I am beginning to think that ADHD is overdiagnosed. The reason I am posting this is because of the alarming number of kids that are medicated in our neighborhood.
What are your thoughts?
Is it overdiagnosed?
Are parents medicating their kids so that it is easier to cope with the stresses of parenting? Moms who medicate their kids and themselves is not unusual in UT for example. Large families, pressure from their extreme religious views are some of the reasons.
Are We Overdiagnosing ADHD In Our Kids?
Tess May 14th, 2009
by Rachel Klein, Ph.D.
The question is not trivial. Parents, educational administrators, teachers and physicians are called upon to make important decisions that profoundly affect the educational and emotional of more than a million school children.
Although there is a substantial body of research on the diagnosis and treatment of Attention-Deficit/Hyperactivity Disorder (ADHD), the media are quick to produce headlines, soundbites and interpretations of research findings designed to attract attention rather than to accurately transmit scientific facts. Some examples of media coverage:
LIFE IN OVERDRIVE - Doctors say huge numbers of kids and adults have attention deficit disorder. Is it real? Time Magazine Cover Story (7/l8/94)
Michigan ranks third in nation in prescribing Ritalin: Some say schools turn to medication to control students. Ritalin's routine use raises alarm over diagnosis, goals. Use of Ritalin in schools nearly out of control. The Detroit News (3/8/98)
ADHD May Be Over-Diagnosed in Children; Condition is estimated to occur in up to 5% of youngsters nationwide but found being treated in about 8% in one area. Los Angeles Times (9/2/99)
The L.A. Times article cites a study published in the American Journal of Public Health in which researchers examined about thirty thousand grade school children in southeastern Virginia and found that pupils took drugs for ADHD in school at two to three times the expected rate. The LA Times article goes on to state that doctors may be overdiagnosing some groups of children with ADHD and overprescribing drugs to treat the condition.
According to Gretchen LeFever, a pediatric psychologist and lead author of the study, ADHD has been estimated to affect 3 to 5% of school-age children nationwide, with less than 3% actually receiving medication. By comparison, her research found that 8 to l0% of children in second through fifth grades routinely took ADHD medication in school during the 1995-96 school year.
"It's hard to believe this many children have the specific brain-related problem called ADHD," said LeFever, assistant professor of pediatrics and psychiatry at the Center for Pediatric Research, which is a joint program of Eastern Virginia Medical School and Children's Hospital of the King's Daughters. She stated that there probably are regions across the country with similar trends, indicating that more research is needed.
I n the study, researchers reviewed records of pupils enrolled in the second through fifth grades in Portsmouth and Virginia Beach. Those two cities were chosen because they were the most diverse in southeastern Virginia. The study's findings also revealed that the use of the medication increased as children aged, and by the fifth grade, 19 to 20% of white boys received ADHD drugs. ADHD medication was used by three times as many boys as girls and twice as many whites as blacks.
The LA Times article quotes reactions from a faculty member in the Family Medicine Department of Louisiana State University Medical School who said the study confirms what he has long suspected in his own 20-year practice: that kids are being overdiagnosed with ADHD.
A scientific point of view
Rachel G. Klein, Ph.D., an internationally recognized expert on the diagnosis and treatment of children with ADHD, reacts to the study featured in the LA Times article.
There is overwhelming evidence that stimulant medications are the treatment of choice for children with ADHD. There is little systematic information, however, about community practice in the diagnosis and treatment of ADHD. Recently, investigators from Virginia examined how many children in grades 2 to 5 received medication in school and also had a diagnosis of ADHD, as indicated by their treating physician on the school records (Lefever, Dawson & Morrow, l999).
Two neighboring cities were selected - one with a mostly African-American population (67%), the other mostly white (71%). Overall, about 9% of these school children met those criteria, with almost all (90%) receiving methylphenidate (Ritalin) .
Does a rate of 9% of school children treated with stimulants reflect overdiagnosis and treatment of ADHD? Unfortunately, population studies that report on the frequency of ADHD have been more confusing than informative since the rates have varied widely across surveys, with several reporting frequencies of ADHD above 15% in elementary school age children.
