Children are being diagnosed with A.D.H.D. at historic rates. The question is why. PHOTO: Jens Rötzsch, Wikimedia Commons
“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. “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.”
Dr. Graf hits on a central issue with A.D.H.D.: there are incentives beyond the doctor's best judgment to diagnose children with the disorder. A.D.H.D. is typically treated with medication such Ritalin and Adderall, which combat the inability to focus and sit still typical of A.D.H.D. by temporarily improving one's ability to concentrate. That's not something that benefits just students with A.D.H.D., children, especially in very competitive schools, enjoy the medically fueled boost. According to the New York Times:
Several doctors mentioned that advertising from the pharmaceutical industry that played off parents’ fears — showing children struggling in school or left without friends — encouraged parents and doctors to call even minor symptoms A.D.H.D. and try stimulant treatment. For example, a pamphlet for Vyvanse from its manufacturer, Shire, shows a parent looking at her son and saying, “I want to do all I can to help him succeed.”
Sales of stimulants to treat A.D.H.D. have more than doubled to $9 billion in 2012 from $4 billion in 2007, according to the health care information company IMS Health.
So, kids benefit from higher performance, and parents feel assured that they are helping their child succeed. Drug companies make billions and doctors get paid and keep everyone happy. It's an insidious cycle. Why insidious? Because it can get young kids hooked on stimulants from a young age, lead to high blood pressure, and put kids who aren't getting medication at a disadvantage, who have to compete with turbo-powered classmates with loosely given A.D.H.D. diagnoses.
“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.”
There's no clear mechanism to put the brakes on this cycle. In fact, new changes to the Diagnostic and Statistical Manual of Mental Disorders to be released in its 5th edition, may specifically allow more adolescents and adults to qualify for a diagnosis, according to several people involved in the discussions. Currently, symptoms have to appear before the age of 7 for a diagnosis of A.D.H.D. to be given. That may be changed to the age of 12, which will open the gates wider to more A.D.H.D. diagnoses. One can qualify for A.D.H.D. with signs like repeatedly losing one’s cellphone or losing focus during paperwork, and the requirement that symptoms merely “impact” daily activities, rather than cause “impairment.”
Seriously, how many people can you think of that wouldn't qualify under those criteria?
There's no easy solution here, but one thing that isn't helping is the profit-motivated drug companies pushing on all sides. I don't blame them for wanting more profits, but that should not be a principle motive in diagnosing childhood disorders.