Pediatrician Group Seeks to Boost ADHD Diagnoses

This week the American Academy of Pediatrics (AAP) began recommending that "any child 4 through 18 who has school or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity" be evaluated for attention deficit hyperactivity disorder (ADHD). Previously the AAP's guidelines applied only to kids between 6 and 12. An ADHD diagnosis is considered confirmed if a patient meets the criteria in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, which lists characteristics that are very common in children but tries to narrow the label's reach by requiring that the "symptoms" last for at least six months "to a degree that is maladaptive and inconsistent with developmental level." It looks like that caveat has been somewhat successful, since far less than 100 percent of American 4-to-17-year-olds have been diagnosed with ADHD—only about 10 percent, according to the National Survey of Children's Health. One in 10 is still a pretty impressive number, of course, and the AAP's new guidelines can be expected to boost it further.

The measured prevalence of ADHD has risen as the diagnostic criteria for it have have evolved. In 1994, when the DSM-IIIr prevailed, the American Psychiatric Association said 3 percent to 5 percent of school-aged children had ADHD, less than half the current rate. There are also substantial variations in ADHD prevalence across states, with 2007 rates ranging from a low of 5.6 percent in Nevada to a high of 14.3 percent in Alabama, and across countries, which a 2007 review in The American Journal of Psychiatry found was due largely to differences in diagnostic criteria.

An ADHD diagnosis often means a prescription for a stimulant such as Ritalin, Adderall, Vyvanse, or Provigil. The share of American children taking such drugs by prescription rose from less than 1 percent in 1987 to 3.5 percent in 2008. Stimulants do indeed help children (and adults) pay attention and remain focused on tasks, although whether that means they are a treatment for a disease remains a matter of substantial debate and in practice hinges on a magical slip of paper from an M.D. According to the new AAP guidelines, "behavioral interventions should be considered first-line therapy" for "preschool-age children," while "for children 6 to 11, the AAP recommends combination treatment with medication and behavioral therapy if feasible." Children 12 and older "should begin treatment with medication, and physicians might also prescribe behavioral therapy." Confusingly, the AAP urges doctors to "carefully weigh the risks of drug therapy at an early [prepubescent] age with those associated with delayed diagnosis and treatment" even though "evidence for use of stimulants in this age group is particularly strong." By contrast, doctors should go straight to speed for adolescents, even though "the evidence in this age group is not as strong as in the younger patients."

For more on how psychiatrists create diseases by defining them, see my essay on the continuing relevance of Thomas Szasz in the October issue of Reason. For more on medical vs. nonmedical use of psychoactive substances, see my 2008 essay "No Bad Drugs."

[Thanks to Nicolas Martin for the tip.]

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  • Live Free or Diet||

    "any child 4 through 18 who has school or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity" be evaluated

    Four?! Inattentive or impulsive at four?! Ye Gods! Every healthy four-year-old boy I've ever known would qualify!

  • Some Guy||

  • RoboCain||

    Their bullshit criteria really does seem to target boys, rather than girls.

  • ||

    i'd be worried if a kid did NOT show "symptoms of inattention, hyperactivity, or impulsivity"

  • ||

    My kid's Kindergarten class has a student with a full time para. The student's "illness"? Social disorder with a tendency to be violent (i.e a psychopath).

    FULL TIME PARA ... whose only job is to babysit and remove the little shit when he acts up.

    Our society of coddling is an embarrassment.

  • Maxxx||

    How the fuck does a five year old get diagnosed that way?

  • Neu Mejican||

    I do this kinda thing professionally, let's just say I have worked with five year olds that are actually dangerous to those around them. Very rare, but it happens.

    Standard comment regarding JS on these issues...don't believe the hype the man is full of shit on these issues for the most part.

    Recent review
    Title: The evidence-based pharmacological treatment of paediatric ADHD
    Author(s):Brigette S. Vaughan, March John S., Kratochvil Christopher J.
    Online Publication date: 2011
    Volume: FirstView Start page:1
    Publication: The International Journal of Neuropsychopharmacology
    DOI: 10.1017/S1461145711000095
    URL: http://dx.doi.org/10.1017/S1461145711000095

  • jtuf||

    So, psychiatrists insist that psychiatry is necessary. These patients disagree ( http://www.mindfreedom.org/ ). If psychiatry is beneficial, why is the pysch ward of a hospital the only section that is locked to prevent the patients from escaping?

