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ADHD Diagnosis and Drug Prescription—2013

ADHD DIAGNOSIS AND DRUG PRESCRIPTION

The Over Diagnosis and Over Medicating of American Children

Prepared by Student 1

November 25, 2013

Prepared for

California State University California San Bernardino

Management 306

ADHD Diagnosis and Drug Prescription—2013

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TABLE OF CONTENTS

ABSTRACT……………………………………………………………………………… v

EXECUTIVE SUMMARY………………………………………………………………. 1

INTRODUCTION……………………………………………………………………….. 2

Definition and Symptoms of ADHD……………………………………………... 2

Criteria for diagnosis of ADHD………………………………………………….. 3

ANALYSIS OF ADHD DIAGNOSIS AND PRESCRIPTION RATES………………… 4

Diagnosis Statistics………………………………………………………………... 4

Over Diagnosis Argument………………………………………………… 4

Prescription Statistics……………………………………………………………... 5

Over Prescription Argument ……………………………………………… 6

CONCLUSIONS AND RECOMMENDATIONS………………………………………… 7

REFERENCES …………………………………………………………………………….. 8

GLOSSARY…..…………………………………………………………………………… 9

ADHD Diagnosis and Drug Prescription—2013

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ABSTRACT

Attention Deficit Hyperactivity Disorder (ADHD) is the leading brain disorder diagnosed in

American children. An astronomical increase of diagnoses over the past decade has caused great

concern that American children are being over diagnosed with ADHD. These diagnoses are

often based solely on parental and teacher reports, adding fuel to the claim that diagnoses are

handed out too frequently and far too easily. Another serious concern stemming from this issue,

is the prescription of psycho stimulant medication to children. If the theory of over diagnosis is

correct, then many children are unnecessarily taking ADHD medications to correct behavior that

is indicative of childhood. Many professionals in the field of psychiatry and neurology have

expressed their disbelief and concern in the enormous increase in ADHD diagnoses and children

taking powerful prescription medicine to correct “abnormal” behavior. While some children will

need to take medication based on the severity of their condition, many others with mild ADHD

can benefit from behavioral therapy, better nutrition, and exercise. This paper examines the

statistics behind the over diagnosis and over prescription claims and offers recommendations for

parents of children with ADHD.

ADHD Diagnosis and Drug Prescription—2013

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EXECUTIVE SUMMARY

Attention Deficit Hyperactivity Disorder (ADHD) is the leading brain disorder diagnosed in

American children. An astronomical increase of diagnoses over the past decade has caused great

concern that American children are being over diagnosed with ADHD. The disorder is often

diagnosed at an early age, so many feel that normal behavior for younger children can be

mistaken for symptoms of ADHD. Diagnoses are often based solely on parental and teacher

reports, adding fuel to the claim that they are handed out too frequently and far too easily.

Another serious concern stemming from this issue, is the prescription of psycho stimulant

medication to children. If the theory of over diagnosis is correct, then many children are

unnecessarily taking ADHD medications to correct “abnormal” behavior. In addition, because

ADHD has become so common, parents are more comfortable placing their children on these

medications. In fact, some parents have turned to asking their doctors for ADHD medications as

a study enhancement for their children. Also, many college students are taking the drugs to

study better and boost grades.

The sheer amount of teenage boys diagnosed with ADHD, is a testament to the great increase of

diagnoses of the disorder over the past 10 years. Many professionals in the field of psychiatry

and neurology have expressed their disbelief and concern in the enormous increase in children

diagnosed with ADHD, as well as the increase in those taking powerful prescription medicine to

correct “abnormal” behavior. It is difficult to believe that the behavioral or learning problems

these children have are all because of ADHD. Due to the increase in doctors diagnosing and

prescribing medications for ADHD, it is important that parents do their research in determining

the severity of the ADHD in their child, and the alternative treatments to medication.

ADHD Diagnosis and Drug Prescription—2013

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INTRODUCTION

A very controversial topic in medicine today is the diagnosis of Attention Deficit Hyperactivity

Disorder (ADHD) and the prescription of ADHD drugs to children. ADHD is one of the most

common neuro behavioral disorders in children, and is especially high in the United States.

