ADHD cases rising among school kids in U.S.
- Article by: Alan schwarz and Sarah cohen
- New York Times
- March 31, 2013 - 10:13 PM
Nearly 1 in 5 high-school-age boys in the United States and 11 percent of school-age children overall have received a medical diagnosis of attention deficit hyperactivity disorder, according to new data from the federal Centers for Disease Control and Prevention (CDC).
These rates reflect a marked rise over the past decade and could fuel growing concern among many doctors that the ADHD 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 ADHD 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 such as Ritalin or Adderall, which can drastically improve the lives of those with ADHD but can also lead to addiction, anxiety and occasionally psychosis.
“Those are astronomical numbers. I’m floored,” said Dr. William Graf, a pediatric neurologist in New Haven and a professor at the Yale School of Medicine, who 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 Psychological Association plans to change the definition of ADHD to allow more people to receive the diagnosis and treatment. ADHD 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 CDC study 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 land line and is currently compiling its reports. the New York Times obtained the raw data from the agency and compiled the results.
No firm criteria
ADHD 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 CDC 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,” Frieden said. “The right medications for ADHD, 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 ADHD, 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 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, a professor of medicine at Harvard Medical School.
Fifteen percent of school-age boys have received an ADHD 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 1 in 10 high-school boys currently takes ADHD 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 ADHD diagnosis. The rates in Colorado and Nevada were less than 10 percent.
“There’s no way that 1 in 5 high-school boys has ADHD,” said James Swanson, a professor of psychiatry at Florida International University and one of the primary ADHD 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 ADHD 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 CDC data, have among the highest rates of ADHD diagnoses: 14 percent for school-age children, about one-third higher than the rest of the population.
Sales of stimulants to treat ADHD have more than doubled to $9 billion in 2012 from $4 billion in 2007, according to the health care information company IMS Health.
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