View Full Version : Salon: Is ADHD Actually undertreated?


APSJ
05-01-13, 08:24 PM
Just came across this article, which seems an informative and fairly balanced piece on the ADHD diagnosis 'controversy':

I think this is particularly good information to have out there to counter some of the irresponsible reporting on this subject:

Many media sources report that stimulants have been widely prescribed for children without ADHD. As Dutch pharmacologist Willemijn Meijer of PHARMO Institute in Utrecht and his colleagues observed in a 2009 review, stimulant prescriptions for children in the U.S. rose from 2.8 to 4.4 percent between 2000 and 2005. Yet most data suggest that ADHD is undertreated, at least if one assumes that children with this diagnosis should receive stimulants. Psychiatrist Peter Jensen, then at Columbia University, noted in a 2000 article that data from the mid-1990s demonstrated that although about three million children in the U.S. met criteria for ADHD, only two million received a stimulant prescription from a doctor.


The perception that stimulants are overprescribed and overused probably has a kernel of truth, however. Data collected in 1999 by psychologist Gretchen LeFever, then at Eastern Virginia Medical School, point to geographical pockets of overprescription. In southern Virginia, 8 to 10 percent of children in the second through fifth grades received stimulant treatment compared with the 5 percent of children in that region who would be expected to meet criteria for ADHD.
http://www.salon.com/2013/05/01/is_adhd_actually_undertreated_partner/singleton/

The overdiagnosis vs. underdiangosis discussion often seems to proceed as an either or proposition, when in truth, it's likely both are happening, even if underdiagnosis remains the general trend.

Also, I've taken methylphenidate for close to twenty years, and never knew this:

Published reports of using stimulants for ADHD date to 1938. But in 1944 chemist Leandro Panizzon, working for Ciba, the predecessor of Novartis, synthesized a stimulant drug that he named in honor of his wife, Marguerite, whose nickname was Rita.

mctavish23
05-04-13, 08:32 PM
Thank You for this.

It's actually underdiagnosed.


u r welcome :cool:

1Buster
05-04-13, 10:19 PM
It's is certainly underdiagnosed in the sense that a lot of kids have it but not recognized as ADHD by the adults around them, particularly the girls who usually have less of the hyperactivity that makes it more obvious in boys.

Also, it's not as if this condition has just popped up 20-25 years ago or so when it started being reported in the media. Guess what, one of the reasons there are so many more people overall being treated is because the parents of kids with ADHD, like me, have realized we've been suffering with it all out lives.

However, I think it's being "over-treated" in the sense that some kids without it are getting meds, either because of lazy teachers or more suspect reasons. In fact, there's a brewing controversy about some docs "diagnosing" underprivileged kids with ADHD just to get them stimulant meds to help them concentrate better in school. That worries me - giving kids amphetamines whose brains don't need them to think "normally."

Donjohn8
05-18-13, 01:32 PM
All drugs have pernicious side effects and Adderall is no exception. From sleep disorders, impotency, ravaged teeth, and self-delusion, its downside can only be justified by the realization one does not operate well enough in society without it. Kudos to those who can minimally medicate, who can get by with diet changes and coaching.

Have sympathy for those of us who can't.

Reserve your contempt for those who advocate widespread use among children, thereby maximizing profits without concern for deleterious long-term effects. Does this not amount to child abuse?

Bethylphenidate
08-22-13, 01:08 AM
If I could take a wild, uneducated guess...

I'd say that ADHD is highly misdiagnosed.

Fraser_0762
08-22-13, 01:18 AM
If I could take a wild, uneducated guess...

I'd say that ADHD is highly misdiagnosed.

Agreed.

It's vastly over-treated. The increase in stimulant prescriptions year on year is insane. It's no wonder there are shortages.

The pharmaceutical companies will be happy though...

Bethylphenidate
08-22-13, 01:38 AM
Agreed.

It's vastly over-treated. The increase in stimulant prescriptions year on year is insane. It's no wonder there are shortages.

The pharmaceutical companies will be happy though...

Indeed. It is vastly over-treated. Big Pharma probably isn't deeply disheartened that some random Joe Schmoe isn't getting his (legitimately needed) medication, because Susie Snoozie and her friends wanted some "uppers." As far as they are concerned, there is a spike in sales, and that's what's important. Well, that's what's most important; I'm sure it makes someone somewhat happy that someone is getting actual help from their medications.

Further, I think there are a lot of reasons for the vast misdiagnoses (e.g. that so much about ADHD is unknown, societal misconceptions and stereotypes reinforced by people with ADHD alike, etc.). Mental health professionals... parents of children with ADHD... adult patients (with and without ADHD)... society... all of us, in some way, could be accountable.

But even still... misdiagnosis is just gonna happen, 'cause again, ADHD is "confusing" in itself.

Dizfriz
08-22-13, 08:34 AM
Agreed.

It's vastly over-treated. And you know this how?


The increase in stimulant prescriptions year on year is insane. It's no wonder there are shortages. And you know this is a problem how?

It is easy to make statements like this, it is another to back them up. As a note, did your read the Salon article linked to?

Dizfriz

Lunacie
08-22-13, 08:48 AM
All drugs have pernicious side effects and Adderall is no exception. From sleep disorders, impotency, ravaged teeth, and self-delusion, its downside can only be justified by the realization one does not operate well enough in society without it. Kudos to those who can minimally medicate, who can get by with diet changes and coaching.

Have sympathy for those of us who can't.

Reserve your contempt for those who advocate widespread use among children, thereby maximizing profits without concern for deleterious long-term effects. Does this not amount to child abuse?

Wha... :scratch: Those sound like problems from abusing the meds (taking too
much too often) rather than side effects. If side effects are that troublesome,
one should try changing the dose or try a different medication entirely.


