'Astronomical' rise in ADHD diagnoses raises questions

CDC: Nearly 20% of high school boys have been diagnosed with ADHD

A new CDC report finds that the number of children diagnosed with attention deficit hyperactivity disorder (ADHD) has increased 53% over the last decade— but some experts say that increase may reflect overuse of the diagnosis and its medications. 

CDC report finds major increase in ADHD cases

For the report, CDC researchers surveyed more than 76,000 parents nationwide from February 2011 to June 2012.

Researchers say that about 11% of all school-age children have been diagnosed with ADHD, with rates varying from state to state. About 23% of school-age boys are diagnosed with ADHD in southern states, such as Arkansas, Kentucky, Louisiana, South Carolina, and Tennessee, while fewer than 10% of children in Colorado and Nevada are diagnosed with the disorder.

In addition, the report found that ADHD is more common among high school-aged boys—19% are diagnosed with the disorder, compared with just 10% of high school-aged girls.

Altogether, the survey data suggest that an estimated 6.4 million U.S. children between the ages of four and 17 have been diagnosed with ADHD, up 16% from 2007 and 53% in the past 10 years. "Those are astronomical numbers. I'm floored," Yale School of Medicine professor William Graf told the New York Times.

Experts: Increase in diagnoses may prompt stimulant overuse

According to CDC Director Thomas Frieden, the most troubling statistic from the report addresses medication rates: About 66% of those diagnosed with ADHD have prescriptions for stimulants such as Adderall and Ritalin. Frieden told the Times that the rising rates of stimulant prescription among children mirrors the overuse of pain medication antibiotics in adults.

"We need to ensure balance," Frieden says, adding that 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."

According to data from IMS Health, ADHD medication sales have more than doubled between 2007 and 2012, from $4 billion to $9 billion. Specifically, the report found that one in 10 high school-aged boys has a prescription for stimulants.

Florida International University professor James Swanson notes that 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%."

Some health experts say that parents and older children may be seeking ADHD diagnoses to obtain stimulant prescriptions that may calm behavioral issues and increase focus for school work.

"There's no way that one in five high-school boys has ADHD," says Swanson.

New DSM-V may increase ADHD diagnoses

Even more children may be diagnosed with ADHD after the American Psychiatric Association releases new criteria for ADHD diagnoses in its fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), according to the Times.

Although the final language for the DSM-V has not yet been released, experts say it will allow for more adolescents and adults to qualify for the diagnosis by the requirement for "impairment" on daily life to simply "impact" on daily life. For example, "repeatedly losing one's cellphone or losing focus during paperwork" will be a symptom of ADHD in the new DSM-V, according to the Times.

"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," Graf says (Schwarz/Cohen, Times, 3/31; Bennett, "The Atlantic Wire," The Atlantic, 4/1).

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