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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
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Wednesday, March 27th, 2013
A new study suggests that a significant number do – almost 30%.
This report is noteworthy for two reasons:
- It is based on a large database of kids (5,718) seen originally at the Mayo Clinic (in Minnesota)
- It utilized a 29-year follow-up
Other significant findings include increased rates of one (or more) other psychiatric disorders, and a greater risk for suicide.
There’s one other number that makes this study especially important – the base rate of ADHD in the childhood sample was about 6%, which is in line with population estimates. This suggests that ADHD was not being over-diagnosed. Or put another way, the kids that were diagnosed with ADHD in all probability had pretty severe symptoms.
So this study – while not breaking new ground – provides further evidence that ADHD in childhood can lead to lifelong impairment. As such, it certainly suggests the importance of intervention in childhood when the level of symptoms and impairment warrants it. But it’s important to remember that this does not necessarily mean getting medication (though that helps some kids) – psychosocial interventions can be quite powerful as well.
Perhaps future reports on this sample will offer more insight into the factors that promote – or inhibit – the continuity of ADHD from childhood through adulthood.
ADHD via Shutterstock.com
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Wednesday, February 27th, 2013
Following a stimulating Intelligence Squared debate, we’ve been discussing genetic engineering (think of it as directly changing DNA) here at Parents.com – both in terms of using it to create a “Super Baby” and to prevent disease. As a follow-up, let’s consider the likelihood of genetic engineering being a factor in the future for a number of childhood psychiatric disorders – or more to the point, the challenges that lay ahead.
Autism Spectrum Disorder (ASD)
There would be hope that genetic engineering would be feasible in the future, as ASD is believed to be highly genetic in origin. However, the genetic basis for ASD is not clear. In fact, there may be a range of genetic etiologies. For example, some cases may be due to a rare genetic mutation – but there could be a number of mutations that can lead to ASD (not just one identified disease gene) making the idea of genetic engineering more challenging. The majority of ASD cases may reflect a complex mix of genetic and environmental influences – and the latest statistical modeling suggests that the genetic contribution to ASD may not be as strong as previously thought (and that the role of the environment may be more pronounced). For those situations, the idea of using genetic engineering is even more murky, because there may be many genes involved and they probably interact with a variety of environmental factors. All of this is not to say that genetics won’t lead to possible biological therapeutics – rather it’s to point out that the lure of genetic engineering as a solution may not be the avenue that will be pursued.
The best evidence to date suggests that ADHD is due to a mix of genetic factors along with the influence of a number of environmental factors. As discussed above, this makes the pure application of genetic engineering difficult to imagine. There may a large number of genes involved, each of which may only have a small effect on the likelihood of developing ADHD – which, simply put, would make it very difficult to know what genes to target. Again, it’s tough to predict where genetic research will go, but while it may certainly lead to improved treatments over time for ADHD, it’s tough to see the role of genetic engineering.
You’re starting to see a pattern here. Like ADHD, depression is also thought to be influenced by many genes as well as the environment. As discussed above, this constellation of risk factors does not suggest that genetic engineering will be a factor any time soon.
Conduct Disorder (CD)
This is the same deal as the case for ADHD and depression – and it may be that the environment plays an even stronger role in the etiology of CD.
The idea of genetic engineering is provocative. But the reality may be far in the future for most childhood psychiatric disorders – and in many cases it may not be the way in which genetic research gets translated into prevention and intervention.
Molecular Biology Test via Shutterstock.com
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Sunday, December 30th, 2012
Two themes stand out for me this year with respect to research on ADHD:
Diagnosis: We continued to observe a potential paradox – ADHD may be overdiagnosed, yet many kids do not receive proper diagnosis and care. Here’s why. The overdiagnosis aspect comes about because kids are given a label of ADHD without going through a rigorous interdisciplinary evaluation. And that’s where some kids slip through the cracks – some kids with severe symptoms do not get evaluated properly and struggle for years without appropriate intervention. So even though studies suggest that the rate of ADHD is very high (like some of the data reported by the Centers for Disease Control and Prevention), that does not translate into saying that all kids who may suffer from high levels of severity and impairment are getting the clinical services they need.
Treatment: The debate about using medications to treat ADHD got more extreme this year. A controversial opinion piece by a leading developmental researcher essentially negated the role of biology as a root cause of ADHD. On the other side of the issue, there were suggestions that kids as young as 4 years of age should start receiving medications to control their symptoms – and there were reports that in some (economically disadvantaged) areas of the country doctors are giving kids ADHD medication (without assessment and diagnosis) to try to improve their behavior and performance in school. Lost in the debate is the very real need for behavioral treatments that focus on parental strategies to help kids with ADHD function better both at home and in school. My viewpoint on all this continues to be that behavioral approaches should be tried first and should always be in place – and that once those effects are established clinicians and parents can have a more meaningful dialogue about the possible additional advantages of medication.
Time For Review via Shutterstock.com
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Wednesday, November 28th, 2012
This will be brief.
There continues to be loads of information on the role of genetics on behavioral/emotional/developmental disorders. This pace will continue. But the big picture for parents can be elusive. So here is a primer.
Some disorders are “genetic” in the classic sense—meaning they primarily have a genetic foundation. They tend to be very rare and distinctive. Examples are Fragile-X syndrome, and Down syndrome.
That said, most disorders these days are assumed to be “complex”—meaning that they arise from a combination of risk factors, both genetic and non-genetic in origin. In many cases, there may not be “one” definitive etiology but rather a range of causes that can vary from kid to kid. For example, it is believed that some cases of autism are due to rare genetic mutations (some of which may be associated with paternal age). But this type of causation may only account for a small fraction of the cases in the population. There may be a number of genes (some suggest it could be in the hundreds) that convey some level of risk for autism. And for these cases, the environment can also be a potent influence, as evidenced by recent twin studies. That said, the actual environmental factors remain elusive.
This idea of “complex” causation probably applies to the vast majority of behavioral/emotional/developmental disorders. ADHD is believed to be highly heritable—but there are no genetic markers that distinguish normative levels of inattention and hyperactivity from problematic ones. And just because ADHD is heritable, that doesn’t mean that the environment doesn’t matter. Biological environments (such as prenatal exposures) may play a role. The psychosocial environment is also very important in terms of shaping how ADHD gets expressed. In the case of “complex” disorders, genetics is often described as influencing “what is,” but not “what can be”—which is another way of saying that psychosocial interventions can be powerful approaches for altering behaviors that are “genetic” in origin.
We’ve learned a lot about genetics over the past few decades. We will continue to learn even more. But the reality right now is that, with the exception of rare “genetic” disorders, there is still more unknown than known about the role that genes play in the evolution of behavioral/emotional/developmental disorders. What we do know, though, is that environment matters. So whether we are talking about autism or ADHD or conduct problems or other issues, a parent’s best line of action is to get reputable psychosocial interventions that have been shown to work. Remember, genetics is, more times than not, more about “what is” rather than “what can be.”
Lab Experiment via Shutterstock.com
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