Study: Broad ADHD Definition May Lead to Unneeded Drug Therapy

Scientists say that a broader definition for attention deficit hyperactivity disorder (ADHD) has led to inappropriate diagnosis and unneeded, potentially dangerous medical treatment that has led to some $500 million in costs in the United States.

With less constrictive criteria for ADHD diagnosis, a steep rise in diagnosis—specifically in pediatric patients—and use of related medications, is being seen, according to Rae Thomas, senior researcher at Bond University in Australia, according to Reuters. Thomas said that the looser definition “devalues the diagnosis in those with serious problems.” Thomas led the analysis, which has been published in the British Medical Journal (BMJ).

“The broadening of the diagnostic criteria is likely to increase what is already a significant concern about over-diagnosis,” said Thomas. “It risks resulting in a diagnosis of ADHD being regarded with skepticism, to the harm of those with severe problems who unquestionably need sensitive, skilled specialist help and support,” he added, Reuters reported.

ADHD is a disorder under the larger Autism Spectrum Disorder (ASD) that includes autism; Asperger’s syndrome; and pervasive developmental disorder, not otherwise specified, and involves issues with social interaction, verbal and nonverbal communication, and repetitive behaviors. ADHD is a neurobiological development disorder that is generally characterized with hyperactivity and some attentional problems, with behaviors typically occurring together and presenting themselves before the age of seven. The National Institutes of Health (NIMH) describes ADHD as involving difficulty staying focused, paying attention, and controlling behavior, and with hyper- or over-activity.

Individuals diagnosed with ADHD suffer from severe restlessness, impulsiveness, and being easily distracted; children diagnosed with ADHD often have problems in school. ADHD is frequently diagnosed in boys and can continue into adulthood, according to Reuters. There is no cure for ADHD; however, some symptoms can be controlled with a collaboration of behavioral and drug therapy.

“I suspect that the reason for increased prescriptions of Ritalin and similar medications for ADHD has to do with better detection of the condition in children and the recognition that 50 percent or more of children with ADHD still have it as an adult,” said Barbara Sahakian, a professor of clinical Neuropsychology at the University of Cambridge, who was not involved in the research, Reuters reported.

Ilina Singh, an ADHD expert at King’s College London, England, cautioned that “it is important to take care when making generalized claims about the drivers of ADHD diagnosis,” adding that, “In many regions, under-diagnosis and under-treatment of ADHD are also a significant concern,” she said, according to Reuters.

An ADHD diagnosis involves ensuring that patients meet criteria set out in either the International Classification of Diseases (ICD) or the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), Reuters explained. Both diagnostic tools are used worldwide in the categorization of mental disorders.

The team pointed out that ADHD definitions have expanded with each new edition of the DSM, which has led to an increased number of diagnoses, according to Reuters. In Australia, a 73 percent increase has been seen use of ADHD medication from 2000 to 2011; prescriptions in Great Britain increased two-fold in children and teens and four-fold in adults between 2003 and 2008, according to Reuters. In the Netherlands, between 2003 and 2007, prescribing rates for children diagnosed with ADHD increased two-fold.

Prescriptions for methylphenidates and amphetamines—the two drug types used in ADHD management—have risen consistently in the United States between 1996 and 2008, according to the researchers. The greatest increase has been seen in teens, 13 to 18 years of age, Reuters  reported.