Do You Think ADHD is Real?

Earlier this week I read a summary of a newly published study about the increased prevalence of Attention Deficit/Hyperactivity Disorder (ADHD). The study was conducted by Kaiser Permanente in California and covered a time span from 2001 to 2010. It got me thinking about the diagnosis, its prevalence and treatment.

The findings showed that the rate of diagnosis of ADHD increased from 2.5% to 3.1%, or nearly 25%, in the ten years of the study. Because the number of children in the study was large, the researchers were able to compare by race. The greatest increase was among white children, with black children coming next and Hispanics after that. There was no appreciable change among Asian or other ethnic groups.

Children with ADHD were most likely to be white or black, come from families making at least $70,000 a year, and they were more likely male than female. For many years we have seen that learning difficulties of all kinds are more frequent among boys than girls.

The authors say that "It (ADHD)is one of the most common chronic childhood psychiatric disorders, affecting 4% to 12% of all school-age children and persisting into adolescence and adulthood in approximately 66% to 85% of children." They are confident in their findings because of the large and diverse nature of the sample in the study.

What do we make of these findings? I know that many parents feel that ADHD is over diagnosed and that the psychiatric community is too eager to put children on medications for ADHD. People will assert that children were not on stimulant medication when they grew up and people got along fine.

Let me get my opinion out there. I believe that ADD and ADHD really exist, and when children (or adults) get a proper diagnosis, they are often helped a great deal by appropriate treatment and medication. Treatment includes working with parents on their parenting style and teaching children strategies to stay organized and on task.

In my practice I tend to be conservative. I will work with a child and parents for awhile trying to understand the issues. We work on organization and on clearer and calmer parenting ¬-strategies. When these approaches do not work, and the child is still impulsive, distractible, and disorganized, we have to take a hard look at the symptoms and make the diagnosis. Then I will advocate that the parents consult with their pediatrician or a child psychiatrist to discuss medication. Why? Well, over the years I have seen the quality of life of children and parents radically improved by the use of medication.

However, medication does not solve all the problems. It does not teach children coping strategies or ways to keep stuff organized. It does make the children better able to learn and use such strategies. So our work continues even after a child starts medication. But the work is easier. A very good book about this is Parenting Children With ADHD: 10 Lessons that Medicine Cannot Teach by Vincent Monastra, Ph.D.

I trust that the diagnoses in this study were legitimate. Why is the prevalence of ADHD increasing? Perhaps it is because of greater awareness. Why is the diagnosis more likely in the higher income levels? Perhaps they had more leisure to focus on their children’s symptoms and thus get the diagnosis and treatment. It would be interesting to know. In any case, I do not think that the income level casts doubt on the diagnosis. More likely, the less affluent children are under-diagnosed.

As for the children of forty years ago who were not on medication—did they really get along fine? I look back on my classmates and I can see some that I believe probably had ADHD. They were class clowns. Teachers said that they had the ability but they didn’t try. Some got into trouble in high school. Perhaps their lives could have been easier and more productive if we had known more about ADHD then.