ADHD: Overdiagnosis or better access to healthcare?
An average of nine percent of children ages 5 to 17 were diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), according to a 2011 report released by the U.S. Centers for Disease Control and Prevention (CDC).
The new data, representing a 29 percent rate of increase from 1998–2000 figures, has generated significant controversy about what some healthcare professionals consider an overdiagnosis of the disorder.
Is ADHD truly present in all children diagnosed, or is it simply becoming a catch-all disorder? Some researchers say overdiagnosis may occur if clinicians fail to consider all disorder possibilities.
Patients are evaluated based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV); however, overdiagnosis is likely if clinicians rely solely on symptoms and ignore other criteria specified in the DSM-IV since ADHD symptoms are not unique to the disorder, researchers say.
Other researchers believe the rise stems from better access to health care, more clinical familiarity with ADHD, and better reporting. Dr. Lara Akinbami, medical officer at the CDC and author of the report, said, “This is probably about better screening rather than a real increase, and that means we may continue to see this pattern unfold.”
Peter Breggin, New York psychiatrist and director of the Center for the Study of Empathic Therapy, Education, and Living, argues that ADHD symptoms are spontaneous behaviors of normal children (hyperactivity, impulsiveness, inattention). When these traits become age-inappropriate, Breggin said, the causes could be innumerable and should not be limited to ADHD. “By making an ADHD diagnosis, we ignore and stop looking for what is really going on with the child,” he added.
The rise in ADHD has had a significant impact on pharmaceutical companies. A 2007 study found half of all children diagnosed with ADHD are currently receiving medication. While studies show the effectiveness of both stimulant and nonstimulant medication in reducing symptoms compared to placebos, the question remains as to whether these drugs are helping children or masking a more severe problem.
Breggin documented his observations of stimulant drugs and found that although they suppressed children’s spontaneous behaviors, they did not improve learning or psychosocial development. “We are diagnosing and drugging millions of our children instead of providing them the improved educational and family life they truly need,” he said.
While school and home solutions are one form of treatment, the most effective form is multimodal – stimulant drugs paired with psychosocial modifications. Still, children should be reevaluated on a regular basis to determine the necessity of stimulant treatment over time, according to the American Academy of child and Adolescent Psychiatry. Some psychiatrists are concerned that long-term stimulant use may be less effective as the body adapts, or that medication is being issued without conjunctive behavioral therapy, which provides education of vital coping mechanisms.
Due to the rising prevalence of ADHD, doctors urge parents to seek highly trained and specialized physicians who are broad in their diagnostic considerations. There is no substitute for a careful, comprehensive assessment.