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Sunday, March 9, 2014

ADHD: Overdiagnosed and Inappropriately Treated?

From Smart Kids with LD

March 4, 2014

In a recent Huff Post Science blog post, ADHD researcher Dr. Keith Connors, psychologist and professor emeritus at Duke University added his voice to a growing chorus of experts questioning the rapid rise in ADHD diagnoses in the past 15 years.

Dr. Connors first raised the red flag several weeks ago in The New York Times, in an article entitled “The Selling of Attention Deficit Disorder.” In that piece, he made the case that the rise in ADHD diagnoses paralleled “a remarkably successful two-decade campaign by pharmaceutical companies to publicize the syndrome and promote the pills to doctors, educators and parents.” That phenomenon coincided with the results of a large study that suggested medications were the most effective treatment for ADHD.

The Huff Post revisits the controversial topic, clarifying Dr. Connors’ position, in which he suggests a middle ground between those who say ADHD is a manufactured disease, and those who say it’s at epidemic levels:

Both extremes are wrong. The high numbers do not reflect clinically meaningful ADHD. But the idea that ADHD should never be diagnosed and treated misses the clinical reality that some kids have an early onset of severely impairing symptoms that do require diagnosis and do respond well to treatment.

The ridiculous epidemic-like level is most surely a mistaken exaggeration caused by careless neglect of differential diagnosis. Doctors are prescribing stimulant drugs for a hodgepodge of childhood disorders and for basically normal kids who happen to be on the active and distractible side of the spectrum…

What therefore, should the public conclude about the “diagnosis” of ADHD?

First, there is no doubt that 2% or 3% of children and adolescents suffer from a serious and treatable disorder, for whom medication or CBT [Cognitive Behavioral Therapy] or both is required to avoid the serious lifetime impairments.

Second, no child should be diagnosed with ADHD without a thorough clinical assessment that includes self-report by the child or adolescent, a family psychiatric history, and developmental history of the child. Reports from teachers are essential and represent one of the most neglected sources of information in ordinary pediatric practice. Treatment almost always requires working together on school-related problems.

Third, it is apparent that the DSM’s are part of the diagnostic problem, providing definitions that are too loose and insufficient guidance to the practitioner on how to make a proper diagnosis.

Finally, the public should be skeptical both of the diagnostic enthusiasts who see ADHD everywhere and the diagnostic nihilists who see it nowhere.

Where Does This Leave You?

For those who suspect their child needs treatment for ADHD, Dr. Connors suggests seeking out a specialist with a record of extensive care for patients with ADHD. He reminds us that most prescriptions for ADHD medications come from pediatricians, many of whom do not “specialize in developmental behavior problems.”

He further recommends checking credentials, as well as asking about the evaluation process. “Do not accept cursory, brief examinations that do not involve a complete picture of family environment, school, and development from an early age.”

For those who have children taking ADHD medication, but still experiencing challenges in school, at home, or with peers, Dr. Connors suggests checking and adjusting medications and getting help in the areas your child is floundering in (e.g. academics or social skills).

The bottom line? Dr. Connors maintains that parents who are well informed about the condition are in the best position to evaluate if their child’s ADHD diagnosis is valid, and if so, to help manage the condition effectively.

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