ADHD: Epidemic of Incidence or Over-Diagnosis?

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The latest numbers on ADHD appear to be seriously out of step with historical prevalence rates and suggest an epidemic not so much of occurrence but rather of over-diagnosis.

The number of school age children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) has skyrocketed in the past few decades. A recent report from the Centers for Disease Control estimates that approximately 15 percent of high school students now carry the ADHD diagnosis and are taking some type of medication for the condition. This has sounded alarm bells for many in the medical and research communities. To some, the numbers suggest that a true epidemic exists. But to others, the numbers (which on their face appear both inflated and seriously out of step with historical prevalence rates) suggest an epidemic not so much of occurrence but rather of over-diagnosis. Because of all the ramifications of so many children being prescribed powerful (often, stimulant type) drugs even some of the early pioneers in the field, who fought long and hard to legitimize the illness, are beginning to assert that something is indeed amiss in the world of ADHD diagnosis and treatment.

A well-written and in-depth piece in the New York Times quotes the eminent Duke University Psychologist Dr. Keith Conners as asserting that the astronomical rise in rates of diagnosis for the disease is “a national disaster of dangerous proportions,” adding that the official numbers “make it look like an epidemic” whereas the “preposterous” rates of diagnosis really most likely represent “a concoction to justify the giving out of medication at unprecedented and unjustifiable levels.” When an allegation of this type comes from any distinguished researcher and professional it should raise an eyebrow or two. When such an allegation comes from one of the earliest and staunchest advocates for the legitimacy of the illness, it should prompt even deeper concern.

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Early in my clinical training I had the privilege to intern at one of the premier child study centers, out of which had come some of the earliest scholarly papers on a syndrome that would one day be known as ADHD; at the time, the syndrome was referred to by most as Minimal Brain Dysfunction, or MBD. It was a real eye-opener to realize that there were children, who through no fault of their own, struggled with a form of neurological impairment that made it extremely difficult for them to pay attention (especially, to focus in the classroom), to keep still, to moderate their impulses, and to achieve academically at levels consistent with their intellectual capacity. Prior to the discovery of the syndrome, it was often assumed that these children’s problems were the result of other factors such as anxiety, poor discipline, “laziness,” or possibly even a mindset toward opposition or contrariness. What a relief it was to discover that some children, who had been unfairly labeled with all sorts of illnesses, were actually simply doing their best to cope with an inability to focus, and when properly treated with medication were almost miraculously transformed into the more ideal student their parents had always hoped they’d be.

One of the principal instruments we used at our child study center to assess youngsters for their attentiveness capacity was an assessment scale devised by Dr. Conners. Because of how the scale was constructed and the kind of input it required, it proved to be a reliable indicator of whether a child was in fact struggling with a neurologically-based attention deficiency. I gained a good deal of respect for Conners and his research back then, and that respect only increased over the years with his many publications. That’s not the only reason why I take his recent criticisms about ADHD prevalence rates so seriously; another reason is that I too have witnessed the explosion in ADHD diagnosis as well as many of the factors that appear to be driving the numbers. Chief among these is the relentless marketing to doctors, parents, and teachers by pharmaceutical companies promoting their drugs as the instant, effective, and “harmless” answer to a wide variety of classroom and child management difficulties.

The Times article implies it’s probably no accident that charges by the U.S. Food and Drug Administration (FDA) against pharmaceutical companies for false and misleading advertising have often involved drugs used to treat ADHD. The ADHD “industry” is a very big and very profitable business. Drug companies have been relentless in their marketing campaigns. But drug companies don’t deserve all the blame. There’s plenty of blame to go around. Parents, doctors, teachers, even students have all been far too quick both to ask for and to rely upon a little pill as the simplest, easiest, and least time- and energy-demanding solution to a host of academic and behavioral problems. It’s the rare occasion that any child experiencing difficulties receives the kind of comprehensive evaluation we once used to perform quite routinely before conferring an ADHD diagnosis upon a child. Pressure from third-party payers has had a lot to do with that. So what we have ended up with is a “perfect storm” of sorts: excessive demand, deficient assessment, incessant drug company marketing (including marketing even to those who fashion the diagnostic criteria that might justify the prescription of a company’s drug), all of which has produced what Keith Conners is calling the “unjustifiable” over-medicating of a significant segment of the population.

I certainly don’t want to go back to the days when we inappropriately labeled children who have true attention deficits with all sorts of other disorders. Nor do I want to see any child fail to achieve at the level at which they’re intellectually capable merely because of symptoms they can’t control and which are readily treatable. But I also know that Dr. Conners and the many colleagues who agree with him have raised a very legitimate and serious concern that demands further, objective investigation. We owe this to ourselves and especially to our children. Genuine ADHD is a serious and debilitating condition and we would all do well not to mistake it for POMS (Pharmaceutical Over-Marketing Syndrome).

All clinical material on this site is peer reviewed by one or more clinical psychologists or other qualified mental health professionals. This specific article was originally published by on and was last reviewed or updated by Dr Greg Mulhauser, Managing Editor on .

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