Although many people believe it to be a childhood disease, ADHD is a chronic condition that is

often carried into adulthood (“Attention Deficit”, 2013). The high rate of diagnoses of ADHD

and prescription of psychostimulants in an attempt to treat the disorder, has spark concern that

ADHD is being over diagnosed and medications to treat the disorder are being over prescribed.

The purpose of this paper is to examine the increase diagnoses and prescriptions of medication in

children, and whether the trend suggests an over diagnosis and over prescription of medication

associated with ADHD.

Definition and Symptoms of ADHD

According to the National Institute of Mental Health, ADHD is the most common brain

disorder in children that often continues into teenage years and adulthood. The symptoms of

ADHD make it difficult for those affected to do well in school, complete tasks, or get along with

others. The main symptoms that are characteristic of ADHD are inattention, hyperactivity, and

impulsivity. Although these behaviors are typical in children, those with ADHD experience them

more severely and frequently than other children of the same age (“Attention Deficit”, 2013).

More specifically the symptoms of inattention, hyperactivity, and impulsivity are as follows:

Inattention:

 Easily distracted, forgetful, and often switch from one activity to the next

 Difficulty focusing on organization, completion of tasks, or learning new subjects

 Quickly becoming bored of a task after a few minutes unless doing something he or she enjoys

 Often daydreams, become easily confused, and appears not to be listening

 Struggle to follow instructions and processing information quickly and accurately

Hyperactivity:

 Fidgety and unable to sit quietly

 Talking non stop

 Constantly moving—always touching or playing with everything in sight

 Have difficulty performing quiet tasks and activities

Impulsivity:

 Very impatient

 Interruptive

 Act without regard of consequences

 Show emotions without restraint

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Criteria for diagnosis of ADHD

The controversy over the diagnosis of ADHD stems from the fact that there is no true test used to

diagnose the disorder. Typically, the diagnosis is based on reports given by the parents and

teachers of the child. In theory, the disorder is difficult to diagnose because symptoms vary from

individual to individual, and therefore, doctors must go through a detailed assessment of the

child’s behavior. Parents or teachers will usually begin to notice symptoms of ADHD between

the ages of 3 and 6 and will seek the advice of his or her pediatrician. The pediatrician can

access the child his or herself, or refer the family to a mental health professional for assessment.

The health professionals must first rule out any other reasons for the symptoms. For example,

depression, family issues, or bullying. Next, the doctors should take considerable time to access

the child’s behavior by watching how the child interacts with others, investigate his or her

medical and family history, and interviewing the child (“Attention Deficit”, 2013). With a

relatively vague criteria required for diagnosis of ADHD, many Americans are concerned that

doctors are hastily diagnosing and prescribing stimulant medications to children. The increasing

rates of children diagnosed with ADHD and/ or taking ADHD medications may be a testament to

this theory of over diagnosis and over prescription of medications.

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ANALYSIS OF ADHD DIAGNOSIS AND PRESCRIPTION RATES

DIAGNOSIS STATISTICS

The diagnosis of ADHD has increased an overwhelming amount over the past decade. In fact, a

recent report by the Center of Disease Control (CDC) showed a 41 percent increase in the

number of children whom have received a diagnosis of the disorder at some point in their lives.

This percentage is equivalent to 6.4 million children, ranging from ages 4 to 17. In addition,

ADHD is historically more prevalent in boys than girls. As reported by the CDC, nearly one in

five (20 percent) high school age boys have been medically diagnosed with ADHD, compared to

10 percent of girls belonging to the same age group (as cited in Cohen & Schwarz, 2013). Figure

1.1 shows the breakdown, by gender, of children who have been diagnosed with ADHD at some

Figure 1 ADHD diagnoses by age and gender

point in their lives. These numbers reflect the percentage of all children in the United States ever

to be diagnosed with the disorder. The data suggests that a large majority of children in the U.S.

have or have had the disorder at some point in his or her life. It is difficult to believe that the

data reflects the number of children that truly have the disorder. The issue is not whether ADHD

is a real disorder, but rather, if doctors are taking the necessary time and efforts to appropriately

diagnose children with a mental disorder.