    I was an adjunct professor for Animal Behavior. No one in the field with tell you that a behavior just the result of genetics, yet this is the standard line that psychiatrists give. Every behavior is a result of both nurture and nature. Pediatric psychiatrists don't just sell mind-altering drugs. They sell caregivers absolution for the nurture part of a child's behavior.

  • Joe M||

    Awesome reply. Thanks.

  • Neu Mejican||

    No one in the field with tell you that a behavior just the result of genetics, yet this is the standard line that psychiatrists give. Every behavior is a result of both nurture and nature.

    Sorry, you're talking out your ass. No competent psychiatrist thinks it is all genetics, or even all physiological, and all prescription guidelines for ADHD treatment include medication as a component of treatment that also includes environmental (read nurture) interventions. Like I said, don't believe the hype.

  • Colonel_Angus||

    "all prescription guidelines for ADHD treatment include medication as a component of treatment that also includes environmental (read nurture) interventions"

    Like the guardians are actually going to bother to do anything different in most cases. The "professionals" know this. Maybe a competent psychiatrist should evaluate the actual willingness of a parent to participate in their part of the "therapy" before the kid gets doped with no other supplemental change in environment.

  • Neu Mejican||

    So, psychiatrists insist that psychiatry is necessary.

    The link has nothing to do with necessary. It says reviews the evidence that the drugs work. As well as reviewing the evidence for non-drug therapies. The "controversy" over their effectiveness is kinda sorta like the controversy over vaccines and autism.

  • ||

    I just want to say that 'para' is the worst truncation of any word I'm likely to see all week. I had to look it up to find out what it was, and it turns out that you can attach 'para' to almost any occupation. Should I assume paramedic? It seems like overkill. Not as much overkill as 'paratrooper', perhaps.

    Still, a full-time job at the taxpayer's expense to monitor one kid? I know exactly which 'para' we're talking about, here.

    It's a full-time parasite, right?

  • Jello Biafra||

    I'm tired of kissin' ass
    I can't sit still all day
    You know I know your school's a lie
    That's why you dragged me here
    'You're a hyperactve child
    You're disruptive, you're too wild
    We're going to calm you down
    Now this won't hurt a bit'

    Drag me to the floor
    Pullin' down my pants
    Ram a needle up my butt
    Put my brain into a trance

    'No more hyperactive child
    Got too much of a mind
    Wouldn't you rather be happy?
    Now this won't hurt a bit'

    Cameras in the halls
    No windows, just brick walls
    Pledge allegiance to a flag
    Now you will obey...

  • GroundTruth||

    Well done! And I was just going to bitch about being bored stiff by the teachers teaching to the dolts. No wonder my mind wandered!

    Not many of the folks on the cutting edge fit in that well. By definition, none of them are average.

    When the pill pushers get done, we'll be permanently consigned to dark ages.

  • Fluffy||

    You realize that's nonsense, right?

    You know what Bill Gates would have been like on Ritalin?

    He would have still been Bill Gates, he just would have worked 17 hours a day instead of 16 and would have had a 169 IQ instead of a 161.

  • State Edukation Agent||

    "Drug that misbehaving little bastard!"

  • sevo||

    "You know what Bill Gates would have been like on Ritalin?
    He would have still been Bill Gates, he just would have worked 17 hours a day instead of 16 and would have had a 169 IQ instead of a 161."

    That's a pretty strong claim; got any cites?

  • jtuf||

    + 10

  • Jordan||

    Oy, that picture. Time Magazine is pretty much an anthology of aging leftwing concern trolls.

  • rather||

    Pediatrician Group Seeks to Boost ADHD Diagnoses is your title?
    How about Pediatrician Group Seeks to Boost Revenue with ADHD Diagnoses Scheme

    Like they give a shit about anything but $

  • sevo||

    Sorta like blog-whores?

  • rather||

    sevo, if you can prove I receive money for my site, or that I am pursuing wealth, I will make epi a happy man and on video

  • Fluffy||

    There is a GREAT BIG GIANT contradiction between Reason's wholehearted embrace of transhumanism and steroids and its panicky pearl-clutching about ADHD drugs.

    The drugs in question are wonder drugs that raise IQ. If steroids are good and gene therapies that change the human genome are good, then wonder drugs that raise IQ are ALSO good.

