Friday, April 5, 2013

Read my comments in the New York Journal News on April 2, 2013 on the arguable overdiagnosis of ADHD. Send me your thoughts.

ADHD may be overdiagnosed, Lower Hudson Valley experts fear

Study: 20% of H.S. boys classified with disorder

Apr 2, 2013 |


Student in class / Getty Images/Comstock Images

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The decades-long debate over how many children have attention-deficit hyperactivity disorder — and whether those who do should be treated with medication — will only intensify with a new study that shows ADHD diagnoses soaring across the country.

Eleven percent of all school-age children have received a medical diagnosis of ADHD, including 20 percent of all high school boys, according to a New York Times analysis of a new national survey done by the U.S. Centers for Disease Control and Prevention.

Experts in the Lower Hudson Valley who deal with the diagnosis and resulting treatment needs say the figures may indicate too many children are being classified with the disorder.

“My impression is that it is definitely overdiagnosed,” said Eric Neblung, a Nyack-based psychologist and president of the New York State Psychological Association.

“A lot of times, the diagnosis is made by primary care physicians who aren’t trained to do it,” he said. “Parents may say that their son or daughter has trouble concentrating, and the physician will jump on it based on a quick screening. It could be typical adolescent behavior or other things like depression or anxiety.”

Neblung can’t see how one in five high school boys could have ADHD, a disorder characterized by inattentiveness and impulsiveness that is attributed to genetic and possibly environmental factors.

“The consensus traditionally is that it’s 1 to 10 percent, but even 10 percent is pushing it,” he said.

The Times report, based on a CDC telephone survey of more than 76,000 parents between February 2011 and June 2012, found that about 6.4 million children between 4 and 17 had received a diagnosis of ADHD at some point. This would represent a 16 percent increase from 2007, when the CDC did its last survey, and a 53 percent upsurge over the last decade.

The Times found that about two-thirds of all school-age children currently diagnosed with ADHD receive prescribed stimulants like Ritalin.

The CDC was not involved in the Times’ study, and a representative for the federal agency said it did not have enough information to assess the report. The CDC will have its own report analyzing the data later in the spring. The agency’s survey sought information on children’s overall health.

(Page 2 of 3)


Esta Rapoport of Chappaqua, the author of “ADHD and Social Skills: A Step-by-Step Guide for Teachers and Parents” (2009), said that many will be alarmed by the possible overdiagnosis of ADHD because they assume that children will be medicated. But this doesn’t have to be so.

“People become hysterical because of medication,” she said. “But we should be trying conservative methods first — teaching kids to self-regulate their behavior, to recognize when their behavior is inappropriate or when their academic work is ineffective. These kids struggle and need help, but they may not need medication.”

There is no simple test for ADHD, so it’s up to individual pediatricians, psychiatrists and psychologists to make the diagnosis.

A lot of factors have come into play to drive up the number of diagnoses, local experts said. Dr. Ronald Jacobson, chief of pediatric neurology at the Maria Fareri Children’s Hospital at Westchester Medical Center in Valhalla, said that it can be simpler and cheaper to get a prescription for Ritalin than to seek ongoing counseling.

“We should insist that patients have a comprehensive evaluation, but you don’t always see that,” he said. “You may want to think about therapy and counseling and medication or all of those, but many families don’t have the resources or care to make use of all options.”

State rules governing prescriptions also have an impact, Jacobson said, and a new New York law that takes effect in August will create a “real time” online registry that tracks who prescribes drugs to whom.

“People may be more thoughtful about what gets prescribed,” he said.

Regardless of whether the growing number of diagnoses are accurate, the higher profile of ADHD should produce more public awareness of the challenges facing children, said Christine Reinhard, executive director of the Rockland County Association for Learning Disabilities.

“There are not enough support services,” she said. “We need more services like specialized tutoring and skills training to help them identify strategies that might reduce the need for medication.”

(Page 3 of 3)


Robert Fraum, a psychologist who provides counseling for attention deficit disorder and hyperactivity in White Plains and Manhattan, said that it’s very difficult to judge the numbers without having another survey for comparison.

“But if the numbers turned out to be true, I wouldn’t be surprised,” he said. “You would be talking about a wide range. Not everyone with attention-deficit disorder is hyperactive. There are a lot of daydreamers who are inattentive and try to keep their restlessness down as much as they can.”

Fraum said that while school districts may resist the diagnosis, suburban parents can be very aggressive in seeking services that come in the wake of an ADHD diagnosis and other accommodations such as “extra time on the SAT exam.”

Michael Schulman, assistant director of special services for Southern Westchester Board of Cooperative Educational Services, said that schools have to be careful about how they explain children’s behaviors to parents and doctors.

“What is the message we send to parents when a student may be behaving outside the norm?” he said. “We need to see if these behaviors can be ameliorated in a simpler fashion without a diagnosis. If a child isn’t sitting still, is it ADHD or is the child bored?”

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