Why has the number of diagnosed ADHD patients in the United States increased by over 4.2 million within the past decade? Could the change be caused by our increasing use of technology, our genetics, or just the pharmaceutical companies’ greed? In an article published in the British Medical Journal last week, scientists suggest that perhaps a mix of all these factors contribute to the increased prevalence of ADHD. However, the scientists do warn that the increase in diagnoses might be misleading because of the “risk of confusing ADHD with normal development processes, such as pubertal restlessness and distractibility.” Because there is not enough research about the long-term effects of powerful ADHD medications, doctors should be more hesitant before diagnosing patients with just mild traces of ADHD symptoms.
ADHD or Attention Deficit Hyperactivity Disorder is a mental disorder, predominantly found in adolescents, which causes frequent impulses of hyperactivity and difficulty with focusing for extended periods of time. While doctors know that the condition affects the part of our brain responsible for self-regulation and management, they are unsure what causes the disorder. Over eleven percent of students under the age of 18 currently have ADHD; however, scientists predict that each year 320 to 500 million dollars are inappropriately spent on medication. Less than fourteen percent of diagnosed patients are considered to have “severe” cases of the disorder; researchers for the British Medical Journal believe that “severe cases of ADHD are obvious, but in mild and moderate cases — which constitute the bulk of all ADHD diagnoses — subjective opinions of clinicians differ.”
A recent expansion of ADHD’s classification may also fuel the subjectivity and increase in its identification. Earlier this year, the Diagnostic and Statistical Manual of Mental Disorders, sometimes known as the “Bible of Psychiatry,” loosened its previous definition of ADHD. Researchers from the British Medical Journal state that “the latest edition [to this manual] — DSM-5… has widened the definition of ADHD in several ways, by including, for example, more behaviors that qualify as symptoms and by increasing the maximum age of the onset of symptoms from 7 to 12 years.” They are concerned that the loosening of this definition will soon lead to a fifteen percent increase in diagnoses.
However, more troubling than the diagnoses is the medication children are given to control the disorder. Eighty-seven percent of diagnosed Americans are usually prescribed either Ritalin or Adderall; both of these medications were created in the 20th century to treat “severe” cases. Because patients’ brains have trouble releasing dopamine, a chemical that promotes motivation, memory, and focus, these drugs increase the brain’s receptivity to the chemical, in hopes of helping patients cope with their symptoms. Both Ritalin and Adderall can cause liver toxicity, weight loss, issues with sleep, mood swings, thoughts of suicide, and sometimes interference with growth. The increased feelings of productivity and focus can be effective, but dangerous. Clinician Sara Jones from Wake Forest University of Medicine conducted a study on the effect of Ritalin on rats and found that “[the reported abuse of ADHD medication] is more dangerous than generally believed.” Students who take the drug risk the possibility of growing addicted to the good feelings triggered by dopamine and may desire more powerful and dangerous drugs.
Although the number of prescribed medication users increases, scientists like Ilinah Singh from King’s College London believe a lack of diagnoses in certain regions may be a liability too; Singh asserts that “in many regions, under-diagnosis and under-treatment of ADHD are also a significant concern.” Failing to diagnose a child could risk the possibility of them struggling inside and outside of school and setting them on a course that could be easily corrected with treatment. Some experts believe that the increase in diagnoses leads to several benefits: teachers do not have to deal with noisy and unproductive classrooms, physicians can treat patients both efficiently and effectively with medication, and patients may have less struggles at home.
Perhaps certain regions in the U.S. are under diagnosed. California, for example, has a diagnosis rate that is a mere one third of the rate in North Carolina. However, the risks of giving too many patients strong medication outweigh the benefits to the pharmaceutical industry and physicians. It is unjust for students to be prescribed medication that could potentially cause long-term health issues or addiction to other drugs, just for the sake of improving their grades and their productivity. It is fine for doctors to continue diagnosing ADHD, but not to give drugs to patients with “mild” or “minor” cases. Until doctors either come up with an unambiguous definition for the disorder or prescribe medication more cautiously, parents should be wary when choosing to give their children Ritalin and Adderall.
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