Understanding the Rise in ADHD Diagnoses: 11% of U.S. Children Are Affected

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Adderall is a medication often prescribed to children diagnosed with ADHD, but it has side effects

The rates of U.S. children affected by attention-deficit/hyperactivity disorder (ADHD) are skyrocketing, according to a recent report, but experts caution that the latest numbers require a bit of decoding.

That information shows that 11% of children ages 4 to 17 were diagnosed with ADHD, a 16% increase since 2007, the last time that researchers at Centers for Disease Control and Prevention (CDC) did a comprehensive survey for the prevalence of the neurobehavior disorder. The rise was especially dramatic among boys, with an estimated 1 in 5 boys in high school diagnosed with ADHD. What’s more, about two-thirds of the children diagnosed were treated with stimulant medications that can improve attention but also come with side effects.

Are rates truly climbing at such an alarming rate? Possibly. But many experts believe that’s unlikely. The data was collected by the CDC and analyzed and reported by the New York Times; the CDC plans to publish its own report on the data in the coming months.

(MORE: ADHD Medications Improve Decisionmaking, but Are They Being Overused?)

To start, the information on ADHD rates came from parents reporting on the diagnosis for their children during telephone interviews. Such reports are useful but not as reliable as the verified diagnoses from medical or school records, says Dr. William Barbaresi, director of the developmental-medicine center at Boston Children’s Hospital.

Second, such records-based data suggests that ADHD rates among children may be somewhere between 7.5% and 9.5%, with boys at the higher end of the range, not 11%. In its previous round of analysis, CDC found that ADHD diagnoses rose by 22% between 2003 and ’07, based on the same telephone surveys of 76,000 families in the U.S., climbing by an average of 3% to 6% each year between 2000 and ’10. But the latest figures, which included responses collected between 2011 and ’12, show a far higher prevalence that hints at classrooms full of hyperactive and impulsive kids. “By definition, ADHD requires that symptoms have to have a significant effect on life,” says Barbaresi. “To say that a tenth of all children have a biologic condition that affects their life enough to call it a disorder just does not make sense.”

(MORE: Teens Taking ADHD Drugs to Get Good Grades: How Big a Problem Is It?)

If that’s the case, then a significant proportion of these children may also be mistreated with medications that they don’t need. “This report and others raises questions about whether we may not be overdiagnosing ADHD and overusing medications,” says Thomas Power, director of the center for management of ADHD at Children’s Hospital of Philadelphia.

That could have serious implications for children’s long-term mental and physical health since ADHD drugs such as Ritalin and Adderall have been linked to dramatic weight loss and suppressed growth. And some experts have voiced concern that early use of the behavior-modifying drugs could alter the natural arc of children’s social and creative development.

The apparent rise in the prevalence of ADHD highlights several shortcomings in the way that not only ADHD but also mental-health issues in general are diagnosed and treated in the U.S., says Barbaresi. Most children are labeled with the disorder by their pediatrician or family doctor, who aren’t always trained in providing the in-depth evaluation that a reliable diagnosis requires. “Symptoms are not and should not be sufficient,” says Ruth Hughes, CEO of Children and Adults With Attention-Deficit Hyperactivity Disorder. “The symptoms have to occur every day for a long period of time, and, more importantly, these symptoms have to lead to major disruption or impairment in at least two areas of a person’s life, such as at school or in relationships.”

(MORE: New ADHD Guidelines Include Kids as Young as 4)

While the American Academy of Pediatrics (AAP) recently provided an updated guideline on the criteria for a proper ADHD diagnosis, including reports not only from parents but also from teachers and other day-care personnel about a child’s hyperactive, impulsive and inattentive behavior, not all physicians have the time to carefully collect and vet the input from these sources.

In addition, in order to properly identify a child affected by ADHD, Barbaresi, for example, conducts a medical and psychological assessment that takes several hours and requires the child and the parents to complete questionnaires about how the child responds to different situations, which factors seem to trigger hyperactive behavior or inattentiveness, as well as how disruptive these episodes are to the child’s daily activities. Unfortunately, most insurers do not reimburse for such evaluations, and that pushes already busy doctors to take the path of least resistance — prescribing medications such as Ritalin or Adderall. “That’s the big elephant in the room — pediatricians and the family practitioner are being asked to sort out a complex situation in an inadequate amount of time without access to data from psychological assessments they need to make these fine distinctions,” says Barbaresi. “So it’s a setup for inappropriate decisions to be made.”

