The New York Times is reporting that the most recent U.S. Centers for Disease Control study of children’s health issues shows that 11% of U.S. children ages 4 and above have been diagnosed at some point in their lives with ADHD. The study also reports that 15% of boys have been diagnosed with ADHD, and that nearly 20% of high school boys (along with 10% of high school girls) have received an ADHD diagnosis and one in every ten high school boys currently takes medication for ADHD. The data was compiled by reporters from the Times from raw data on the CDC website from the 2011-12 Survey of Children’s Health Issues…a phone survey of 95,000+ U.S. households, with a minimum of 1,800 surveys from each U.S. state. Here’s a link to the full article in today’s New York Times…I would encourage you to read the article for the comments of prominent physicians quoted in the piece. Here’s my two cents…
- Assuming the data are accurate, we have a serious societal problem if 20% of our high school boys have a condition that by definition requires functional impairment in at least two settings and “clear evidence of interference with developmentally appropriate social, academic or occupational functioning.” We need to consider the possibility that the demands and expectations of the environments where our kids and teens spend much of the time are a big part of the problem and question whether we need to rethink our expectations for academic productivity and the design of the learning environments where our kids spend much of their day.
- I’d hypothesize that too many kids are getting a diagnosis of ADHD without an appropriately thorough assessment from a physician or other professional with the proper training and qualifications to diagnose. One immediate observation I made when reviewing the graphic from the article (above) is that many of the states where the prevalence of ADHD is highest are states where the shortage of child psychiatrists is most acute. If I had one takeaway point for parents from this discussion, I’d encourage them to make sure that whoever they take their child to for assessment or treatment of ADHD takes the time to do a comprehensive assessment including separate interviews with the parent and child, input from teachers and other adults from outside the family involved in the child’s life and a thorough review of the child’s educational records, including report cards and standardized testing results. Some of this may be a byproduct of physicians (the majority of whom are now employed by large clinics and healthcare organizations) pressured to see too many patients in too short a period of time.
- I’m a big proponent of free speech, but I wouldn’t have any problem with Congress passing a law to prohibit “direct-to-consumer” advertising of prescription drugs to the general public. Back in the day when I spent much of my time involved in physician education it became obvious to me that for all too many doctors, the path of least resistance was to give patients what they asked for, especially if their experience or communication skills made it difficult for them to explain concisely why a specific product or treatment may not be in the patient’s best interest.
- We need to examine the possibility that medication is being used as a substitute for effective psychosocial treatments in our publicly-funded mental health centers, or as a replacement for appropriate assessment and remedial education services in public schools in impoverished areas. Rates of medication usage are significantly higher among kids covered under Medicaid compared to private insurance. While some of this discrepancy may be due to genetic loading (unplanned pregnancy rates are higher among persons with ADHD, divorce rates among parents of kids with ADHD are double that of families in the general population up to age 8), medication may be the only option in situations when high quality counseling or effective educational interventions are unavailable.
- Finally, I wonder if the explosion of technology available to kids may be fueling our ADHD epidemic? I did a brief Medline search looking for high-quality studies demonstrating an association…the available data is muddled and doesn’t adequately control for kids who seek out technology as an escape from academic frustration or because they already have ADHD and computer games provide gratification mediated through dopamine reward circuits in their brains. Experientially, I’ve found that I crave more new information and have a shorter attention span after spending too much time with social media. We do need well-designed studies to look at the impact of texting, social media, smartphones and video games on traits associated with ADHD.
Those are my thoughts…What do you think?
Check out Key Ministry’s page on ADHD and Spiritual Development! The page features links to an extensive blog series, expert tips on teaching kids with ADHD from Karen Sunderhaft, links to a video featuring Dr. Russell Barkley explain brain mechanisms in children and adults with ADHD, and links to the American Academy of Child and Adolescent Psychiatry’s Resource Center on ADHD. Feel free to share the links with church staff, volunteers, friends and family members.