In ADHD data, growing worry of a diagnosis that’s overused

Alan Schwarz and Sarah Cohen / New York Times News Service /

Published Apr 1, 2013 at 05:00AM

Nearly 1 in 5 high-school-age boys in the United States and 11 percent of school-age children overall have received a medical diagnosis of attention deficit hyperactivity disorder, according to new data from the federal Centers for Disease Control and Prevention.

These rates reflect a marked rise over the last decade and could fuel growing concern among many doctors that the ADHD diagnosis and its medication are overused in American children.

The figures showed that an estimated 6.4 million children ages 4 through 17 had received an ADHD diagnosis at some point in their lives, a 16 percent increase since 2007 and a 53 percent rise in the past decade.

About two-thirds of those with a current diagnosis receive prescriptions for stimulants like Ritalin or Adderall, which can drastically improve the lives of those with ADHD but can also lead to addiction, anxiety and occasionally psychosis.

“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. He added, “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.”

And even more teenagers are likely to be prescribed medication in the near future because the American Psychological Association plans to change the definition of ADHD to allow more people to receive the diagnosis and treatment. ADHD is described by most experts as resulting from abnormal chemical levels in the brain that impair a person’s impulse control and attention skills.

While some doctors and patient advocates have welcomed rising diagnosis rates as evidence that the disorder is being better recognized and accepted, others said the new rates suggest that millions of children may be taking medication merely to calm behavior or to do better in school. Pills that are shared with or sold to classmates — diversion long tolerated in college settings and gaining traction in high-achieving high schools — are particularly dangerous, doctors say, because of their health risks when abused.

The findings were part of a broader CDC study of children’s health issues, taken from February 2011 to June 2012. The agency interviewed more than 76,000 parents nationwide by both cellphone and landline and is currently compiling its reports. The New York Times obtained the raw data from the agency and compiled the results.

ADHD has historically been estimated to affect 3 to 7 percent of children. The disorder has no definitive test and is determined only by speaking extensively with patients, parents and teachers, and ruling out other possible causes — a subjective process that is often skipped under time constraints and pressure from parents. It is considered a chronic condition that is often carried into adulthood.

The CDC director, Dr. Thomas Frieden, likened the rising rates of stimulant prescriptions among children to the overuse of pain medications and antibiotics in adults.

“We need to ensure balance,” Frieden said. “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.”

Given that severe ADHD that goes untreated has been shown to increase a child’s risk for academic failure and substance abuse, doctors have historically focused on raising awareness of the disorder and reducing fears surrounding stimulant medication.

A leading voice has been Dr. Ned Hallowell, a child psychiatrist and author of best-selling books on the disorder. But in a recent interview, Hallowell said that the new CDC data, combined with recent news reports of young people abusing stimulants, left him assessing his role.

Whereas Hallowell for years would reassure skeptical parents by telling them that Adderall and other stimulants were “safer than aspirin,” he said last week, “I regret the analogy” and that he “won’t be saying that again.” And while he still thinks that many children with ADHD continue to go unrecognized and untreated, he said the high rates demonstrate how the diagnosis is being handed out too freely.

“I think now’s the time to call attention to the dangers that can be associated with making the diagnosis in a slipshod fashion,” he said. “That we have kids out there getting these drugs to use them as mental steroids — that’s dangerous, and I hate to think I have a hand in creating that problem.”