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,(ADHD), 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 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 such stimulants as Ritalin or Adderall, which can drastically improve the lives of those with ADHD but also can 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. 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 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 landline and is currently compiling its reports. The New York Times obtained the raw data from the agency and compiled the results.
ADHD HISTORY
ADHD historically has been estimated to affect 3 percent 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 often is skipped under time constraints and pressure from parents. It is considered a chronic condition that often is 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 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, a professor of medicine at Harvard Medical School and the author of “How Doctors Think.”
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 one in 10 high-school boys currently takes ADHD medication, the data showed.
Rates by state are less precise but vary widely. Southern states, such as 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.
The medications — primarily Adderall, Ritalin, Concerta and Vyvanse — often afford those with severe ADHD 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 ADHD diagnosis has become a popular shortcut to better grades, some experts said, with many students unaware of or disregarding the medication’s health risks.
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.
Criteria for the proper diagnosis of ADHD, 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, such as repeatedly losing one’s cellphone or losing focus during paperwork, that emphasize that ADHD 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 ADHD but continue to function acceptably in their daily lives.”
Given that severe ADHD that goes untreated has been shown to increase a child’s risk for academic failure and substance abuse, doctors historically have focused on raising awareness of the disorder and reducing fears surrounding stimulant medication.
A leading voice has been Dr. Ned Hallowell, a child psychiatrist and author of best-selling books on the disorder. But in a recent interview, Hallowell said that the new CDC data, combined with recent news reports of young people abusing stimulants, left him assessing his role.
While Hallowell for years would reassure skeptical parents by telling them that Adderall and other stimulants were “safer than aspirin,” he said last week, “I regret the analogy” and that he “won’t be saying that again.” And while he still thinks that many children with ADHD continue to go unrecognized and untreated, he said the high rates demonstrate how the diagnosis is being handed out too freely.
Article by ALAN SCHWARZ and SARAH COHEN of the New York Times