Children in the United States are being diagnosed with attention deficit hyperactivity disorder at higher rates than ever before, according to recent data from the Centers for Disease Control. While historical rates of ADHD have hovered around 5 percent, the study, which was conducted from February 2011 to June 2012, revealed that 11 percent of American children have received the diagnosis. The results have sparked discussion in the medical community about diagnosis in a time with increasing pressure for children to succeed. Yale School of Medicine pediatrics and neurology professor William Graf sat down with the News Monday to discuss the causes and implications of the rising rates of ADHD diagnosis in America.
Q: Why do you think we are seeing increasing rates of ADHD diagnosis?
A: We are talking about this now because of the recent [CDC] paper, but the rates have been drifting upwards by most of our measures. There are a lot of reasons why clinicians would be fast to diagnose, some of which have to do with our society, our health care system and the difficulty in making this diagnosis. The quick doctor visit is a setup for a quick diagnosis with a quick fix. There is this common misperception that if a child responds to Ritalin, he must have ADHD. I drink coffee every day as a stimulant and I have a response to it, but I don’t believe I have ADHD.
Q: Do you think there are social roots of the increasing diagnosis of ADHD?
A: One of the big debates that has been going on has been with children, high school students and college students that are multitasking all day long with multiple distracters through electronic devices. There is a big overlap here because part of the definition of ADHD is inattention and inability to focus and concentrate. One of the big debates is that there is a rising rate of ADHD because people are more distracted.
Q: Do you think that the increase in diagnosis rates has anything to do with increasing pressure for children to perform at consistently high levels in schools?
A: I think that’s playing a major role. “Race To The Top,” “No Child Left Behind,” these pressures on schools to have higher test scores and have all kids succeed, even those that have learning problems, put the schools under a lot of pressure for those kids who are not performing. There are not numbers to answer that question — these are societal changes that are observable. How much that is playing a role in the rising diagnostic rates of ADHD isn’t completely clear.
Q: In the study, one in five high school-aged boys has a diagnosis of ADHD, twice the rate of girls. Why do you think prevalence is so much higher in boys?
A: There seems to be a greater tendency to make the diagnosis in boys for multiple reasons. Some studies show that the hyperactivity components of ADHD is higher in boys than in girls, but in addition, hyperactivity is more common in preschoolers and early grade school children than it is in high school students and adults with ADHD. In the study that just came out, the teenage boys make the single biggest jump — they were 20 percent — and why that was I’m not sure because teenage boys tend to be less hyperactive.
Q: What do you think are the long-term biological effects of the use of the stimulants, especially in those that don’t have ADHD?
A: Generally, stimulants are safe, but there is concern about the potential for side effects, and those depend on the individual, the dose and the length of time they are taken. But in principle, the standards for safety have to be much higher for healthy individuals as opposed to those with impairments. The willingness to accept the side effect of a medication is higher if you can’t function in day-to-day life, but if you are otherwise healthy, the concerns of having a significant side effect when you don’t actually need the treatment is greater.
Q: If prescription medication like Adderall, even for those who don’t have ADHD, can produce increases in attention and performance, why should we be worried about increasing diagnosis?
A: There are both ethical and biological arguments here — why not just put it in the water? It’s not natural, and it has potential side effects. There are ethical concerns about giving strong medications to people who don’t need them. There are health concerns. There are concerns about changing the developing brain in ways that we can’t understand. There are just lots and lots of medical concerns.