
and landline and is currently compiling its reports. The New York Times
obtained the raw data from the agency and compiled the results.

A.D.H.D. has historically been estimated to affect 3 to 7 percent of
children. The disorder has no definitive test and is determined only by
speaking extensively with patients, parents and teachers, and ruling out
other possible causes — a subjective process that is often skipped under
time constraints and pressure from parents. It is considered a chronic
condition that is often carried into adulthood.

The C.D.C. 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,” Dr. Frieden said. “The right medications for
A.D.H.D., given to the right people, can make a huge difference.
Unfortunately, misuse appears to be growing at an alarming rate.”

Experts cited several factors in the rising rates. Some doctors are hastily
viewing any complaints of inattention as full-blown A.D.H.D., they said,
while pharmaceutical advertising emphasizes how medication can
substantially improve a child’s life. Moreover, they said, some parents are
pressuring doctors to help with their children’s 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<http://jeromegroopman.com/>,
a professor of medicine at Harvard Medical School and the author of “How
Doctors Think.”

Fifteen percent of school-age boys have received an A.D.H.D. diagnosis, the
data showed; the rate for girls was 7 percent. Diagnoses among those of
high-school age — 14 to 17 — were particularly high, 10 percent for girls
and 19 percent for boys. About one in 10 high-school boys currently takes
A.D.H.D. medication, the data showed.

Rates by state are less precise but vary widely. Southern states, like
Arkansas, Kentucky, Louisiana, South Carolina and Tennessee, showed about
23 percent of school-age boys receiving an A.D.H.D. diagnosis. The rates in
Colorado and Nevada were less than 10 percent.

The medications — primarily Adderall, Ritalin, Concerta and Vyvanse — often
afford those with severe A.D.H.D. the concentration and impulse control to
lead relatively normal lives. Because the pills can vastly improve focus
and drive among those with perhaps only traces of the disorder, an A.D.H.D.
diagnosis has become a popular shortcut to better grades, some experts
said, with many students unaware of or disregarding the medication’s health
risks.

“There’s no way that one in five high-school boys has A.D.H.D.,” said James
Swanson <http://bayonet.fiu.edu/library/www3/psychiatry.php?ss=psyf_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 <http://www.imshealth.com/portal/site/ims>.

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."Given that severe A.D.H.D. that goes
untreated has been shown to increase a child’s risk for academic failure
and substance abuse, doctors have historically focused on raising awareness
of the disorder and reducing fears surrounding stimulant medication.

A leading voice has been Dr. Ned Hallowell <http://www.drhallowell.com/>, a
child psychiatrist and author of best-selling books on the disorder. But in
a recent interview, Dr. Hallowell said that the new C.D.C. data, combined
with recent news reports of young people abusing stimulants, left him
assessing his role.

Whereas Dr. Hallowell for years would reassure skeptical parents by telling
them that Adderall and other stimulants were “safer than
aspirin<http://www.drhallowell.com/blog/dr-hallowells-response-to-ny-times-piece-ritalin-gone-wrong/>,”
he said last week, “I regret the analogy” and he “won’t be saying that
again.” And while he still thinks that many children with A.D.H.D. continue
to go unrecognized and untreated, he said the high 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.”

Allison Kopicki contributed reporting.

This article has been revised to reflect the following correction:

*Correction: April 1, 2013*

A headline with an earlier version of this article misstated the disorder
that saw an increased diagnosis, according to new data from the federal
Centers for Disease Control and Prevention. It is attention deficit
hyperactivity disorder, not hyperactivity, which is present in A.D.H.D. in
only a portion of cases. The article also misstated the name of the
organization that plans to change the definition of A.D.H.D. to allow more
people to receive the diagnosis and treatment. It is the American
Psychiatric Association, not the American Psychological Association.


-- 
Art Deco (Wayne A. Fox)
art.deco.studios at gmail.com
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