Potentially harmful: A wider classification of symptoms for ADHD in the psychiatric 'bible' used by the profession has led to a steep rise in diagnosis and prescriptions for medication, the study warned (picture posed by model)
The diagnosis of ADHD may have become too broad, leading to needless and potentially harmful treatment for some children, researchers warn.
A wider classification of symptoms for ADHD in the psychiatric ‘bible’ used by the profession has led to a steep rise in diagnosis and prescriptions for medication, the study warned.
The group of researchers from Australia and the Netherlands said there was now a risk of over diagnosis which could fuel scepticism about the disorder.
In addition, stretched resources may mean some seriously affected children do not get medical help, or they are undertreated.
In recent years, the term ADHD has been given to a collection of behavioural problems linked to poor attention span including impulsiveness, restlessness and hyperactivity.
Around three to seven per cent of children are believed to have ADHD, about 400,000, with many being prescribed drugs to try and improve their concentration at school.
Prescriptions for stimulant drugs such as Ritalin increased twofold for children and adolescents in the UK, and fourfold in adults between 2003 and 2008.
There have been similar rises elsewhere despite little data showing the long term benefits of treatment, says Rae Thomas, a senior researcher at Bond University in Australia, and colleagues.
In a report published on bmj.com (must credit), they say Australian data shows a 73 per cent increase for ADHD medication between 2000 and 2011.
Increase: Prescriptions for stimulant drugs such as Ritalin increased twofold for children and adolescents in the UK, and fourfold in adults between 2003 and 2008
Prescribing in the US increased steadily between 1996 and 2008 - mostly for adolescents aged 13-18 years - with estimated drug costs up to $500m.
Such medications can cause adverse reactions such as weight loss, liver toxicity, and suicidal thoughts, and in the short term may suppress pubertal growth.
Dr Thomas said ‘Compared with children with asthma, children with ADHD have been described as lazier, less clever, and less caring, and they are also more likely to be stigmatised.’
Having a diagnostic label often means teachers and parents have low academic expectations of them potentially creating a self fulfilling prophecy, she added.
To be diagnosed with ADHD, a patient should meet diagnostic criteria outlined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) - used around the world to classify mental disorders - or International Classification of Diseases (ICD-10).
Diagnosis: Around three to seven per cent of children are believed to have ADHD, about 400,000, with many being prescribed drugs to try and improve their concentration at school (picture posed by model)
But definitions have been broadened in successive editions of DSM, resulting in higher rates of the disorder when compared with ICD 10, Although clinicians are likely to have got better at detecting and diagnosing ADHD, some of the rise could stem from overdiagnosis or misdiagnosis.
‘Severe cases of ADHD are obvious, but in mild and moderate cases - which constitute the bulk of all ADHD diagnoses - subjective opinions of clinicians differ’ says Dr Thomas.
‘The broadening of the diagnostic criteria in DSM-5 is likely to increase what is already a significant concern about overdiagnosis.
‘It risks resulting in a diagnosis of ADHD being regarded with scepticism to the harm of those with severe problems who unquestionably need sensitive, skilled specialist help and support’ she added.
Prof Eric Taylor, Emeritus Professor of Child and Adolescent Psychiatry, Institute of Psychiatry, King’s college London, said the UK was different because NHS guidelines already recommend careful specialist assessment, with psychological treatments given priority over medication in most cases.
‘Probably too few children here get help’ he said.
In the UK, the increase in stimulants was from a very low base rate: 4.8 per 1,000 schoolchildren in UK compared with around 70 per 1,000 in parts of the USA.
Prof Taylor said ‘The increase in the UK follows an increased ability in the medical profession to recognize ADHD; but all too many children with severe problems still go untreated.’
Prof Philip Asherson, Professor of Molecular Psychiatry at the MRC Social, Genetic and Developmental Psychiatry centre at the Institute of Psychiatry, King’s College Londo, said ‘This paper makes a set of arguments relating to the inappropriate use of the diagnostic criteria for ADHD.
‘I would see their arguments as largely correct, and does explain the potential dangers of over diagnosis of ADHD.
‘However, they are not against the diagnosis and treatment of children with ADHD when this has been properly evaluated by specialists.’
Read more: http://www.dailymail.co.uk/health/article-2488149/ADHD-diagnosis-broad-causing-needless-harmful-treatment.html#ixzz2jtDsOvjZ
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