Posts Tagged ‘ New York Times ’

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

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“Meducation”: Giving ADHD Medication To Kids Who Are Struggling In School (But Not Diagnosed)

Friday, October 12th, 2012

There is much ongoing conversation about an article in the New York Times which featured a pediatrician who reports giving kids who are struggling in school Adderall – which is prescribed for kids with ADHD –  without first diagnosing them with ADHD. His rationale is that he does this for kids who are in low-income families who do not get sufficient support for their academic development or for services to help them if they have problems. He notes that this is a short-cut he takes because he knows that society, overall, does not invest nearly enough resources into giving kids the proper social and academic resources they should get. This practice was aptly captured by Stephen Colbert who coined the term “meducation” to refer to this practice of giving pills to kids to improve their school performance. 

A lot can be said about this (and much has been already written). I’ll make three points.

First, it’s dangerous practice to give kids medication for anything unless a clinician goes through the proper steps to make a meaningful clinical diagnosis. For ADHD, there is a series of steps which include:

  • gathering information from a number of sources, including parents, teachers, and sometimes the kids themselves (because kids with ADHD don’t just show problems in school or in home – the problems should appear across a number of contexts)
  • using that information to consider a diagnosis in relation to the standard criteria (it’s not just a subjective impression)
  • assessing symptoms of a number of other conditions such as anxiety, sleep problems, and learning problems like dyslexia (because symptoms of ADHD can be seen in kids with a number of other clinical conditions)

Without taking these steps, it’s just not acceptable practice to make a diagnosis. It would be like seeing that a kid is sneezing and has a runny rose and assuming they have the flu. Now it’s acknowledged that we don’t have biological markers that allow us to diagnose ADHD – it’s a behavioral syndrome. But ensuring that a kid meets the criteria that have been established is the best available way of identifying kids who could greatly profit from intervention – and it’s also a way to make sure a kid isn’t just slapped with a label without going through a rigorous diagnostic process.

Second, even when a child is diagnosed with ADHD, it is not a given that they will go on medication. A number of behavioral methods are available and should always be considered (and in my opinion used). And when a decision is made to go on a medication, the dosage, potential side effects, and impact on symptoms needs to be tracked carefully and consistently. Drugs like Adderall can be used safely but only with sufficient monitoring.

Third, giving kids medications to try to solve social problems is just not right. We shouldn’t be messing around with kids’ biology to circumvent the lack of adequate resources, overcrowding of classrooms, and the multitude of other factors that can undermine a kid’s academic progress. These are, without question, very hard problems to solve. But rather than giving kids pills, it’s interesting to note that Paul Tough’s new book begins to explore the utility of giving kids psychological boosts via social initiatives that may turn out to have real educational advantages.

There are kids in the world who have the severe level of symptoms that are consistent with a diagnosis of ADHD. I would guess that it’s about 2% of school-aged kids (prevalence estimates land somewhere around 9%, but estimates of kids with severe levels of symptoms are typically less than 2%). Routinely treating kids who suffer from social disadvantage with a medication that should be reserved for kids with the most severe symptoms is just not the solution anyone is looking for.

ADHD via Shutterstock.com

 

 

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Autism And The Immune System: What’s The Take-Home Message For Parents?

Friday, August 31st, 2012

Last week, an essay was published in the New York Times describing the hypothesis that one of the causes of autism involves a dysfunction in the immune system. In this opinion piece, autism was described as an inflammatory disease that starts during gestation (in the womb). The author speculated that 1 in 3 cases of autism may be due to mechanisms relating to problems with the immune system. 

This line of research is certainly being pursued. Autism Speaks, for example, published a news report in response to the opinion piece, in which they discussed how they have, and continue, to support research that examines the role of the immune system as one of the pathways that may influence the development of autism. That said, they make two very important points:

1) Researchers disagree on the extent to which immune system dysfunction actually is a cause of autism – it may be that the immune system responds to brain and developmental changes that are due to other causes

2) There is currently no evidence that treatments for autism that are rooted in treating an immune system dysfunction are effective – though some are under study

I would add the following:

3) There is no definitive evidence that 1 in 3 cases in autism is due to immune system dysfunction, and as of now there are no diagnostic tests that would screen for this with precision

It’s important that science gets discussed in the popular press, and that parents have an opportunity to become informed on the latest thinking and research. However, opinion pieces – like the one in the New York Times – should (in my own opinion) present a more balanced viewpoint that accurately assesses the landscape (including divergent or more tempered opinions) and the real implications for parents right now. Without that, parents who read these pieces may come away with take-home messages that are not really accurate.

Having a child who has been diagnosed with autism changes a parent’s life. Theories come and theories go – and the realities of the difficulty in elucidating the causes of autism persist. When introducing relatively new ideas into the mainstream, I would hope that authors would exercise more caution with their viewpoints, and understand that, in the end, parents just want to know where things really stand – with more grounding and less hyperbole.

Immune system background via Shutterstock.com

 

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