Making Sense of the Rise in ADHD
Making Sense of the Rise in ADHD
The New York Times recently reported that attention-deficit/hyperactivity disorder (ADHD) is being diagnosed in "nearly 1 in 5 high school-age boys in the United States and 11% of school-age children." The article's author commented that this is a 16% increase since 2007 and a 41% increase over the past decade. The article then immediately jumps to the editorial concern that this represents overdiagnosis and overmedication by physicians pressured by parents and influenced by the pharmaceutical industry.
The New York Times took the somewhat unusual step for a newspaper of obtaining raw data from the Centers for Disease Control and Prevention's (CDC's) 2011-2012 National Survey of Children's Health and analyzing and reporting these data, rather than waiting for the CDC or other professional groups to do so. The Times article is primarily an editorial presenting the downside of such overdiagnosis and consequent medication abuse, addiction, and "diversion long tolerated in college settings and gaining traction in high-achieving high schools." It goes further and raises the concern that DSM-5 will open the door to even broader mislabeling of normal child behavior as ADHD.
However, there might be more to this story. The concern about overdiagnosis and overmedication has received much attention in the popular press over the past 40 years. My first insights into the passions raised in this quarter came in 1971 when I attended a meeting with a Midwest school board called specifically to address overmedication of school children for attention deficit disorder (ADD). In 2007, Sciutto and Eisenberg nicely summarized the legacy of claims of overdiagnosis and overmedication (including concerns voiced by Hillary Clinton in a March 2000 press conference). Their review of the evidence found little evidence to support or refute these claims. Parent report, the basis of the CDC data, is known to overreport the prevalence of ADHD. Clearly, rapid diagnosis without adequately collecting and weighing information from multiple sources can lead to diagnostic error both in terms of false positives (eg, the hyperactive problematic child) and underdiagnosis (eg, the inattentive child).
But what if the prevalence of the behaviors that lead to the label of ADHD really are increasing? Is the automatic conclusion about overdiagnosis and overmedication correct? What issues might be raised by a more balanced consideration of the CDC data (assuming that the Times analysis used the appropriate statistical methods)?
More Attention for Rising ADHD
The New York Times recently reported that attention-deficit/hyperactivity disorder (ADHD) is being diagnosed in "nearly 1 in 5 high school-age boys in the United States and 11% of school-age children." The article's author commented that this is a 16% increase since 2007 and a 41% increase over the past decade. The article then immediately jumps to the editorial concern that this represents overdiagnosis and overmedication by physicians pressured by parents and influenced by the pharmaceutical industry.
The New York Times took the somewhat unusual step for a newspaper of obtaining raw data from the Centers for Disease Control and Prevention's (CDC's) 2011-2012 National Survey of Children's Health and analyzing and reporting these data, rather than waiting for the CDC or other professional groups to do so. The Times article is primarily an editorial presenting the downside of such overdiagnosis and consequent medication abuse, addiction, and "diversion long tolerated in college settings and gaining traction in high-achieving high schools." It goes further and raises the concern that DSM-5 will open the door to even broader mislabeling of normal child behavior as ADHD.
However, there might be more to this story. The concern about overdiagnosis and overmedication has received much attention in the popular press over the past 40 years. My first insights into the passions raised in this quarter came in 1971 when I attended a meeting with a Midwest school board called specifically to address overmedication of school children for attention deficit disorder (ADD). In 2007, Sciutto and Eisenberg nicely summarized the legacy of claims of overdiagnosis and overmedication (including concerns voiced by Hillary Clinton in a March 2000 press conference). Their review of the evidence found little evidence to support or refute these claims. Parent report, the basis of the CDC data, is known to overreport the prevalence of ADHD. Clearly, rapid diagnosis without adequately collecting and weighing information from multiple sources can lead to diagnostic error both in terms of false positives (eg, the hyperactive problematic child) and underdiagnosis (eg, the inattentive child).
But what if the prevalence of the behaviors that lead to the label of ADHD really are increasing? Is the automatic conclusion about overdiagnosis and overmedication correct? What issues might be raised by a more balanced consideration of the CDC data (assuming that the Times analysis used the appropriate statistical methods)?
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