National Edition

Sick, injured or merely different? Rising ADHD cases fuel running battle among mental health experts

Published: Tuesday, Feb. 18 2014 10:15 a.m. MST

Tom Metge has struggled with ADHD all his life. He's had to learn systems that work for him and has forged an unconventional but very successful career path.

Eric Schulzke, Eric Schulzke @2013

In second grade, Paul couldn’t stay in his seat — and his rigorous South Florida private school had lots of seat work. After counseling with the principal, a series of visits to therapist followed. They probed issues from allergies to home stability before concluding that Paul, who is now 13, had attention deficit hyperactivity disorder.

While the family scrambled to learn more, the school tried to adapt. But there was no way Paul could stay at a desk for 40 minutes. He was soon struggling with reading comprehension, and his parents and teachers feared he would be left behind.

Paul’s mother would love to have enrolled Paul at a Montessori school, with its flexible curriculum and emphasis on body movement. But their city had none. And a public school would have been less attentive and no less dull. They toyed with homeschooling, but she couldn’t fit it into her own work schedule as a writer.

Medication was the next step. It wasn’t easy, Paul’s mom said. But she and her husband knew they somehow had to help him fit in and keep pace with his fellow students. They felt his education and career hung in the balance. So he ended up on Concerta, a variant of Ritalin. Both are powerful stimulants closely linked to amphetamines.

Still, the family worried about addiction and possible health effects of long-term use, a fear that still dogs them. Paul does thorough medical checkups every three months, including electrocardiograms.

Now 13, Paul has been using prescription stimulants off and on for six years. His parents have tried everything from folk remedies to Omega 3. Nothing worked. They lived on Google, looking for options. They took breaks from the medication. But sooner or later Paul would always come back and say, “Mom, I want to go back on the 'focus pill.' ”

Paul and his family have lots of company in this nervous leap into branded focus drugs. ADHD diagnosis rates for school age kids keep climbing, the Centers for Disease Control reports. As of 2011, 6.4 million kids had been diagnosed. In 2003, 7.8 percent of kids aged 4-17 had been diagnosed with ADHD. That number jumped to 9.5 percent in 2007 and to 11 percent in 2011. The ADHD drug prescription market jumped even more sharply, from $4 billion U.S. sales in 2007 to to $7.9 billion in just four years, IMS Health reports.

Is the rise of ADHD diagnosis signs of an epidemic — or a product of mass hysteria? And are the ubiquitous stimulants used to treat the condition a blessing or a curse? Experts argue, kids struggle, parents worry — and the jury remains out.

Vast overdiagnosis?

Sharply rising ADHD diagnosis rates are raising the blood pressure of Dr. Keith Conners, the emeritus Duke University psychiatrist and icon in ADHD circles. Conners was a pioneer in the field, publishing his first paper on Ritalin treatment in 1963. He developed the widely used Conners ADHD diagnostic test. Now he wishes it were used less often.

Conners is perturbed that 11 percent of school-age kids have received an ADHD diagnosis. “The best evidence for occurrence among kids” he said, “is about 2 to 3 percent. But there’s lots of bad evidence going as high as 20 percent. It depends on what kind of evidence you prefer.”

Even assuming a given diagnosis is correct, Conners said, an effective treatment program requires frequent monitoring to adjust dosages as patients get older. Sometimes doctors agree to higher doses because of pressure from patients and parents who enjoyed the modest bump in mood and focus, and simply want more of that effect.

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