ADHD may be overdiagnosed, study says
September 1, 1999
Web posted at: 1:42 p.m. EDT (1742 GMT)
(CNN) -- A recent study says attention deficit hyperactivity disorder, or ADHD, may be overdiagnosed, and the drug used to treat the condition may be overprescribed.
Nearly 6 percent of the school-age population in the United States has been diagnosed with ADHD, a condition characterized by impulsive behavior and difficulties in paying attention and keeping still.
Approximately 90 percent of patients with ADHD take the drug Ritalin.
Ritalin, or methylphenidate, is a mild central nervous system stimulant. It boosts the brain's ability to control impulsive behavior and helps children concentrate.
In recent years there have been reports of heavy Ritalin use in various communities around the country, but until this latest study it was only speculation.
Pediatric psychologist Gretchen LeFever became concerned when she was suddenly inundated with ADHD referrals. She worried that the disorder was being overdiagnosed and began a study of 30,000 grade-school students in two school districts in Virginia.
"What we found was that in our region of Virginia, the prevalence of children getting a dose of ADHD medication during the school day was two to three times the national estimate of the disorder," LeFever said.
In her study, published in the American Journal of Public Health, LeFever found the number of children medicated in school for ADHD was 17 percent for white boys, 9 percent for African-American boys, 7 percent for white girls and 3 percent for African-American girls.
"And we have reason to believe that there are other regions that probably look more like we do than the national estimates," LeFever said.
The study raises many questions about ADHD diagnosis but provides few answers. Were previous estimates too low? Is ADHD being overdiagnosed, or are doctors now doing a better job of diagnosing it?
"Certainly no one has found the prevalence of Ritalin use to be this high up until now," said Xavier Castellanos of the National Institute of Mental Health.
Castellanos said that based on LeFever's study, he is encouraging other communities to study their rates of Ritalin use in school-aged children.
"There is Ritalin that's being used in high proportions in some communities, and we need to know more about other communities, and we need to find out whether it's appropriate or not," Castellanos said.
Once on the drug, children with ADHD usually perform better in school and relate better to family and friends.
But some child care experts believe problems are associated with the drug.
Dr. Mary Ann Block is the author of "No More Ritalin." She refers to the drug as "kiddie cocaine" and contends it can cause dangerous behavior.
"These drugs are mind-altering drugs. And in the case of Ritalin, it's a drug almost identical to cocaine -- goes to the same receptor site in the brain, causes the same high when taken in the same manner," Block said.
But doctors who prescribe Ritalin said it is safe when taken under close supervision and does not have long-term effects even if started at a very young age.
"After 60 years of using stimulants in children and 40 years of using Ritalin, I think we have a pretty good track record of safety in children," Dr. Lawrence Diller said.
Because Ritalin is a stimulant, the American Heart Association has recommended children be evaluated for heart problems before starting the medication. ADHD should not be diagnosed without a thorough medical, behavior and educational evaluation.
A diagnosis of ADHD is a way of identifying children who are at risk for school failure, but experts warn that parents should be sure their child's diagnosis is correct.
Medical Correspondents Rhonda Rowland and Dr. Steve Salvatore contributed to this report.
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American Journal of Public Health
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