Harold Koplewicz is president of the Child Mind Institute.
Recently, the news has been full of reports, based on data from a nationwide survey by the Centers for Disease Control and Prevention, that the prevalence of attention-deficit hyperactivity disorder in the child and adolescent population is dramatically on the rise. The headline grabber in this analysis is that as many as 1 in 5 high school-age boys have been diagnosed with ADHD, and 11 percent of school-age children overall. And these numbers have prompted concern that too many kids are being diagnosed and put on stimulant medication.
It's important to pay close attention to the methodology of these mass surveys, lest we overreact. The CDC survey is based on parent responses to questions I believe could possibly elicit misleading responses. For instance: "Please tell me if a doctor or other health care provider ever told you that [the child] had the condition."
Often psychiatry is accused of being an unscientific, disturbingly subjective enterprise full of clinicians desperate to label and then medicate people – the more the better. For one, most ADHD diagnoses are made by primary care doctors, not psychiatrists, and it is in all of our interests to be very careful about who we diagnose and medicate.
But we should also be careful about throwing around accusations of fraudulent diagnoses, claims that ADHD isn't a real disorder, and horror stories about stimulant medication use by schoolchildren leading to addiction. ADHD is a real brain disorder; it can create severe barriers to success in school, in relationships, in life; and kids who don't get treatment are at heightened risk for drug abuse, not the other way around.
Whenever we see a surprising increase in the prevalence of a diagnosis, two responses spring to mind: One is that diagnostic standards have been changed – weakened – so that kids whose symptoms wouldn't have met standards before are now being diagnosed. This is a claim that doctors are guilty of overdiagnosis, or misdiagnosis, or pathologizing normal behavior.
The other response is that an increase in diagnoses means kids who weren't getting the attention they needed are now getting it because of increased access to care, better information, or a decrease in the stigma that has so long been attached to seeking mental health care.
Both of these things can be true. Not all kids who have trouble paying attention in school or behaving well in the classroom have ADHD, and it's sometimes easier to try medication than to investigate out what's really behind problematic behavior. A knee-jerk diagnosis is a disservice to kids whose problems are rooted in anxiety, depression or family crisis.
But there's also an increase in awareness among families, educators and health professionals that kids who are struggling in school or exhibiting dangerous misbehavior really can, and must, be helped. Just washing our hands of children who have problems and letting a lot of them drop out of school is not a viable option either for those youngsters or for our society. They need to become successful learners in order to be successful adults, and we need them to be prepared, intellectually and emotionally, to form a prosperous and competitive new generation.
That's a reason a lot more parents are hearing that they might want to have their kids evaluated, which results in more diagnoses.
- Read Gary Shaprio: American Exceptionalism Is in Our Genes
- Read the U.S. News Debate: Should the Boy Scouts of America Lift Its Ban on Gay Members?
- Check out U.S. News Weekly, now available on iPad