Trendy Diagnosis of ADHD Is Bad Medicine

Earlier this month, the New York Times told a story, “The Selling of Attention Deficit Disorder,” about how diagnoses for Attention Deficit Hyperactivity Disorder (ADHD) have boomed since the problem was accepted in recent decades as a true neurological problem in some children. How drugs such as Adderall and Concerta have become popular for helping kids moderate their problematic behavior.

The story also told how Keith Conners, the doctor who lead the fight to recognize ADHD as a legitimate medical issue feels less than satisfied about the evolution of its treatment. He has called the rising rates of diagnosis “a national disaster of dangerous proportions,” and told The Times that “[t]he 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.”

A follow-up commentary in The Times, addressed the issue not only of the “hard-sell” by the pharmaceutical industry to boost the number of people diagnosed with ADHD, but its campaign to enlarge that market beyond children to adults.

ADHD is a real problem for some children, perhaps 5 in 100. Medication can alleviate the symptoms (including difficulty staying focused, paying attention, controlling behavior and staying still) that impair a kid’s ability to succeed in school or social settings. But research from the Centers for Disease Control and Prevention (CDC) show that 15 in 100 high-school age children have been diagnosed with ADHD, and that the number of kids taking medication for it has grown from 600,000 in 1990 to 3.5 million today.

According to the first Times story, the disorder is the second most frequent long-term diagnosis made in children, just behind asthma.

But, as the op-ed says “Many of these children, it appears had been diagnosed by unskilled doctors based on dubious symptoms.”

We’ve written about the disturbing practices in the treatment of ADHD on our Child Safety blog (See “Boom in ADHD Diagnoses Can Lead to Overmedicating and Drug Abuse.”)

As The Times reported, the pharmaceutical companies’ strategy to enlarge the market for Adderall and its medicating kin is brazen, misleading and even deceitful. Sure, some drugs might make an active kid’s behavior less irritable, but “active” is not “sick,” and the op-ed reminds readers, as do we, always to be aware of the potential dangers of a drug that might solve an immediate, but not medical, problem.

These drugs can be addictive. They can cause psychosis and, rarely, suicidal thoughts and hallucinations. They can cause insomnia, anxiety, loss of appetite. Last week, the FDA issued a warning that some ADHD meds, including Ritalin, Concerta and Strattera, could cause prolonged and sometimes painful erections (“priapism”) in males of any age.

But, as the op-ed noted, “So many medical professionals benefit from overprescribing that it is difficult to find a neutral source of information. Prominent doctors get paid by drug companies to deliver upbeat messages to their colleagues at forums where they typically exaggerate the effectiveness of the drugs and downplay their side effects. Organizations that advocate on behalf of patients often do so with money supplied by drug companies, including the makers of ADHD stimulants. Medical researchers paid by drug companies have published studies on the benefits of the drugs, and medical journals in a position to question their findings profit greatly from advertising of ADHD drugs.”

Since 2000, although the feds have pursued “every major ADHD drug” for false and misleading advertising, their manufacturers just stop making those particular claims; they don’t stop using other methods to hawk them to any receptive buyer. According to The Times, the number of ADHD prescriptions written for adults ages 20 to 39 nearly tripled between 2007 and 2012; sales of stimulant medications in 2012 were more than five times higher than a decade earlier.

The Times calls for more aggressive action by the FDA and Federal Trade Commission to address the unwarranted and unsafe upsurge in diagnoses and drug treatments. It calls for doctors and patients to acknowledge that these meds are dangerous, that prescribing them should not be mindless or routine.

We would add that, often, careless and impulsive behavior is best addressed by other approaches, at least initially.