Final Installment On the ADHD Article by By Rahil R. Jummani, MD, highly edited.
My opinions and comments are in italics. For what they’re worth.
Prevalence estimates have been increasing, with a prevalence in US children of over 8% now and 4% in adults. However, prevalence estimates of ADHD remained static for older adolescents and decreased for children who were multiracial or of other races. Because?
Of those diagnosed, 69% were treated with medication—6.1% of US children.
There seems to be a generally increasing prevalence of ADHD in the US. This upward trend may reflect better public and medical education and awareness of the disorder, increasing recognition of the inattentive subtype, environmental factors such as pollution, prematurity, and food additives, although no clear relationships have been established. This will not, however, stop some people from having very definite opinions.
Methodological and criteria changes may also contribute.
There are also realistic concerns that the increasing prevalence of ADHD may be artificial and reflect poor diagnostic practices and that treatment that is increasingly reliant on medication. When child and adolescent psychiatrists evaluate children, they are less likely to initiate medication management immediately upon diagnosing ADHD. But child and adolescent psychiatrists represent a small percentage of clinicians, and the vast majority of ADHD cases are identified and treated by primary care practitioners.
A study of pediatricians showed significant variability:
• Parent and teacher rating scales were used in only about half of the cases
• DSM criteria were not universally documented
• 93.4% of patients with a diagnosis of ADHD were treated with medication
• Only 13% received any form of psychosocial intervention
Although rating scales are sensitive, they lack specificity, leading to a high false-positive rate for the disorder. Rating scales must therefore be combined with a comprehensive assessment of patients, and in the case of children, their parents.
Obtaining information about symptoms in multiple environments with the use of multiple informants is critical. For example, it is good clinical practice to interview teachers and, at times, conduct observations in the classroom before making a diagnosis. This is ridiculous, given the time pressure on physicians.
Meticulous assessment for ADHD reduces misidentification of the condition when symptoms are caused by another disorder, such as a mood, anxiety, substance use, learning, or disruptive behavior disorder. Conditions that frequently co-occur with ADHD must be a focus of treatment as well.
All true, but of equal concern is the number of undiagnosed and untreated children and adults who suffer from ADHD.