Here’s one of the more popular ones from the NYTimes if you haven’t seen one yet:
Historic estimates have put the incidence at 3-7% just to give you an idea of what 11% means.
So, I expect if you’ve read this far, you are expecting my opinion of why this is…Remember that this is my opinion from a few years of pediatric practice and counseling many families on the the diagnosis (or not) and treatment of ADHD.
I think there are multiple factors but I will handle them in categories…
Doctors have become more and more comfortable prescribing stimulant medications for ADHD. There is a quote in the article above where a doctor states that he used to tell his families that the stimulant medicines are “safer than aspirin.” Because of this, I believe doctors will be a bit lax in their requirements that children actually meet criteria for ADHD.
Couple this together with a developing medical marketplace that favors competition and convenience as well as online ratings, etc and it makes standing up against a families demands more difficult. I’m definitely not saying that this is the right thing to do but you can certainly see how a doctor is put in a difficult place.
It is important as physicians that we consider the information carefully and evaluate the child in front of us based on appropriate criteria. Treatment decisions should be made based on this information and not based on the pressure from the family.
I have to remind my families in diagnostic consultations and follow up appointments to evaluate treatment that talking back, aggression and “being bad” are not the core symptoms of ADHD. It is not uncommon for me to be sitting with parents who tell me that I need to “fix this kid.” Well, unfortunately, there isn’t a medicine that can fix a child.
ADHD can be managed but many of the behaviors that parents want fixed need to be addressed with counseling and parenting skills. I commonly refer the children of this type of parents for counseling because they need it but also because my counselors will help the parents come up with more effective parenting techniques.
Because of the growing awareness of ADHD, parents are more pushy about getting their children diagnosed and treatment started and I believe that this increases the incidence of ADHD.
In some arenas, there is a still a small stigma associated with having ADHD. This is sad and I wish it weren’t true. But, in reality, this has significantly decreased even in the past couple of years.
It used to be common for parents to give their children “vitamins” each morning that were actually stimulants to keep from having to explain to their children about the diagnosis. Things are different now and I almost feel like it’s to the point that ADHD is a trendy diagnosis. I have teenagers that come in wanting to be diagnosed and start treatment and you can almost feel they are there because “everybody else is doing it.”
While I’m proud that any mental illness carries less stigma than it did in the past, it does create a problem when ADHD becomes so commonplace that it’s almost “cool” to have it.
Schools are different now than even 20 years ago when I was in junior high and elementary school. We didn’t start phonics until 1st grade, most kindergardeners finish reading now. Early school used to be about centers and getting up and moving around but now it has become much more about sitting still for lectures and worksheets.
Don’t get me wrong…I’m not saying that individual schools or teachers are to blame. Many of our teachers feel tied to doing things a certain way in order to prepare their students for standardized tests, etc. School ratings are dependent upon performance on these tests as well.
However, because of this culture, there is little flexibility for the little boy who is smart but is bouncing around the room like a bouncy ball. I hope no one takes this the wrong way, I’m not blaming schools. This is simply just the way it is. The requirements for sitting still and paying attention for longer periods have changed and have gotten younger and younger.
So, as you can see, I have lots of opinions about what might be contributing to the increase in ADHD diagnoses.
Is there anything to do about all this? Probably not. We just need to be aware of what’s going on and make sure that diagnoses are appropriately made based on the child’s symptoms and not the result of some outside pressure or trend.
Here is the full table of contents for the ADHD Series:
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