If the higher figures are correct, having 9% of children treated with stimulants is not out of line. However, if the lower figures of 3 to 5% for the prevalence of ADHD are accurate, then the treatment rate of 9% found in two Virginia cities appears excessive. However, that may not be the case at all. True, on school forms completed by doctors that allow school nurses to dispense the medication, a diagnosis of ADHD was indicated. But this seems inevitable since ADHD is the only childhood condition for which stimulants have an FDA approved indications.
Therefore, the diagnosis will be given to outside agencies , such as schools and third party payers, for children who receive stimulants, regardless of the actual reason for treatment. It is likely that these compounds are used in a broad spectrum of childhood dysfunctions, only one of which is ADHD, and that a garden variety of children with school difficulties are treated with stimulants in order to enhance their academic performance. In such cases, ADHD is likely to be the official diagnosis on record.
The issue then becomes whether it is justified to use stimulants in children other than in those with frank ADHD. There is no clear answer to this question since there have been no systematic studies. It is not at all unusual for effective medications to be used clinically beyond the limits of their approved indications. One might even argue that doing so is desirable since it allows for the discovery of new treatment applications.
However, in doing so, it is also likely that treatment rates will exceed the rate of the disorder in question, leading to concerns about overtreatment. That is true for all effective treatments, including antibiotics. This practice may vary across localities, especially with regard to stimulant treatment since one or two prescribing practitioners can make a huge difference in the number of children who receive stimulants.
This situation seems to have occurred in one of the two cities of the Virginia study where two-thirds of the second-graders were receiving stimulants, whereas the rate in the other city was less than 4%. This speaks to overuse o f stimulants in one locality, the reasons for which are unknown.
In spite of these observations, it would be erroneous to conclude that there is overdiagnosis and overtreatment of ADHD. Why is that? That is because wherever the treatment of documented cases of ADHD has been examined, only a fraction has been adequately treated.
Among children with ADHD, treatment is regularly found to be wanting. A case in point is the recent systematic study of stimulant and psychosocial treatment of ADHD. The study included close to six hundred children with ADHD, 7-9 years of age, from six sites across the country. They came from exceptionally well-informed families; the children were referred by schools because of behavior problems, parents completed scales designed to assess ADHD symptoms, parents consented to have teachers contacted, parents and children were interviewed, and families were informed that their child had ADHD. All families knew that treatment with medication was a likely possibility if the child entered the study.
What is relevant is that, after completion of all diagnostic assessments, close to 150 families were told that they could not be treated in the study and would have to rely on their own resources for treatment. Over the 14-month follow-up, a third of these children with well documented ADHD never received stimulants in the community.
In those for whom stimulants were prescribed, average doses were too low for optimal clinical benefit, and duration of treatment was insufficient.
We conclude, based on these as well as other similar findings, that ADHD is not overtreated, and that many, if not most children with ADHD are not receiving adequate treatment. At the same time, it seems that, in some areas, the use of stimulants has been extended to a broader clinical population. Only through systematic clinical studies will the merit of such practice be determined.
About the author:
Rachel G. Klein, Ph.D. has been the Director of Psychological Services at the New York State Psychiatric Institute and the New York Presbyterian Health System for the past twenty years. Dr. Klein was Professor of Clinical Psychiatry at the Columbia University College of Physicians and Surgeons until this month (October) when she became Professor of Psychiatry at the New York University School of Medicine and Director of Research Training at the NYU Child Study Center. Dr. Klein has been the Principal Investigator of some of the most important studies of children with ADHD in the field including a 25-year follow-up study of ADHD children grown up.
This article is courtesy of AboutOurKids.org
OMG YES
Are parents medicating their kids so that it is easier to cope with the stresses of parenting?