Over Diagnosis Argument

These statistics have invoked strong reactions among the medical community. While some

doctors believe the increase in diagnoses is attributed to an increase of awareness of the disorder

over the years, many others have concluded that the increase is due to the over diagnosis of

children that may not actually have ADHD.

7

10

8

4

15

20

18

10

TOTAL

14-17

10-13

4-9

Percentage

A g

e i

n y

e a

rs

Children Diagnosed with ADHD

Boys Girls

ADHD Diagnosis and Drug Prescription—2013

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Sanford Newmark, head of the Pediatric Integrative Neurodevelopmental Program at the

University of California, San Francisco, believes that doctors are too quick to diagnose

children’s behavior as ADHD. In a Wall Street Journal article titled “Are ADHD Medications

overprescribed?”, Newmark says the over diagnosis of ADHD is due to issue that “the people

making the diagnoses aren’t distinguishing, in many cases, between normal developmental

immaturity and ADHD” (2013). Children as young as 4 years old are diagnosed with the

disorder. When the symptoms of ADHD are compared to the idea of a typical 4 year old, it

becomes less clear whether the behavior is evidence of a disorder, or normal behavior for young

children. In addition, many doctors may not take extensive measures of examining children

before they diagnose ADHD as the cause of their “abnormal” behavior. Newmark says, “ADHD

is often diagnosed without the type of thorough history and examination needed for an accurate

assessment. Instead, many children are diagnosed after a visit of 15 to 20 minutes with a

pediatrician or other professional” (2013). The explanation for the high diagnosis rates can be

explained by this idea. The concern of many whom believe ADHD is over diagnosed is that

children are not being accessed in depth, resulting in children that do not fully meet the criteria,

being diagnosed.

Parents can also play a role in the over diagnosis of the disorder. Over the years, ADHD has

become a household name. Because ADHD is no longer an uncommon disorder, some parents

feel more comfortable with the idea that their children may have ADHD. In a sense, a diagnosis

can be the answer many parents are looking for to explain their child’s disruptive behavior or

slipping grades (Cohen & Schwarz, 2013). If parents continue to turn to an ADHD diagnosis to

explain children’s behavioral issues, the diagnosis rates of ADHD will continue climb.

Although, parents have their children’s best interest at heart, it is important that they do not

pressure doctors to diagnose their children too quickly.

PRESCRIPTION STATISTICS

In most cases of ADHD, medication is prescribed to control symptoms. In fact, medication used

to treat ADHD is among the most prescribed medication in the country. According to the CDC,

approximately 3.5 million children are taking ADHD medication (as cited in Jaslow, 2013). As

can be expected, an increase in diagnoses have resulted in an increase in prescriptions of ADHD

drugs. The number of ADHD medication prescriptions given to children under 17 rose 46

percent from 2002 to 2012 (Jaslow, 2013). This dramatic increase has also invoked suspicion

that many of the children prescribed ADHD medications could benefit from other treatments.

The percentage of children prescribed ADHD drugs are reflective of the percentage of children

diagnosed with the disorder. Across the country, states in which diagnosis rates are particularly

high, also have a high rate of children prescribed medication. Figure 2 shows a geographic map

of the U.S. and identifies the percentage of children taking ADHD medications in 2011. This

invokes the belief that ADHD medications are being over prescribed, with doctors writing

prescriptions for the majority (if not all) children diagnosed.

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Figure 2. State breakdown of percentage of children taking ADHD medications

Over Prescription Argument

A very important concern of many who feel ADHD is being over diagnosed, is the idea that

doctors are also over prescribing medication as a quick fix to behavioral or learning problems.

ADHD medication has also become a study tool used by high school and college students to

study for exams with the intent to boost their grades. This is due to the fact that medications

used to treat ADHD can drastically improve focus and motivation in most individuals, regardless

of the degree of ADHD symptoms experienced (Cohen & Schwarz, 2013). This is a dangerous

trend derived from the ease of obtaining a prescription for ADHD medications. Many parents

and teens overlook potential risks associated with taking prescription medication unnecessarily.

