Is Medication the Answer to America’s ADHD Epidemic?

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ImageAccording to the CDC the number of children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) in the United States has increased steadily since 1997. In 2007, parents reported that almost 10% of all children ages 4-17 had an ADHD diagnosis, which is a 22% increase from just 4 years earlier in 2003. It is unknown whether this is due to an actual increase in ADHD incidence, or more diagnoses due to changing definitions of the disorder and better diagnostic tests. Regardless, ADHD is a significant problem facing America’s children today and parents are desperate to find a treatment that will enable their child to lead a normal life.

Medication is by far the most commonly used treatment for ADHD in children in the United States, with it being prescribed more often in older children (ages 11-17) and boys compared to girls.

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Percent of children aged 4-17 years with a reported diagnosis of ADHD currently taking medication for ADHD by state: United States, 2007-2008

However, the National Institute of Mental Health recommends the use of psychosocial methods such as behavioral therapy, social skills training, support groups, and parent/educator training before trying pharmaceutical approaches. Unfortunately, these alternative treatments are more time consuming and demanding of resources both in the home and the academic setting and are often dismissed when medication alone is able to treat the problem.

The rise in medication of children and adolescents has also lead to an increase in medication diversion, or ADHD medication misuse by people without an ADHD diagnosis. Its ability to enhance concentration and academic performance makes ADHD medication desirable to non-ADHD students. Additionally, the high prevalence of ADHD among their classmates and friend makes these pills very accessible.

There is no question that ADHD medication has positively changed the lives of many American children struggling with ADHD. However, medication alone is not sufficient and time and attention must be paid to ensure accurate diagnosis and dosage in each and every case, and to help prevent medication abuse.

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8 Responses to “Is Medication the Answer to America’s ADHD Epidemic?”

  1. sdennis76 Says:

    I agree this is a very important issue and medication diversion among teens and older adolescents is going to be an even greater issue in the coming decades. As a family physician I often have have young people in their 20s wanting to restart the medication they used as children. This creates a dilemma for me as I am aware of the potential for abuse and diversion.

    One potential barrier to non-medical treatment is the shortages of child psychiatrists. Behavioral health teams in school clinics could be a ways to help children access these therapies.

  2. ymc0214 Says:

    Thanks for your interesting post. I agree with sdennis76 that shortage of child psychiatrist is a potential barrier to behavioural therapy and other non-medication management. Another potential barrier is time required for parents to attend to these sessions with their children. ADHD requires rather long-term therapy, and parents will need to make commitments for it to be effective. With such high prevalence of ADHD in schools, maybe it would be worthwhile for a school to invest in inviting counsellors for after school sessions or group therapies.
    On the other hand, preventing medication diversion is still a tricky issue. Perhaps more strict repeat prescription rules can apply so that children/young adults cannot get repeat prescription unless they run out of the medications (taking into account their dose and number of days since last prescription).

  3. dc777 Says:

    totally agree. IN Australia, we face a similar problem where there is a shortage of available psychotherapists.

    some parents I speak to in my line of work also view medication as a quick fix “magic pill” approach to solving the behavioral issues associated with ADHD, when in fact a multifactorial approach is needed.

    the problem of being lost to follow-up can also be an issue. many a time after the first diagnosis/assessment is complete, patient’s can sometimes fail to attend subsequent appointments, and continue on the medication without any rationalization or alteration for the foreseeable future – which clearly is not ideal.

  4. omsdeux Says:

    Thanks for the interesting story – I am in agreement with your point of view. The problem seems to garner increasing attention regarding its growth and prominence in the U.S., however with less emphasis on causality. While medical intervention provides short term answer, the U.S. healthcare system does not seem to be focused on the longer term problem. I am not a physician, however i wonder if the criteria for diagnosis should also be revisited?

  5. jagoldbe Says:

    Thank you for posting this – I am in 100% agreement that medication is not the answer for this problem. As an Emergency Physician, I see many parents who bring their children for behavioral outbursts due to their “ADHD.” I acknowledge that there is a true ADHD diagnosis, and that many new cases are identified simply through better recognition and diagnostics. However, there is a large population that is classified as “ADHD” because parents require a diagnosis for their badly behaved children, and physicians are reluctant to point out that parenting itself is the problem. Many of these children do NOT require medications or psychotherapy, and when they fail these modalities, parents blame drugs or the system rather than themselves. The financial burden that these children have on the healthcare system is enormous. That being said, I have several adult friends that have true ADHD, and without medications, they are not able to function in daily life.

  6. lmeller2013 Says:

    Hello,
    Thank you for the very interesting post,

    My main concern with ADHD and medical treatment is that boys/young men especially African American are over-diagnosed. My question would be why the increase in diagnosis, I would agree awareness has increased,

    Could it be that very active boys are a variant of normal, but do not function well in this environment

    Could it be that boys need a different type of environment for learning? Should school for some boys be more physically active? Should school for boys be more individualized, perhaps not everyone is meant to sit in a chair for 8 hours?

  7. oluakinlaja Says:

    Thank you for this insightful and interesting post on ADHD, which is often a life changing disorder to both the patient and their family.

    As stated in the original post, there has been a significant increase in the diagnosis of ADHD over the past decade, which could be attributed to its changing diagnostic criteria and perhaps the increase in its actual incidence.
    Again as stated in the original blog, the often preferred form of intervention for ADHD in the US, at this time is essentially pharmacotherapy with the unintended negative consequence of medication diversion, addiction and overdose.

    Efforts should be made to incorporate the recommendation of the National Institute of Mental Health, by initiating other psychosocial alternatives to treatment and possibly evaluating its success prior to prescribing medication.

    I recommend that:

    – Needed resources to facilitate the use of psychosocial alternatives be made more readily available and accessible for the treatment of ADHD.

    -Research continues, as Imeller2013 has hit on areas worth exploring, such as the racial and sexual disparity in the diagnosis of ADHD as well as the need for environmental adaptation such as allotting and increasing time for physical activity, etc.

  8. jhmoon1 Says:

    Thanks for sharing very interesting post. I really enjoyed reading. In South Korea, we are also facing similar issues on ADHD drugs. On of my close friend who is teacher of elementary school says these days seeing the 1-2 students having ADHD in her class is no more a rare occasion. Her question to me was she sometimes don’t know they really in need of medication. I found interesting news from washington post, (http://www.washingtonpost.com/wp-dyn/content/article/2006/02/24/AR2006022401773.html) and it saids in US there are more than 7 million people who are abusing the ADHD drug for their unproper use. Moreover, 75,000 people are showing symtoms of addiction. This is truely a problem and efforts should be made in national level.

    As you mentioned above, the drug is truely helpful for kid who really in needs of drug however, unproper use or abuse should be eliminated from our society. Moreover, dependece only on drug should be changed for ADHD which can be alleviated from psychosocial interventions such as behavioral therapy, social skills training, support groups, and parent/educator training before trying pharmaceutical approaches. Building several education centers for children or their family in the community can be an alternative solution. With many people which is not related to their school or grades, they can learn how interact with people, how to relax, how to solve problems with others. Also, I believe more goverment regulations for the use of ADHD drug should be prepared to prevent addiction and large societal campaign to increase public awareness also can be considered.

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