YESSS!!!!!!!!!!!!!!!!!!!!!! that is exactly it and it drives me insane. I dont know if i even really think its a disorder, and i know im going to get criticized for saying that but seriously i dont think it is something that should be treated with medication. this is something i wrote for a literature class on this topic (its about my df):
"Some Body Smart kids may even be labeled hyperactive or told they have attention deficit hyperactivity disorder (ADHD)." (Armstrong, 2003, p.100) Which, interestingly enough, his mother went out of her way to make sure he was diagnosed with so she could get him on medications (She has a lot of issues that we won't get into in this thread, but suffice it to say she was/is an unfit mother). I really feel that he doesn't have any type of disorder whatsoever and so does he. After doing the reading I really agree with it, the kids who are given that label are really just super Body Smart and since not everyone recognizes it as an intelligence the kids get labeled with a "disorder". I also agree, wholeheartedly, with the reading when it points out that "[p]art of the problem is that being called ADHD or hyper can keep everyone, including you, from seeing who you really are inside, how you learn, and what you do best." Which is exactly what happened to him growing up. (Armstrong, 2003, p.100)
I know some are going to jump down my throat but I think MANY childhood "illnesses" are overdiagnosed. ADHD is definately one of them. Doctors see a hyper little kid and say, "oh he must have ADHD... here give him this medication." Why? Because the doctor makes money everytime you have to come see him and the pharmacutical company makes money off of your perscription. Many parents dont want to mess with an "unruly" child so they self-diagnose their child and get them all doped up. Now... NOT everyone does this and obviously ADHD is real but it is definatley overdiagnosed...
I also think that these "illnesses" come and go. ADHD used to be the major childhood go to reason for a kid acting out. Now it is Autism.
Yeah, that's what I am beginning to think. It's ridiculous.
Quoting BellaRose17:
OMG YES
Are parents medicating their kids so that it is easier to cope with the stresses of parenting?
YESSS!!!!!!!!!!!!!!!!!!!!!! that is exactly it and it drives me insane. I dont know if i even really think its a disorder, and i know im going to get criticized for saying that but seriously i dont think it is something that should be treated with medication. this is something i wrote for a literature class on this topic (its about my df):
"Some Body Smart kids may even be labeled hyperactive or told they have attention deficit hyperactivity disorder (ADHD)." (Armstrong, 2003, p.100) Which, interestingly enough, his mother went out of her way to make sure he was diagnosed with so she could get him on medications (She has a lot of issues that we won't get into in this thread, but suffice it to say she was/is an unfit mother). I really feel that he doesn't have any type of disorder whatsoever and so does he. After doing the reading I really agree with it, the kids who are given that label are really just super Body Smart and since not everyone recognizes it as an intelligence the kids get labeled with a "disorder". I also agree, wholeheartedly, with the reading when it points out that "[p]art of the problem is that being called ADHD or hyper can keep everyone, including you, from seeing who you really are inside, how you learn, and what you do best." Which is exactly what happened to him growing up. (Armstrong, 2003, p.100)
LOL - there will always be someone jumping down one's throught on CM! I get what you are saying, it drives me nuts here. All of my kids friends are medicated and because of it have no apetite, so they hardly eat. Seriously, how can that be good? being wound up is what kids do, lol. My advice, cut out the sugar and the caffeine, lol.
Quoting Mommy_of_Riley:
I know some are going to jump down my throat but I think MANY childhood "illnesses" are overdiagnosed. ADHD is definately one of them. Doctors see a hyper little kid and say, "oh he must have ADHD... here give him this medication." Why? Because the doctor makes money everytime you have to come see him and the pharmacutical company makes money off of your perscription. Many parents dont want to mess with an "unruly" child so they self-diagnose their child and get them all doped up. Now... NOT everyone does this and obviously ADHD is real but it is definatley overdiagnosed...
I also think that these "illnesses" come and go. ADHD used to be the major childhood go to reason for a kid acting out. Now it is Autism.
HA HA HA True True!
