ADHD in Children: Controversy over Diagnosis and Medication

By Lamia Haider

Overview- Psychiatric Disorders In Children

Ages range from 2 to 17 years old. Prevalence of any psychiatric disorder: 12-19% Most frequently occurring are anxiety disorders, conduct disorder, oppositional defiant disorder, and attention deficit disorder Boys had 2.1 times greater prevalence of attention-deficit/hyperactivity disorder than girls, girls had twofold higher rates of mood disorders than boys. Greater prevalence in children with intellectual disabilities

ADHD Overview
Attention deficit-hyperactivity disorder Disorder of performance in various environments No research showing lack of intelligence associated with ADHD. Studies indicate that the disorder may be neurological and/or genetic. Environment has been shown to play a very small role.

ADHD- DSM IV
Six or more symptoms of INATTENTION persisting for at least 6 months. Six or more symptoms of HYPERACTIVITY/IMPULSIVITY persisting for at least 6 months. Developmental level affected.

ADHD- DSM IV
Symptoms present before the age of 7. Impairment in two or more settings. Clear evidence of impairment in various aspects of life. Symptoms do not occur because of some other disorder.

Financial Costs
Children with ADHD incur an average of $1465 per capita vs the $690 non-ADHD children incur. Had 9.9 times more outpatient mental health visits. 3.4 times more pharmacy fills (11.25/year vs 3.30/year).

Treatments
Prescription medication Behavioral-Psychosocial therapy Multi-modal therapy

Getting to Know your Prescription Medications

Stimulants are the most commonly prescribed. Methylphenidates (e.g. Ritalin) and amphetamines or amphetamine combinations (e.g. Adderall) are the most common stimulants. How do they work?

Criticisms
Symptoms of ADHD are social/cultural. Physicians are hasty in diagnosing ADHD. Alternative treatments aren't presented as options. Stimulants are overprescribed as proven by the huge increase in production and consumption.

Rebuttals, Brought to you by Research

Symptoms of ADHD are social/cultural.
However
Twin studies, sibling studies and adoption studies show significant genetic effects. Combined action of several genes. Familial risk of ADHD has been noted to be two to eightfold greater in parents and siblings. Analysis of 20 international twin studies has revealed the heritability of ADHD to be 0.76.

Rebuttals, Brought to you by Research

Physicians are hasty. Therapy is underused.
However
Physicians generally spend 1 hour or more on initial evaluation. Around 25% of children are not prescribed ADHD medication after being diagnosed. Most physicians and pediatricians recommend therapy. Multi-modal therapy has been shown to be the most effective treatment.

Rebuttals, Brought to you by Research

Stimulants are overprescribed.
However
Rates of ADHD diagnosis increased an average of 3% per year from 1997 to 2006 and an average of 5.5% per year from 2003 to 2007.

Greatest increase in diagnosis amongst

Girls. Youths with attention deficits but without notable restlessness. Teenagers with persisting ADHD symptoms. Non-ADHD youths with conduct problems.

Issues
No prospective studies that span over 5 years. Diagnosis sometimes based on parent or teacher reports. Stimulant treatment is mostly symptomatic and so far has not been shown to improve future performance.

Conclusion
Even though the public complains about treatment being so drug-based, research primarily focuses on psychopharmacology rather than forms of therapy. Current forms of therapy (without medication) shown to be mostly ineffective anyway. There is no cure so far, only symptom management and reduction. Multi-modal treatments or stand-alone medication do not have significant enduring effects but may help to prevent or mitigate comorbid disorders.

Works Cited
American Psychiatric Association. "A 06 Attention Deficit/Hyperactivity Disorder." American Psychiatric Association - DS-5 Development. American Psychiatric Association, 01, May 2012. Web. 27 Sep 2012. (http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=383). Barkley, Russell. "Adolescents with ADHD: An Overview of Empirically Based Treatments." Journal of Psychiatric Practice. 10.1 (2004): 3553. Web. 21 Sep. 2012. (http://www.russellbarkley.org/images/Treating ADHD in Teens 2004.pdf). Biederman, Joseph. Attention-Deficit/Hyperactivity Disorder: A Selective Overview. Biological Psychiatry. 57.11 (2004): 1215-1220, Web. 21 Sep. 2012. (http://www.sciencedirect.com/science/article/pii/S000632230401100X). Center for Disease Control and Prevention, . "Attention-Deficit / Hyperactivity Disorder (ADHD)." Center for Disease Control and Prevention. Center for Disease Control and Prevention, 12, December 2011. Web. 23 Sep 2012. (http://www.cdc.gov/NCBDDD/adhd/data.html). Chan E, Zhan C, Homer CJ. Health Care Use and Costs for Children With Attention-Deficit/Hyperactivity Disorder: National Estimates From the Medical Expenditure Panel Survey. Arch Pediatr Adolesc Med. 156.5 (2002): 504-511. doi:10.1001/archpedi.156.5.504. Harlan Gephart, et al. "Utilization And Cost Of Health Care Services For Children With Attention-Deficit/Hyperactivity Disorder." Pediatrics 108.1 (2001): 71. Khan, Sajjad, and Stephen Faraone. "The Genetics of ADHD: A literature review of 2005." Current Psychiatry Reports. 8.5 (2006): 393397. Web. 27 Sep. 2012. <http://www.springerlink.com/content/d325k4824487662r/export-citation/>.

Merikangas, Kathleen, Jian-Ping He, et al. "Prevalence and Treatment of Mental Disorders Among US Children in the 20012004 NHANES." Pediatrics. 125.1 (2010): 75-81. Web. 27 Sep. 2012. (http://pediatrics.aappublications.org/content/125/1/75.full?sid=279d73f1-fadd-40ce-9594-464ff748f1a9).
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