ADHD Diagnoses are on the Rise

A recent analysis of CDC data by The New York Times found that 11% of school age children are diagnosed with some form of Attention Deficit Hyperactivity Disorder (ADHD). Boys are more likely to receive the diagnosis than girls (15% to 7%), and one out of five high school boys diagnosed with ADHD. The amount of children diagnosed with ADHD has increased 16% since 2007 and 53% in the past decade. Considering the diagnostic changes proposed for the DSM-V, that number is only going up.

There are three categories of ADHD: Combined type, Predominantly Inattentive Type, and Predominantly Hyperactive-Impulsive Type. The core features are distractibility, impulsivity, and hyperactivity. The diagnosis depends on having 6 out of 9 symptoms for inattentiveness and/or 6 out of 9 symptoms for hyperactivity. For example, one symptom for inattentiveness is that the person “often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.” The proposed revisions to the DSM would add some possible symptoms to the list.

In addition, a person must also have some symptoms that cause impairment were present before age 7 years, and there must be clear evidence of clinically significant impairment in social, school, or work functioning (among other things). The proposed changes would change the age from 7 to 12, and the word “impairment” to “impact”. Each change would increase the amount of people who could be diagnosed with ADHD, which has caused concern.

There is already a debate on whether or not ADHD is over diagnosed and over medicated. One 2010 study published in the Journal of Health Economics found that students who just make the cut-off date for a grade are 40% more likely to be diagnosed with ADHD than those who just miss it. In other words, the 8.4% of the youngest students in a grade were diagnosed with ADHD compared to 5.1% of the oldest students. This suggests that physicians are failing to distinguish between normal developmental immaturity and ADHD. The study found that this mistake could account for 20% of all ADHD diagnoses, amounting to 900,000 children in the U.S.

The study went on to say that this can translate into overuse of prescription drugs. The youngest children in 5th and 8th grade are twice as likely as the oldest classmates to regularly use prescription stimulants. Generally, around 70% of children diagnosed with ADHD receive medication. Add on the fact that between one half and two thirds of children with ADHD will continue to have substantial problems into adulthood, and you quickly have a recipe for lifelong drug dependence.

At the same time, these medications can be extremely helpful to those who suffer from ADHD. Studies have found that as many as 80% of children respond well to these medications. Additionally, 85% report only mild or no side effects. While these medications can be effective, they are also frequently abused.

College students and high school students have been using the “up all night cramming pill” to gain a competitive academic advantage. In 2011, an estimated 12% of high-school seniors reported misusing a prescription stimulant and 4% had done so in the past month.

Additional Resources

The New York Times, A.D.H.D. Seen in 11% of U.S. Children as Diagnoses Rise: http://www.nytimes.com/2013/04/01/health/more-diagnoses-of-hyperactivity-causing-concern.html?hp&_r=0

Medscape Today, Psychometric Analysis of the New ADHD DSM-V Derived Symptoms: http://www.medscape.com/viewarticle/764516

CDC, Therapeutic Drug Use: http://www.cdc.gov/nchs/fastats/drugs.htm

Attention Deficit Disorder Association, ADHD Fact Sheet: http://www.add.org/?page=ADHD_Fact_Sheet#

CDC, Attention-Deficit/Hyperactivity Disorder: http://www.cdc.gov/ncbddd/adhd/diagnosis.html

NIDA for Teens, Prescription Stimulants: http://teens.drugabuse.gov/drug-facts/prescription-stimulants

PMC, Prevalence of Medication Treatment for Attention Deficit–Hyperactivity Disorder Among Elementary School Children in Johnston County, North Carolina: http://www.ncbi.nlm.nih.gov/pmc/articles/pmc1447048/

CDC, ADHD Treatment: http://www.cdc.gov/ncbddd/adhd/treatment.html

Science Daily, Nearly One Million Children in U.S. Potentially Misdiagnosed with ADHD, Study Finds: http://www.sciencedaily.com/releases/2010/08/100817103342.htm

Journal of Health and Economics, The Importance of Relative Standards in ADHD diagnoses: https://www.msu.edu/~telder/2010-JHE.pdf

 

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