Over the last decade and a half, the United States has been witnessing changing patterns in the prevalence of attention deficit hyperactivity disorder (ADHD) among youngsters. Between 2003 and 2011, there was a 42 percent increase in the percentage of American children and adolescents aged 4-17 who had ever received an ADHD diagnosis. An estimated 4.4 million children (7.8 percent) had an ADHD diagnosis in 2003, which increased to 6.4 million (11 percent) in 2011. During the same period, an additional 1 million children were reported by their parents to be taking ADHD medication.
Parents and doctors are concerned that too many children are being mistakenly diagnosed with ADHD and probably being over-medicated. There is also a strong contrarian view that many children and adolescents are under-diagnosed and not receiving treatment. Experts had previously highlighted that “very quick diagnoses” will definitely result in over-diagnosis, since other disorders can be mistaken for ADHD. An average ADHD assessment typically involves a 10-minute office visit, particularly for children on Medicaid. Quick evaluations, conversely, can also lead to under-diagnosis.
Variations in educational policies across U.S. states may also be contributing to higher rates of ADHD diagnoses. Past research found a correlation between states with the highest rates of diagnosis (mostly Southern U.S. states) and laws penalizing school districts for students’ failure. Under these laws, school funding is contingent with the number of students who pass standardized tests. Financial incentives lead to a higher likelihood of students being diagnosed with ADHD and given medication for its treatment.
Serious consequences of both over-diagnosis and under-diagnosis of ADHD
The fifth edition of the Diagnostic and Statistical Manual (DSM-5) and the American Academy of Pediatrics (AAP) have prescribed specific standards and recommendations for ADHD diagnosis in children/adolescents. Pediatricians who spend a few minutes evaluating ADHD symptoms are likely to skip critical aspects of valid, evidence-based diagnoses like detailed discussions with patients and their parents, ratings from teachers, comprehensive medical/developmental history examination, and eliminating the possibility of other distraction-causing problems like anxiety, trauma or head injuries.
Stimulants prescribed in the treatment of ADHD are believed to be generally safe, if taken under the supervision of medical professionals. However, they can cause serious side effects, including insomnia, suppression of appetite and mood swings. A higher number of college students without ADHD are using stimulants. The medication does not have any beneficial impact on cognitive performance, memory or learning, as is widely believed. More importantly, using stimulants without an ADHD diagnosis leads to a higher likelihood of developing an addiction.
Under-diagnosis and under-treatment of ADHD have equally serious consequences. According to the American Psychiatric Association (APA), children and adolescents with ADHD have nearly twice the likelihood of suffering injuries requiring a hospital visit than those without the disorder. ADHD can also contribute to short-term and long-term negative consequences like academic difficulties, inability to maintain social and professional relationships, higher risk-taking behaviors and poor self-esteem.
While the increase in ADHD diagnoses in the U.S. appears to be slowing, it is likely to continue for a few more years. The Affordable Care Act (Obamacare) has enabled millions of individuals, who previously lacked health insurance, to access medical care. The emphasis on early childhood education is resulting in more children starting school earlier, resulting in symptoms of inattentiveness being noticed sooner by teachers. Under the AAP recommendations, primary care clinicians should initiate an evaluation for ADHD for children as young as four years old if they exhibit academic/behavioral symptoms of inattention, hyperactivity or impulsivity.
Diagnosing and treating ADHD
ADHD, one of the most common childhood neurodevelopmental disorders, does not have a single test for diagnosis. Diagnosing ADHD in children is a several-step process comprising medical exams, checklists for rating symptoms, and undertaking children’s complete histories from parents, teachers and even children themselves. In most cases, the most suitable treatment for ADHD is a combination of behavioral therapy and medication.
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