    The wider the diagnostic criteria are drawn, the more people can access the drugs (which they should be able to access at will without a prescription anyway under any version of libertarianism with which I am familiar) if they want them. If someone came up with a set of diagnostic criteria that let anyone who wanted to light up get medical marijuana when they wanted it, Reason would be delighted. So why aren't you delighted here?

  • jeff||

    Maybe it's because the evidence piling up about ADHD drugs (and antidepressants, and antipsychotics, and just about everything else these charlatans prescribe) is showing no long term benefits and substantial long-term risks (see Anatomy of an Epidemic by Robert Whitaker, for starters)

  • State Edukation Agent||

    Maybe because we pressure the use of the ADHC "remedies" on captive children.

  • sevo||

    Did you see the last link in the article?
    The gripe is *not* about the drugs, but the rent-seekers attempting to spread authority and thereby capture additional rents.

  • marlok||

    Bingo. When you read "AAP" and "public health" in the same sentence, prepare to read about some new plan to gain authority over your children.

  • Brian E||

    There is a GREAT BIG GIANT contradiction between Reason's wholehearted embrace of transhumanism and steroids and its panicky pearl-clutching about ADHD drugs.

    The only way to see such a contradiction is to assume that all drugs must be approved by and controlled by Official Medicine and must be prescribed only for Official Diseases lest people get any ideas about recreational or beneficial drug use.

  • Colonel_Angus||

    Its the top down nature of physicians and other supposed authorities labeling the the idea of ADD and imposing unnecessary drugs on people who are often not given the option of whether to use them. That's the problem here.

  • Maxxx||

    Beyond that, in 90% of cases ADD is completely politically driven bullshit.

    The reality is "You're little shit doesn't respond appropriately to our prison-school, so he's obviously mentally ill."

    It's completely driven by idiot "educators" that want conforming inmates.

  • Maxxx||

    Fuck those assholes.

  • Some Guy||

    The drugs in question are wonder drugs that raise IQ.

    No, they're not. In more cases than not, they're there to dope up the kids for the convenience of parents and teachers.

    The wider the diagnostic criteria are drawn, the more people can access the drugs (which they should be able to access at will without a prescription anyway under any version of libertarianism with which I am familiar) if they want them. If someone came up with a set of diagnostic criteria that let anyone who wanted to light up get medical marijuana when they wanted it, Reason would be delighted. So why aren't you delighted here?

    I think that they should be available to anyone, just like crack should. But that doesn't make me think that people trying to sell crack to parents to give to their children isn't a scumbag.

  • jtuf||

    + 10

  • Amakudari||

    No one's saying the government should restrict access. But that still doesn't make using the drugs always a wise choice (the same thing applies to cocaine, Oxycontin and bacon-wrapped meat products). I mean, we're really talking about chemicals that are similar in effect to meth and coke (less intensity, longer duration). It's a decision that people should take seriously, but parents have historically been conned into them for kids who don't really benefit from the drugs.

  • Matt||

    As someone who spent most of his adolescence on various ADD drugs, including Ritalin, Adderall, Concerta (extended release-Ritalin) and Strattera, I think I can speak with more authority than most on this topic. And here's the facts: these drugs turn you into a zombie. I did better in school when I was on the drugs, but the physical effects (including a complete loss of appetite when on the first three drugs) and the social effects were awful. These drugs are simply there to cram people who normally wouldn't fit into a traditional school environment very well (as in, sitting in a classroom for 8 hours a day listening to a teacher drone on) without losing attention every once in a while.

    I dropped the last drug (which didn't have any symptoms except that it made me cripplingly nauseous for a few hours after I took it) a few years ago and haven't looked back. Either I've "grown out" of my ADD, or it has magically cured itself, or maybe it wasn't such a big problem to begin with. But I'm not sad to see the drugs go.

  • Joe M||

    Fluffy, you should know better. The objection is to compulsory drugging of our children based on dubious criteria that keep getting changing by interested parties to increase the numbers of diagnoses.

  • Neu Mejican||

    Compulsory?

  • Colonel_Angus||

    Parents forcing children=compulsory. Even if children "don't have full rights".

    Institutions (namely public schools) coercing parents because the child doesn't meet arbitrary standards also results in a somewhat compulsory situation.

  • RoboCain||

    Because those other things are purely voluntary. That's the difference.

  • Dr. Mark||

    That's just what America needs - more therapy.

  • ||

    for my son, at age 5 to 7, my wife and others were concerned about ADHD and open to drugging him up. I said over my dead fucking body. Best last stand I've ever made.