And those include not just misdiagnosis and overmedication of children but mistreatment and even underdiagnosis in some situations. In rural and urban areas where mental-health services are scarcer and more stigmatized, rates of ADHD diagnoses are slightly lower than in affluent areas, and children in these areas are less likely to be treated properly. That could have implications for the long-term health of these children, since studies also show that about 60% of children with ADHD have a learning disability, and that 60% will go on to develop another mental illness by age 19. So a proper diagnosis of ADHD doesn’t just provide opportunities to treat behavior problems but potentially mental illnesses as well. That’s why “it’s clearly inappropriate to do these superficial assessments,” says Barbaresi.

(MORE: Faking It: Why Nearly 1 in 4 Adults Who Seek Treatment Don’t Have ADHD)

Being too quick to diagnose the disorder also means doctors may be bypassing effective, nondrug treatments that may benefit many children, especially the youngest. The AAP recommends that children younger than 6 start with behavior therapy before beginning medications, but writing a prescription is far easier than monitoring a series of sessions that involve training and a commitment of time and effort from parents and family members. “The problem we face is that behavioral, psychosocial and nonpharmacologic interventions are not sufficiently available to people,” says Power. “When I talk to pediatricians and primary-care physicians, they tell me they don’t want to be diagnosing ADHD as often as they are, and they don’t want to be using medications as often as they are, but they don’t have many other options available. It’s difficult to get kids into mental-health treatments and psychosocial treatments that they believe many of these children and their families need.”

These programs are designed to assess what factors trigger and sustain inappropriately impulsive and hyperactive behavior, he says, by involving parents and helping them modify environmental factors or interactions with their children to change their behavior. Playing and engaging more directly with children on a regular basis, for example, tends to calm them down, and setting limits and educating children about the consequences of their actions can also help. In groups that Power has conducted with his patients, parents have reported that such behavioral interventions are effective in improving children’s relationships with their parents as well as with their teachers and classmates in school.

But these programs don’t work in a vacuum, and ideally, parents, doctors and teachers should coordinate their efforts to ensure that the appropriate behavior is being positively reinforced among children with ADHD. “The best treatment is a combination of parent training, behavioral intervention, school interventions and medication where needed,” says Hughes. All too often, current therapies aren’t taking advantage of the full power of this recipe.

34 comments
banana
banana

I anticipate that the etiology of ADHD is multifactorial and wonder if ADHD will not become the new norm given food, media, and sleep impacts as mentioned.  The change in electrical impulse pathways in the brain, the increase in cortisol, and adrenaline, as well as glucose and insulin that comes with all of the mentioned factors will continue to increase problems with focus, impulsivity, and hyperactivity until our new norm develops.  We are rapidly changing an entire generation of children.

And yet I did not grow up that way and still my brain functions differently.  I see and think through things differently than my colleagues.  It is harder for me to keep up in a fast-paced, computer-based, paper pushing environment.  I am not organized and it takes me twice as long as others to do detail oriented tasks but I can envision big pictures.  I can believe that change can occur, I flourish at relationships at work, I can problem-solve outside the box, I can anticipate long-term impacts of interventions.

I would love to see a push toward re-defining ADHD from an illness/disability to helping people identify their strengths with the mind they have.  Many people with ADHD are visionaries who see things in a way that others do not.  A work environment that values these minds can benefit greatly.  Helping children learn basic ways of managing daily tasks while developing their strengths and minimizing excessive stimulation (hormonal and sensory) may have the best outcome.  


GAElbek
GAElbek

What people NEED TO KNOW about brain disorders are the proven severe and irreversible adverse brain and body effects caused by estrogenic hormone disruptors.  Soy isoflavones ARE highly potent estrogenic hormone disruptors or poisons that are transferred to developing fetus from maternal soy consumption, and again transferred to infant through  breast milk!  Soy's estrogenic hormone disruptors, and multiple other "natural" soy toxins are infant swallowed 24/7 for several months when fed soy infant formulas and many infant foods contain soy! FDA will go only as far as "acknowledging concerns about possible isoflavones (estrogenic hormone disruptors) on sexual development, neurobehavioral development, immune function and thyroid disease" yet refuses WARNING labels!  Ask why the FDA protects industry profits and NOT public health?  http://nihtoxictruth.blogspot.com,   http://www.change.org/petitions/fda-commissioner-margaret-hamburg-place-warning-labels-on-soy-foods-fillers-and-soy-formulas


thewholetruth
thewholetruth

We have created ADHD and it is from the food chemicals, there was no ADHD before the food was poisoned in the West  with Aspartame,high fructose corn syrup and sucralose. If you want to stop or reverse ADHD simply use a diet that reverses the damage from food chemicals this worked in Europe.

