Sunday, April 21, 2013

19% of American High School Boys Diagnosed with ADHD

A recent New York Times article reported the disturbing fact that 19% of American high school boys have received an ADHD diagnosis. 11% of school-age children overall have received the diagnosis. There has been a 16% increase in children between ages 4 and 17 being diagnosed with ADHD since 2007, and a 41% increase in the last decade. The increased diagnosis correlates with increased prescriptions to stimulant medications like Ritalin and Adderall. These medications, while offering short-term increased concentration abilities in children with true ADHD, also have risks of side-effects, including addiction, anxiety, and occasional psychosis. Evidence that stimulants improve long-term outcomes in children with ADHD is lacking.

These numbers are making some academic psychiatrists concerned. James Swanson is a professor of psychiatry at Florida International University, and one of the primary ADHD researchers in the last 20 years. According to Swanson, “There’s no way that one in five high-school boys has A.D.H.D. 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.”

Think about this—30% of stimulant medication is going to children who don’t have any disorder. They are using it to focus, to stay awake, and to improve their grades. Parents, doctors, and pharmacists are essentially giving normal children access to speed. Maybe these children will do better at school in the short term. But they are risking a life of drug abuse and dependence. Sure, grades are important, but are they really that important?

Dr. Ned Hallowell, a child psychiatrist and author of best-selling books on the disorder, is another psychiatrist who has changed his viewpoint on ADHD. For years Dr. Hallowell would reassure skeptical parents by telling them that Adderall and other stimulants were “safer than aspirin.” He now says, “I regret the analogy” and “won’t be saying that again.” Halloway still thinks that many children with ADHD continue to go unrecognized and untreated, but wants more rigorous diagnostic procedures. “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.”

Regarding rigorous diagnostic procedures: proposed changes to the DSM, to be released soon in the DSM-V, allow for more adolescents and adults to qualify for the disorder. Some of the proposed changes include increasing the age of first symptoms from 7 to 12; examples, such as repeatedly losing one’s cell phone, that are applicable to teenagers; and a change in the requirement that symptoms cause “impairment” to symptoms simply “impacting” daily activities.

Pharmaceutical companies predictably use their marketing power to persuade parents and doctors to get more children an ADHD diagnosis and prescription for stimulant medication. An example of this is a pamphlet for Vyvanse from its manufacturer, Shire. In the pamphlet, a parent looks at her son and says, “I want to do all I can to help him succeed.”

The stimulant drugging of our youth is a national crisis that needs to be addressed. It is unlikely that psychiatrists and pharmaceutical companies will reform themselves without outside pressure. Left alone, the corrupt pharmaceutical-psychiatric establishment will diagnose and drug more children, as evidenced by the numbers mentioned above, and proposed changes in the DSM-V. The government needs to be involved in the solution. Some needed changes include the outlawing of off-label prescribing to children, tightening the diagnostic standards of ADHD, restricting the prescribing of stimulant medications to children, encouragement of using non-drug alternative solutions to ADHD, encouraging  research in alternative treatments for ADHD, outlawing drug company advertising to the public, outlawing drug companies’ bribes to doctors, and expelling from school any children found with stimulant medication that is not prescribed to them, or any children sharing their medication with other children. There also need to be more long-term studies done of the effects of stimulant medications on children with or without ADHD.

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