But I don't know about the sugar... My son doesn't eat sugar and doesn't have any caffeine but if you see him you would think I put espresso and red bull in his sippy cup! LOL
Quoting eaglemama2:
LOL - there will always be someone jumping down one's throught on CM! I get what you are saying, it drives me nuts here. All of my kids friends are medicated and because of it have no apetite, so they hardly eat. Seriously, how can that be good? being wound up is what kids do, lol. My advice, cut out the sugar and the caffeine, lol.
Quoting Mommy_of_Riley:
I know some are going to jump down my throat but I think MANY childhood "illnesses" are overdiagnosed. ADHD is definately one of them. Doctors see a hyper little kid and say, "oh he must have ADHD... here give him this medication." Why? Because the doctor makes money everytime you have to come see him and the pharmacutical company makes money off of your perscription. Many parents dont want to mess with an "unruly" child so they self-diagnose their child and get them all doped up. Now... NOT everyone does this and obviously ADHD is real but it is definatley overdiagnosed...
I also think that these "illnesses" come and go. ADHD used to be the major childhood go to reason for a kid acting out. Now it is Autism.
I think that there are to many GP Peds diagnosing kids with ADHD. My DD has ADHD and I would not let her Peds diagnose her with it, I took her to a Physiologist / Behavior specialist and after 1 year of working with her he diagnosed her. My DD is not on any meds for it, her physiologist dont believe in giving kids unnecessary meds he has her taking 160 mg of caffeine a day, and it works. I feel that to many parents hold on every word of there Dr. with out talking to someone who knows more then there GP Dr. Just because they trust them. I trust My kids ped. but when it comes to there mental health I want to talk to someone who practices in that area because they will know more then the ave Dr. Here is something I have learned from my DD being diagnosed with ADHD it is hereditary.
beginning to... I am so sick of damn near everyone I know has a kid with add or adhd and truth be told 99% of are brats and their parents use add as a crutch to avoid dealing with their kids shitty behaviour.....Now bring on the onslant of parents who kids really do have add but agree...
Quoting eaglemama2:
I am beginning to think
Jennifer, Crunchy Student Midwife, Wife and mother to Hannah 13, Abby 8 and Liam born June 15 2009
Probably, as is Depression. I have no doubt that there are those who need intervention and even medication for these problems but I seriously doubt it's as many people as are medicated.
Part of our quick fix society, got a problem? take a pill.
Church of The Invisible Pink Unicorn (blessed be her holy hooves)
Interesting , I did not know that it was hereditary. What worries me is that those that actually have the condition, somehow fall through the cracks, it's a good thing that you sought out a professional rather than a peds doc. My daughter had alot of behavioural issues when she was in pre-school which led to school conferences, etc etc, so I took her to a child psych dr and after 10 mins of being with her, he said, she is acting exactly as a healthy and happy 4 year old should. He referred me to a homeopathic dr who tested for about 100 types of allergens and such, only to find out that she has a gluten allergy, lol, who knew? we received a course of drops to flush out her system of toxins and such, then put her on a gluten free diet, problem solved.
Quoting mistyray:
I think that there are to many GP Peds diagnosing kids with ADHD. My DD has ADHD and I would not let her Peds diagnose her with it, I took her to a Physiologist / Behavior specialist and after 1 year of working with her he diagnosed her. My DD is not on any meds for it, her physiologist dont believe in giving kids unnecessary meds he has her taking 160 mg of caffeine a day, and it works. I feel that to many parents hold on every word of there Dr. with out talking to someone who knows more then there GP Dr. Just because they trust them. I trust My kids ped. but when it comes to there mental health I want to talk to someone who practices in that area because they will know more then the ave Dr. Here is something I have learned from my DD being diagnosed with ADHD it is hereditary.
I hear you.....
Quoting Forget-me-not:
beginning to... I am so sick of damn near everyone I know has a kid with add or adhd and truth be told 99% of are brats and their parents use add as a crutch to avoid dealing with their kids shitty behaviour.....Now bring on the onslant of parents who kids really do have add but agree...
Quoting eaglemama2:
I am beginning to think
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on Nov. 15, 2009 at 12:45 PM