The secret is that ADHD is tied to our insulin resistance, reverse this and the ADHD goes way, reverse the poisons in the food.  See here http://type2diabetesdietplan.blogspot.com/2013/01/my-child-has-adhd-what-did-they-put-in.html



JustinSherrill
JustinSherrill

@thewholetruth Just to let you know, ADHD was founded by a Scottish physician in 1798 named Sir. Alexander Crichton, your argument stating, "We have created ADHD" is false, due to genetic mutations that allow the over secretion of chemicals in your brain.

WhisperAtnight
WhisperAtnight

I think this is all BS, adults not wanting to deal with kids with normal kid behaviors. STOP putting active healthy kids on DRUGS. You are causing MORE PROBLEMS for society down the road in dealing with these people.. Recent MASS MURDERS have all been linked to be on some sort of DRUG!!!

BabySleepRight
BabySleepRight

I often wonder if the symptoms of children with ADHD diagnoses are presenting themselves simply because children aren't getting enough quality sleep?  A lot of families have two working parents who leave early and come home late, so that sometimes bedtime is pushed back too late.  This way they have the chance to enjoy their kids company.  I totally understand that there isn't enough time with our kids these days, and that they grow up so fast, but it is worth causing the over-tiredness and worsening symptoms that a proper amount restorative sleep might improve?  A lot of families I know are offering too late bedtimes, and I agree with the other people that mentioned television too, it's extremely stimulating and generally leads to over-tiredness too.  I'm certainly not ruling out or dismissing ADHD as a real condition, only saying that these kids need just as much sleep as kids without the diagnoses, and it may be necessary to approach the sleep situation in a different way.

KravenMoorehead
KravenMoorehead

I suspect that Television has an effect on many people who are diagnosed wromngly as having ADHD. I think that Television with its inherant 1/3 of viewing time going to commercials makes us tedn to not poay enough attention to the details. This also explains the idiots who take everything that is thrown at them by the left as being god given facts instead of looking at things themselves

herbys
herbys

It may be the case that there's a significant over diagnosis of AD HD, but please, please don't assume that if a kid is diagnosed with AD HD is because his (as with Autism and many other mental disorders most cases are boys) parents are lazy. I have three boys. The first one was specially gifted (at age one he had a vocabulary most kids don't get until age five) and easy going. But at age three he started becoming very difficult. He could not focus on anything for more than two seconds (I know a three year old is not expected to have much focus, but one second is very low even by three year old standards), couldn't remain still even if he wanted, and could start screaming or yelling without reason. It took us a while to find a good diagnosis, which in the end came in the form of AD HD when he turned five. We rejected Ritalin since we didn't want to medicate such an old boy, and for two years we tried everything from diet changes, therapy, new schools and, most of all, patience. It only got worse. By age six we had been kicked out of two schools, he wasn't learning anything, and we was a very difficult child to work with. And he was terribly sad. He was smart enough to realize that something was wrong with him, and he knew that he should be able to stand still for five seconds or to listen to a complete sentence without wandering. After he started yelling or screaming spontaneously he would turn red in shame, but he would say he couldn't help it. So after trying every existing resource from alternative medicine to the whole arsenal in psychology we decided to give Ritalin a try. It was night and day. The next day, our problem kid had shot up to top of his class, we was receiving praise letters from his teachers and, most importantly, he was happy. When the Ritalin wears off he still can be quite restless, but having the ability to think clearly during some period of the day allows him to be aware of when things are going awry and control himself to some extent. Three years has passed, he is now top of his class in every single subject, he has friends and he's a happy child. We hope one day he will grow out of it and be able to contain himself without needing potent drugs, but for now, I would consider myself a bad parent if I didn't allow my son to be the best he can be and denied him his chance to be happy.

My other two kids are doing fine for now. One of them is showing significant symptoms of AD HD but without the hyperactivity (fortunately he's also a brilliant kid, in the 95 percentile in intellect, so his constant lack of focus is only enough to drive him to average results, I'm fine with that for now), we'll evaluate if he can do without the Ritalin (or another medication) until we see the effects of the disorder affecting his ability to be happy and to obtain the results he would want to get. But if it gets there, we will not doubt for one second to do what's right for him.

Leftcoastrocky
Leftcoastrocky

Maybe there are more chemicals in the air we breathe, the food we eat and the liquids we drink?

