Is ADHD On The Rise – Or Just Overdiagnosed?

Monday, April 1st, 2013

The latest numbers on the rate of ADHD are extraordinary. The New York Times has reported data collected from the Centers for Disease Control and Prevention which suggest that 11% of youth (between 4 and 17 years of age) have been diagnosed with ADHD at some point in their lifetime. 

This is troubling – primarily because the data come from phone surveys of parents. This means that parents are receiving this diagnosis at unprecedented rates – not that kids are being properly diagnosed with ADHD at higher rates than before. It is too easy for kids to get labeled ADHD and not go through the comprehensive screening that should take place as administered by a multidisciplinary team of professionals.

It’s becoming clear that ADHD is being used as a label to try to provide a quick handle on behavior that may – or even may not – be somewhat troublesome. ADHD involves much more than not sitting still and not paying attention. All kids exhibit “ADHD” like behaviors now and then. It’s a difficult condition to diagnose because it is based on increased frequencies of a number of behaviors across a number of contexts (home and school) for a sustained period of time which cause impairment for the child. Without a detailed diagnostic process, it can be too easy to misread normative behaviors as symptoms of ADHD.

Part of the increase comes from diagnoses of older kids including those in high school. Diagnostic criteria are beginning to reflect the thinking that symptoms can develop later in childhood and even in the teen years (and not just the early years). That said, it can also become another convenient label for a kid who is not doing well in school. At the other end of the spectrum, diagnosing preschoolers can raise related issues in terms of figuring out which kids are really showing early signs and which kids are just being kids.

There are a number of problems with overdiagnosis. Kids typically get treated with drugs that are not appropriate for them. They get labeled rather than receive the kind of attention that they deserve (for example, to improve their engagement in the classroom). And some kids get diagnosed simply because they are in very large classrooms which promote inattention and not sitting still.

The less obvious issue is that the cursory diagnosing that may be going on is also a disservice to kids who do suffer from ADHD. They should be getting full assessments and comprehensive treatment plans that find optimal combinations of psychosocial intervention and, when necessary, well monitored use of drug therapy. Tossing around labels and drugs as a diagnostic and treatment strategy is not going to give them the help they need, especially since we know that ADHD can persist into adulthood and cause much in the way of academic and social impairment.

The bottom line? If you are a parent, and you (or someone else) suspects that your child might have ADHD, try to seek out an assessment from a multidisciplinary team that has the requisite experience to know how to sort out normative behaviors and issues from clinically meaningful ADHD. You might need to network with other parents, your pediatrician, and educators to locate a provider. But it will be worth your time and effort to make sure your child isn’t misdiagnosed as having ADHD – or not given the proper assessment and treatment plan if they do show the clinically meaningful symptoms of ADHD.

ADHD image via Shutterstock.com

Why Is Autism So Common Now?

Monday, April 1st, 2013

In 1980, the rate of autism was typically quoted as 4 in 10,000. The most recent rate reported is 1 in 50. While it is difficult to get a precise estimate, it’s abundantly clear that rates of autism have increased dramatically since 1980 – and in fact over the last decade. So what has changed?

There are a number of factors that have brought the startling levels of autism to our attention. These include:

Better Awareness: In 1980, autism was first introduced as a separate diagnostic category in the third addition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Prior to that time, clinicians using the DSM applied other categories such as childhood schizophrenia. Since 1980, there has been extraordinary growth in awareness – both for professionals and parents alike. This is particularly so over the past decade. Advocacy groups have done an admirable job of helping us understand what autism is (and isn’t). Pediatricians now screen for early warning signs – as do parents. These actions have all led to a much greater awareness of the symptoms of autism which undoubtedly translates in more proper diagnoses being made. In addition, the increased awareness has permitted older kids to be diagnosed more properly when the signs earlier in life were not recognized as autism.

Expansion Of The Symptoms: In parallel with efforts to increase awareness, diagnostic changes that recognized autism as a spectrum – now referred to as Autism Spectrum Disorder (ASD) – helped capture the wide range of symptoms that go beyond “classic” autism. Including a much broader representation of social, communicative, and repetitive/stereotyped behaviors certainly helped recognize the disorder in many youth who would not have been diagnosed in past years. Of course, there is debate about how the changes in the upcoming DSM-5 may result in a reduction in the rate of diagnosed ASD in the future. But up until now, recognizing the variation in symptoms that can characterize ASD has certainly been a factor in understanding how common autism really is.

Changes In Etiological Factors: Less understood is the role of new causative factors that increase risk for ASD. Much attention is being given to a large number of potential environmental contributors. There is the suggestion that specific genetic mutations that may be linked to autism – and associated with paternal age – are more common in the population because of average increases in paternal age over the last few decades. Much of this work, though, is work in progress, as it is believed that ASD typically results from the combination of a number of environmental and genetic risk factors. But many researchers operate under the assumption that there are both environmental and genetic risk factors that may be increasing in the population, though they remain elusive.

So, since 1980, what we have learned? We know now that autism is very common, is best thought of as a spectrum that includes substantial variation in how symptoms are expressed, and may be influenced by increasing levels of risk factors that are not well understood at this time. For all these reasons, it is critical that we keep researching the causes of autism, and continue to promote awareness of the early signs and symptoms in order to support early diagnosis and intervention.

Image: Autism Awareness Ribbon via Shutterstock

Red-Hot Parenting Recap March 2013: Mental Health In Kids

Sunday, March 31st, 2013

This month a primary focus was on mental health. Three broad themes were examined:

Getting Mental Health Services

Many parents ask me for advice on how to get their kids mental health services. I related 4 key tips that make a difference in terms of finding and receiving good treatment.

ADHD: Outcomes and Treatments

Two issues were in the air. First, new data were published showing that nearly 30% of kids with ADHD go on to still have ADHD as adults. Second, although ADHD is being diagnosed in preschoolers, a new study suggests that traditional treatments – primarily drug therapies – are not effective over time. I suggest a heightened need for more intensive psychosocial interventions in the early years.

Autism: On the Rise Again?

Each new estimate of autism suggests the rate is higher than ever – the newest figure is 1 in 50. I discuss some key issues in interpreting the new study. I also geared up for Autism Awareness Month by asking readers to ask me questions about autism that I can answer in blog posts during April.

Is Heading A Soccer Ball Dangerous?

Sunday, March 31st, 2013

When I started reading a recently published study, I thought the answer was yes. But after reading the study – and an expansion by the authors in an interview in the New York Times – I think the answer is that we really don’t know. 

What we do know is that soccer produces a lot of concussions. Many of these result from body to body contact – soccer can be a surprisingly physical sport.

This recent study used a novel method to do cognitive testing on high school girls after they headed a ball a number of times in practice. The data showed that there performance was somewhat lower than a control group – especially if they headed a lot of balls.

But there were plenty of limitations to the study. Most importantly, we’d need to see a full longitudinal study that included a large sample, measurement of cognitive performance before and after playing soccer, and a longer window of follow-up.

So while the question is extremely important, the only thing that is clear is that we don’t really know the answer yet.

Soccer Ball via Shutterstock.com

Autism Awareness Month: What Questions Do You Have?

Friday, March 29th, 2013

April is Autism Awareness Month. As such, I plan on devoting a number of my blog posts to autism. I will cover topics like: 

Why is autism so common now?

What causes autism?

Why are more boys affected?

What is early identification?

What are the best treatment options?

But I want to know if you have questions you would like to pose. So please leave a comment below if you want to suggest a question on autism to take on during Autism Awareness Month.

Autism Awareness via Shutterstock.com