And you know this how?


And you know this is a problem how?

It is easy to make statements like this, it is another to back them up. As a note, did your read the Salon article linked to?

Dizfriz

Everything I've read indicates that only about half of the people diagnosed
with ADHD take stimulant meds to treat it. Perhaps because of unwanted side
effects or because of fear of problems like Donjohn8 posted.

And, until we have more precise ways of testing and diagnosing, mental
health issues like ADHD and Bipolar will be somewhat mis-diagnosed.
However, I don't see any indications that either is highly mis-diagnosed. :eyebrow:

Dizfriz
08-22-13, 08:52 AM
If I could take a wild, uneducated guess...

I'd say that ADHD is highly misdiagnosed.

I can understand why you might feel this way with some of the news articles out there saying this.

This is not a simple issue and there is some controversy involved but when you actually look at the statistics, ADHD is probably underdiagnosed especially in girls. One of the reasons is that many ADHD kids, again especially girls, are not assessed for the disorder.

On the question of under or over treated, did you read the Solon article from the OP?

Most of the research indicates that overall, ADHD is undertreated if anything.

Dizfriz

Fraser_0762
08-22-13, 08:54 AM
And you know this how?


And you know this is a problem how?

It is easy to make statements like this, it is another to back them up. As a note, did your read the Salon article linked to?

Dizfriz

All you have to do is look at the statistics. The increase in ADHD diagnosis steadily increases year after year.

I estimate that around 1/3 of Americans and Brits will be diagnosed with the disorder within the next 10 years.

Does that seem right to you?

SB_UK
08-22-13, 08:55 AM
According to many critics, such overdiagnosis raises the specter of medicalizing largely normal behavior and relying too heavily on pills rather than skills—such as teaching children better ways of coping with stress (http://www.scientificamerican.com/topic.cfm?id=stress).

stress stress stress

Dizfriz
08-22-13, 09:08 AM
All you have to do is look at the statistics. The increase in ADHD diagnosis steadily increases year after year.

I estimate that around 1/3 of Americans and Brits will be diagnosed with the disorder within the next 10 years.

Does that seem right to you?
Not even close.

The ADHD diagnosis rate has increased over the years but one of the major considerations is that there is a lot more awareness of the disorder than just a few years ago.

The criteria are set up for about 5-8% of kids to meet diagnostic standard and, with the better studies, that is more or less what we find. (The not so good studies range all over the place)

Again I can understand where someone might think this from some of the sensationalist articles in the news media but in real life-"It ain't necessarily so".

Dizfriz

Amtram
08-22-13, 10:02 AM
The other thing that always pops into my mind when I see articles about this (and I make sure I don't read the comments unless my meds have kicked in, or I'll go ballistic) is that almost never is it mentioned that medications are only part of the treatment. If you want to talk about real undertreatment, look into how many programs there are(n't) for behavioral therapeutic treatments for children and/or educational programs for parents.

Yeah, I know, that's harder to measure because it's not tracked with prescription records or sales figures. But if you check out the Parenting section here, you will see story after story of the difficulty parents have of getting truly effective help for their children through the schools or from their physicians, and their desperation at not being able to figure out how to help their children themselves.

You can get your child into the special ed program - but not all children with ADHD need special ed, or benefit from being in a class with students with a variety of different learning issues. Even if you know your child would benefit, not only do you have to jump through hoops, but try getting the label off once your child is able to function better in school.

The teachers, assistants, and administrators may or may not know anything about ADHD, and therefore be useless in helping you help your child at home. Outside counseling costs money, and I'm afraid that at least here in the US, the best counselors don't work for clinics - or even take insurance.

Autism is being taken more seriously. I think that's because there are enough outwardly visible signs that people can't really pretend it doesn't exist. (High functioning, not so much, but you can't deny non-verbal.) It's also not primarily controlled with medications. As a result, schools that can afford it have a lot more knowledge and support about autism and offer more specialized help and information for parents. People are aware that early intervention is crucial for children with ASD, and many school districts are therefore proactive.

ADHD is still a "fake disorder." The medical treatments are considered recreational substances. People believe that when it comes to discipline and self-regulation, "If I can do it, anyone can." They don't understand that the observable behavior originate from a processing difference in the brain - that people with ADHD simply don't think the way they do.

So doctors prescribe the medications, and the behaviors get better while they're working, and it might help with coping strategies. . .but the kids who need the medications especially need the therapeutic intervention. And their parents need to learn how to help them.

But the meds work well enough that they're a first-line treatment. That's pretty good, but not good enough. ADHD needs early intervention and parental education almost as much as ASD does. If there were more of that, then maybe the number of prescriptions would inch down a bit. Or the number of people with ADHD treating depression and anxiety would decrease.

As long as the public sees articles about ADHD being overtreated or undertreated with the entire focus on how many stimulant prescriptions are being written, the perception of ADHD won't change, and the non-pharmaceutical interventions won't become more available.

Plognark
08-22-13, 03:37 PM
I agree that it's both over and under diagnosed. I think it's a matter of the squeaky wheel getting the grease; any kid who has high energy levels is more likely to get noticed and possibly diagnosed with ADHD, even if something else is going on.

The inattentives, especially girls, get overlooked. I have two friends who, like me, were completely missed for ADHD in spite of abysmal grades, getting held back, never doing homework, and every other warning sign in the book... except hyperactivity. And that's just because we were miserable and wound up withdrawing.

Nonzens
08-22-13, 05:55 PM
The fact that a lot of people probably obtain the diagnosis merely to get the scripts for entertainment and/or final exams/papers purposes surely does not help the levels of misdiagnosis. I do think it's probably misdiagnosed, especially in children. I think that in adults and especially girls/women, it is probably more on the underdiagnosed side.