Leftcoastrocky
Leftcoastrocky

“To say that a tenth of all children have a biologic condition that affects their life enough to call it a disorder just does not make sense.”   Why doesn't it make sense?


herbys
herbys

@Leftcoastrocky Exactly. Almost one third of children have cavities. Which IS a medical condition.

bibleverse1
bibleverse1

ADHD exist but the numbers are so small there is no need for all the diagnoses.

herbys
herbys

@bibleverse1 But how do you know they are so small? I would agree there's significant overdiagnosis, but when I was a kid I would be surprised if of the kids around me less than 5% had a significant behavioral disorder.

pedipsych
pedipsych

Thanks for this more balanced account that I have seen elsewhere.  For more information about ADHD and

child mental health, please see my blog. 

This comment has been deleted

bldavis36
bldavis36

Wow. Based on this information, my stepson is very obviously sneaking far more poisoned food than my stepdaughter who shares almost exactly the same diet! Clearly there is no other explanation as to why he would have ADHD and she would not...

SelenaRodriguez
SelenaRodriguez like.author.displayName 1 Like

Very easy to understand. The pharmaceutical companies want more money, psychiatrists want more patients-for-life, and schools want more zombie kids. The 'disorder' was invented out of thin air to control normal boy behavior that was seen as disruptive by teachers. It is not a 'disorder', it is a list of boy behaviors.

These boys will very likely commit suicide, or be a school shooter (all of them were drugged).

http://www.ssristories.com/index.php

It's about time to start taking people to court and prosecuting them for this quackery.




ruraynor
ruraynor like.author.displayName 1 Like

@SelenaRodriguez It's not even boy behaviour, it's children behaviour. Children like to daydream, they like to run around, they like to doodle and make noise and a whole host of other "disruptive" behaviours. I was always getting told off in school for not focusing and for looking out the window- because I wanted to be out there on a sunny day enjoying the outdoors inside of stuck in a stuffy classroom where I couldn't breathe. "Focus, focus, focus!" is all I heard in secondary school, despite achieving above average grades. 

BurkeyDevitt
BurkeyDevitt

@ruraynor @SelenaRodriguez Exactly...THANK YOU! Sitting in desks all day is unnatural and unhealthy for kids.  For their minds, for their bodies.  Of course some of them will have to be drugged. School is not for education. It is for obedience.

Anonymous.for.now
Anonymous.for.now

Take floride out of the water and everything else it's in and we wouldn't have ADHD at all.

pendragon05
pendragon05

How about if they cut down on their daily sugar intake?

LessColorPlease
LessColorPlease

@pendragon05 - It's not the sugar.  It's the food coloring.  These dyes have a direct influence on my child's behavior.  Take them away and she'll be a normal kid.  When she has them, she has fits.  She even realizes it.

LisaAtkinsonWaller
LisaAtkinsonWaller

Circumcision?  You must be kidding me?  I have no other words...


hummingbird
hummingbird like.author.displayName 1 Like

A doctor observed my son being hyperactive at the pediatricians' office and suggested  he could have ADHD and need medication. When I brought it up with his pediatrician, she let me know that he had to be hyper in more than one setting. This doesn't apply to my son as he's not hyperactive at school. He focuses and learns well in school. You have to talk with your doctor and question everything before allowing anyone to diagnose and medicate your child.

AdrianSheppard
AdrianSheppard like.author.displayName 1 Like

ADHD is a condition that primarily affects American boys. Not girls.  What is different about American boys?  Most of them are circumcised within two days of birth.  European boys are not.  Asian boys are not.  South American boys are not.  Muslim boys are not until much later.  Even Jewish boys have eight days, and the procedure is much faster.  Circumcision rewires the brain for the rest of one's life. The correlation is obvious.  This needs to be investigated.

hummingbird
hummingbird

@AdrianSheppard What you've said sounds plausible. I keep wondering why so many of our boys have ADHD and autism. The future isn't looking bright for so many American boys based on these diagnoses. What reason would nature have to be giving them all these disorders? It has to be something that we're doing that is hurting our boys specifically. I didn't let them circumcise my son at all. I just let it be.

YesIHaveADHD
YesIHaveADHD like.author.displayName 1 Like

@hummingbird @AdrianSheppard I am a woman and I have ADHD, so does my daughter. Are you telling me its because we were circumsized??  Funniest reason I have ever heard!!

thewholetruth
thewholetruth

It's the food chemicals, there was no ADHD before the food was poisoned in the West  with Aspartame,high fructose corn syrup and sucralose. If you want to stop or reverse ADHD simply use a diet that reverses the damage from food chemicals this worked in Europe.

The secret is that ADHD is tied to our insulin resistance, reverse this and the ADHD goes way, reverse the poisons in the food.  See here http://type2diabetesdietplan.blogspot.com/2013/01/my-child-has-adhd-what-did-they-put-in.html