26 March 2012

ADHD diagnosis rates higher than ever

In the past decade, the number of children receiving a diagnosis of attention-deficit hyperactivity disorder (ADHD) has risen by 66%, new research indicates.


In the past decade, the number of children receiving a diagnosis of attention-deficit hyperactivity disorder (ADHD) has risen by 66%, new research indicates.

In 2000, just 6.2 million physician office visits resulted in a diagnosis of ADHD. By 2010, that number had jumped to 10.4 million office visits.

"This study is really like a 10,000 foot aerial view of this issue," said study author Dr Craig Garfield, an assistant professor of paediatrics and medical social sciences at Northwestern University in Chicago. "We looked at the trends in visits to doctors for ADHD over the last decade, and we were interested in overlaying some of the FDA's public health advisories and the introduction of new medications to see the effect on those trends."

The findings are published in the journal Academic Pediatrics.

Treating ADHD

ADHD is now a common condition in children and teenagers. The parent-reported incidence of the disorder is about 10%, or 5.4 million children in the US. Symptoms of ADHD include an inability to focus, trouble controlling emotions and hyperactive behaviour, according to the National Institute of Mental Health (NIMH).

Treatment for ADHD may include medications - usually stimulant drugs - and behavioural therapies, according to the NIMH. However, new medications - and new health concerns - altered treatment decisions over the decade studied.

In 2002, a nonstimulant medication, Strattera (atomoxetine), was approved for use in ADHD. In 2005, the US Food and Drug Administration issued warnings that sudden death and suicidal thinking had been linked to Strattera. That same year, the FDA also expressed concern about a potential link between amphetamine-dextroamphetamine (Adderall) and cardiovascular risks, as well as adverse psychiatric symptoms. That same warning was extended to all approved ADHD medications in 2007, according to the study.

For their study, Garfield and his colleagues reviewed data from a national database from 2000 to 2010. They examined office visits for patients younger than 18.

In addition to finding a 66% increase in the number of office visits resulting in an ADHD diagnosis, they also found that more children were being treated for ADHD by child psychiatrists than by paediatricians. At the start of the study, about one in four children saw a psychiatrist for their condition. By the end of the study, more than one in three was visiting a psychiatrist for ADHD.

2.8 million kids on ADHD meds

Despite possible concerns about safety, stimulant medications remain the mainstay of treatment. In 2000, 96% were treated with these medications, while 87% were receiving stimulant medication for their ADHD symptoms in 2010, the study found.

The use of Strattera, a nonstimulant drug, dropped from 15% in the year it was introduced (2002) to 6% by 2010. The use of other nonstimulant treatments, such as clonidine (Catapres/Kapvay/Nexiclon), guanfacine (Intuniv/Tenex) and Wellbutrin (buproprion), was relatively constant, but reached a high of 13% in 2010 following the introduction of extended-release Intuniv, the researchers found.

One previous study, published online in the American Journal of Psychiatry, found that about 2.8 million children were taking ADHD medications. Those authors said their use has risen gradually, likely because more teenagers are taking these medications.

The authors of the current study don't think there's suddenly been a dramatic rise in the number of children with ADHD, but instead believe that public awareness campaigns, media coverage of ADHD and advertisements for new medications are probably some of the driving factors behind the rise in diagnoses.

"There's more of an awareness on the part of the parents about this disease," said Garfield.

He said that the authors don't know why more people are taking their children to see psychiatrists for treatment, but said if the trend continues, parents may have trouble finding a doctor to care for their child's ADHD, given the shortage of psychiatrists.

Other experts agreed that the incidence of ADHD probably isn't going up that quickly. "I don't think these data reflect true prevalence. I think it's the total frequency of visits related to ADHD is going up," said Dr. Andrew Adesman, chief of developmental and behavioural paediatrics at Steven and Alexandra Cohen Children's Medical Center of New York in New Hyde Park, N.Y.

"The American Academy of Pediatrics is encouraging paediatricians to play a more active role in the diagnosis and treatment of ADHD, so it's interesting to see that psychiatrists over time are now treating more," he said. "Paediatricians may be referring more, or as safety concerns have been raised by the FDA, it may be that families prefer to see a specialist."

Read more:
Managing ADHD

(Copyright © 2012 HealthDay. All rights reserved.)



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Dr Renata Schoeman has been in full-time private practice as a general psychiatrist (child, adolescent and adult psychiatry) since 2008, currently based in Oude Westhof (Bellville). Renata also holds appointments as senior lecturer in Leadership (USB) and as a virtual faculty member of USB Executive Development’s Neuroleadership programme. She serves on the advisory boards of various pharmaceutical companies, as a director of the Psychiatric Management Group (PsychMG) and is the co-convenor of the South African Society of Psychiatrist (SASOP) special interest group for adult ADHD, and co-founder of the Goldilocks and The Bear Foundation ( She is passionate about corporate mental health awareness and uses her neuroscience background to assist leaders in equipping them to become balanced, healthy and dynamic leaders that take their own and their team’s emotional, intellectual, social health and physical needs into account. Renata is academically active and enjoys research and collaborative work, has published in many peer-reviewed journals, and has presented at local and international congresses. She is regularly invited to present at conferences and to engage with the media. During her post-graduate studies, she trained at Harvard, Boston in neurocognition and neuroimaging. Her awards include, amongst others, the Young Minds in Psychiatry award from the American Psychiatric Association, the Discovery Foundation Fellowship award, a Thuthuka award from the NRF, and a MRC Fellowship. She also received the Top MBA student award and the Director’s award from USB for 2015. She was a finalist for the Businesswomen’s Association of South Africa’s Businesswoman of the Year Award for 2016, and received the Excellence in Media Work award from SASOP during 2016.

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