  • Some Guy||

    My Catholic school principal tried to put me on ritalin when I was 8. She was persistent, but my mom didn't let her.

    I wish she were still alive so I could yell at her for trying to turn me into a suicidal druggie instead of a successful engineer.

  • jtuf||

    Look at this this way, you get to say, "I wish she were alive today ..." The natural cycle of live eventually favors the students over the teacher.

  • PermaLurker||

    but using meth is bad mmkay

  • ||

    Whatever happened to smacking kids upside the head when they misbehave. Don't get me wrong. I'm not saying there aren't kids out there who need this kind of medication. It just seems to me that for every one child who needs ritalin, prozac, etc., it's given to hundreds, if not thousands who just need some good old fashioned discipline.

  • Hate Potion Number Nine||

    Good old fashioned discipline doesn't make money for the makers of ritalin.

  • sevo||

    "That's just what America needs - more therapy."
    I'm hoping this is not as general as it is presented (suggested?) to be. But I'm afraid it is the cause of entirely too many of the 'occupy' groups: "I'm too *wonderful* to fail! Mommy told me so!"

  • ||

    The first problem with psych is that it assumes that the patient is the problem. Instead of teachers doing their job right or exploring more appealing ways of learning *cough Khan Academy cough*, they'd rather blame it on the kid.

    And this continues even into professional schools.

    Oh, btw . . .

    Dear Peds,

    Leave the wetware to the professionals.

    Yours truly,

    The Psych Community

  • ||

    Oh, btw, fuck ritalin, the password is "neurofeedback:" www.eeginfo.org

  • Amakudari||

    "any child 4 through 18 who has school or behavioral problems and symptoms of inattention, hyperactivity, or impulsivity" be evaluated

    Any child or teen who doesn't show symptoms of inattention or impulsivity concerns me. If you keep a kid locked into lectures for seven or eight hours a day, he better become restless.

    FWIW, I was on Dexadrine and Ritalin for a brief while when I was in elementary school. They gave me some pretty nasty headaches. I eventually started hiding the pills the school nurse gave me under my tongue. It was only after my folks heard some equally scary story from a friend who was a physician that they finally gave up.

    And my grades were good (and better) without pills. Damn good. It was all about doping kids up and scaring parents. Those aren't issues of government stealing liberties, but they are inconsistent with making logical decisions for your children.

  • jtuf||

    So where are the inactivists to protect children's brains? I support the right of parents to seek mind-altering drugs for their kids, even though I strongly recommend against doing it. The problem with pediatric psychiatry is that government schools have a habit of funneling kids to it. They pressure parents who don't see anything wrong with their kids behavior into bringing those kids to psychiatrists for drugs.

    As a thought experiment, consider the outrage if the medical community pushed circumcisions for 6 year olds as a cure for ADD and government schools regularly recommended circumcision to any 6 year olds who did not pay attention in class. Aren't the nerves of the cerebral cortex as valuable as the nerves in the foreskin?

  • Joe M||

    Aren't the nerves of the cerebral cortex as valuable as the nerves in the foreskin?


    Oh god, don't open that can of worms!

  • Colonel_Angus||

    In every "behavior" case where drugs are expected to turn a kid in to a good little obedient inmate (not talking about psych patients who are just given drugs to numb the fuck out), I guarantee any problem, if it exists, is 100% environmental.

  • mikey||

    This is one topic that makes me glad I'm an old fart. Impulsive? Inattentive? That was (and still is) mikey. My teachers didn't know for ADHD - they called it "rambunctious" and knew most little boys were that way and would grow out of it (making the teacher's lives a little tougher along the way). Never grew out of it, but did learn to control at least the impulsive part. Still proud that my wife and I wouldn't let them dope our son.

  • Joe M||

    Here's a scary article from a few years ago:

    Toddlers as young as two given ADHD drugs like Ritalin

  • sargon||

    Imagine young children (especially boys) not being able to sit still for hours at a time! The horror! When I homeschooled our sons we started our day outside...riding bikes, shooting baskets, anything physical. Always worked out the 'wiggles' before we sat down to learn. When they were younger, they required more breaks for physical activity. They never had 'focus issues'. They entered a traditional school setting in 6th grade. Now at 14 and 15 they are self-motivated learners, both at the top of their classes. And both are extremely healthy. You drug a kid into inactivity and wonder why so many are obese.

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