Few pediatricians doubt that ADHD — attention deficit hyperactivity disorder — is a real thing than can be quite disabling to some children. Further, few pediatricians question that stimulant medications like Adderall and Concerta can be very helpful for these children. But any reasonable person should be skeptical that 11% of all children and 20% of teenage boys have ADHD requiring medication. Those are the recent numbers reported by the Centers for Disease Control. The person most responsible for identifying ADHD and researching for 30 years how to treat it is Dr. Keith Conners, emeritus professor of psychology at Duke University. In a recent interview he had this to say about this apparent epidemic:
“The numbers make it look like an epidemic. Well, it’s not. It’s preposterous,” . . . “This is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels.”
There is big money to be made in ADHD. As you can see from the graph above, sales of stimulants have risen 500% since 2002. ADHD is also just the kind of disorder the drug companies love — a chronic condition that requires daily medication for many years. They are far less interested in developing drugs that cure things because the market goes away. Drug companies market ADHD. They sponsor a large number of conferences for physicians and mental health workers encouraging them to diagnose it and, of course, to treat it. Patient advocacy groups for ADHD are helpful. But they also get a huge chunk of their funding from the drug industry, something few people know. And now a whole new frontier for Big Pharma has opened up with the identification that some adults have ADHD and respond to stimulant therapy. For those who suffer from ADHD the therapy helps significantly. But you can see the temptation to over-diagnosis it in adults, too. With all these prescriptions you can also see the ease with which they can be diverted to the illicit drug market. That happens frequently.
Is there any hope of moderating this trend, of getting the prescription numbers back down out of the stratosphere? A recent editorial in Psychiatric Times by Allen Frances sees some hope. That hope is based in the common sense of people pushing back. Here is what he has to say about that:
The percentage of kids being diagnosed (11% overall and 20% of teenage boys) is so absurdly high that reasonable people can no longer accept that the label is being applied with anything approaching sufficient care and caution.
I hope he’s correct. The principal problem with diagnosing ADHD is that there is no specific test for it, no blood test or scan that doctors can use to decide who has it. The diagnosis is made by ticking off items on a checklist, a checklist that was devised by committees of experts, committees which periodically change their minds and modify the diagnostic criteria. Inevitably the diagnosis has a fair amount of subjectivity built into it. Dr. Frances also reminds us that psychiatry has always wrestled with the subjective nature of mental illness, a situation that is ripe for diagnostic fads and fashions:
The history of psychiatry is littered with the periodic recurrence of fad diagnoses that suddenly achieve prominence and then just as suddenly fade away. Human distress is always hard to explain and sometimes hard to tolerate. Diagnostic labels, even false ones, can gain great and undeserved popularity because they seem to explain the otherwise unexplainable and provide hope that describing a problem will lead to improving it. And once you have a diagnostic hammer, everything begins looking like a nail.
I think that is quite perceptive.
Sachin on 