Attention Deficit Disorder: Overdiagnosis, Overmedication?
Attention deficit-hyperactivity disorder (ADHD) is a common diagnosed childhood condition. Three to six-fold increases in the number of patient visits for ADHD and the number of prescriptions for Ritalin (methylphenidate) have been noted since 1990.
Recently, diagnostic criteria have been published to make the condition easier to recognize, and guidelines have been written supporting the use of medication into adolescence and even adulthood.
Despite the lack of national prevalence data, experts contend that 3-5% of the U.S. pediatric population suffers from ADHD. Recently, the National Institutes of Health recognized that possible overdiagnosis and overtreatment of ADHD may be an important public health issue.
A study involving nearly 30,000 grade-school students in two U.S. cities (grades two through five) evaluated the extent of medication use for ADHD. Nurses recorded the number of students who received ADHD medication in school; this information was verified by records of primary, secondary and tertiary diagnoses of ADHD as indicated on a physician-signed form listing conditions for which the medication was prescribed.
Results indicated that the percentage of students receiving ADHD medication was similar in both cities (8% and 10%); this percentage was two to three times higher than the expected rate of ADHD. Medication was used three times more frequently on boys than girls, and twice as often in Caucasian children vs. African American children.
By fifth grade, 18-20% of Caucasian boys were receiving medication. In addition, those students deemed "young for one's grade" were also positively associated with medication use.
Short-term benefits of medication seem supported by the literature, but the long-term effects are largely undocumented. The authors suggest that further research on ADHD treatment/therapy approaches is necessary to "...provide a framework for design and implementation of educational programs that ensure appropriate use of stimulant medications and nonpharmacologic interventions."
LeFever GB, Dawson KV, Morrow AL. The extent of drug therapy for attention deficit-hyperactivity disorder among children in public schools. American Journal of Public Health
, Sept. 1999:89(9), pp1359-64.