Many children are placed on these medication with no significant studies proving they are

healthy for developing brains. Although studies have proven that ADHD medications

significantly improve those with severe ADHD, it is unclear how they affect the brain

development of younger children or those with few or no symptoms of ADHD (Newmark,

2013). In addition, there is cause for concern that teenagers may become addicted to these

medications, especially if they are misdiagnosed with ADHD. James Swanson, one of the

primary ADHD researchers in the U.S. says, “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” (as

cited in Cohen & Schwarz, 2013). While medications can be very beneficial for some

individuals with ADHD, it is extremely important for American doctors and parents to notice the

rise in children on stimulant medications. The decision to put a child on prescription drugs

should not be a quick response to slipping grades or disruptive behavior, but an educated

decision based on the child’s needs.

Children Aged 4-17 Years Currently Prescribed ADHD Medication

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CONCLUSIONS AND RECOMMENDATIONS

The alarming increase in the diagnosis rate of ADHD over the past decade, has led many to

believe that children are being labeled with the disorder too quickly. Although, there should be

an extensive look at the child’s behavior and ruling out of any other diseases or disorders that

may be the cause, pediatricians are often making snap decisions based solely on parental reports.

This is a dangerous trend because the majority of ADHD diagnosed children are taking

stimulants to correct “abnormal” behavior. In addition, many parents are taking advantage of an

easy ADHD diagnosis to get drugs prescribed to their children to enhance studying and grades.

Although ADHD medications have a great record for helping children with severe ADHD, it

amazing to think of how many kindergartners are diagnosed with ADHD and taking medication

to improve their behavior. It is important for parents to ensure that their child is given a

complete assessment before taking an ADHD diagnosis as truth. It is especially important that

parents know the severity of their child’s ADHD, and research alternative treatments that may

help correct behavioral issues.

With diagnosis rates rising, and more children taking prescribed medications for ADHD, I offer

the following recommendations for parents of children diagnosed with the disorder:

 Ensure your pediatrician or mental health professional performs a thorough assessment of your child’s behavior before accepting an ADHD diagnosis.

 Consider getting a second opinion if your child is very young.

 Strive for complete understanding of the severity of your child’s ADHD.

 If your child’s diagnosis is mild to moderate, consider alternatives to prescription medications, such as behavioral therapy (to control impulsivity), a change in his

or her diet (i.e. less caffeine and sugar), or exercise (to channel energy in a

positive way).

It is important to tailor treatment to the individual child, and not assume that prescription

medication is the best decision for every child. With these recommendations in mind, doctors

and parents can make better decisions in the diagnosis and treatment of children with behavioral

or learning problems, and possibly decrease the amount of children diagnosed with the disorder,

and the prescription medication use that comes with a diagnosis.

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REFERENCES

Attention Deficit Hyperactivity Disorder. (n.d.) NIMH RSS. Retrieved November 22, 2013, from

http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-

disorder/index.shtml

Cohen, S., & Schwarz, A. (2013, March 31). A.D.H.D. Seen in 11% of U.S. Children as

Diagnoses Rise. The New York Times. Retrieved November 22, 2013, from

http://www.nytimes.com/2013/04/01/health/more-diagnoses-of-hyperactivity-causing-

concern.html?pagewanted=2&_r=0

Jaslow, R. (2013, March 13). Neurologists warn against prescribing ADHD drugs to kids as

"study drugs". CBSNews. Retrieved November 22, 2013, from

http://www.cbsnews.com/news/neurologists-warn-against-prescribing-adhd-drugs-to-

kids-as-study-drugs/

Newmark, S. (2013, February 14). Are ADHD Medications Overprescribed?. The Wall Street

Journal. Retrieved November 22, 2013, from http://online.wsj.com/news/articles/SB1000

ADHD Diagnosis and Drug Prescription—2013

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GLOSSARY

ADHD— a neurobehavioral disorder that causes lack of focus, hyperactivity, and/ or impulsive

behavior.

Behavioral therapy— a type of psychotherapy that uses organizational skills, counseling, and

other means to treat behavioral issues.

Hyperactivity— a characteristic of ADHD in which the individual has excessive level of

activity or excitement.

Inattention— a characteristic of ADHD in which the individual lacks focus, notice, or regard.

Impulsivity— a characteristic of ADHD in which the individual is motivated to act on impulse

rather than thought.