Rates of attention deficit hyperactivity disorder (ADHD) have been on the rise in recent decades, but how much of the increase is due to ADHD and how much is the result of over-diagnosis? Researchers at Bond University in Australia investigated the connection between the prevalence of ADHD and the use of prescription medication used to treat it. They conclude that variations in diagnosis and treatment from country to country indicate that the disorder’s definition may be overly broad.

The authors measured the prevalence of ADHD in four countries based on the number of prescriptions written for ADHD medications. In Australia, prescriptions increased by 73% between 2000 and 2011. The Netherlands saw prescriptions double in the same period. In the United Kingdom, the data showed that ADHD medication prescriptions doubled for children between 2003 and 2008 and prescriptions for adults quadrupled in the same period. Finally, in the United States, the prevalence of ADHD diagnoses, as reported by parents, rose from 6.9 percent of children in 1997 to 9.5 in 2007.

“There is a wide variation in point prevalence rates within and between countries, raising questions about the diagnostic practices contributing to part of the rise,” explain the researchers, “About 87 percent of children diagnosed with ADHD in the US in 2010 subsequently received medication.” They point out that, in the United States, $500 million is spent on ADHD medication every year.

Another issue raised by the researchers is that most children diagnosed with ADHD have only a mild or moderate form of the disorder. Despite this, the new Diagnostic and Statistical Manual, the DSM-V, does not include a definition for either mild or moderate ADHD. The researchers ask whether the lack of criteria for less severe manifestations of ADHD is promoting higher rates of diagnosis, leading to unnecessary prescription interventions.

The researchers conclude by recommending the creation and implementation of new guidelines for diagnosing moderate and mild ADHD, which should include clinicians helping parents and children to identify other possible sources of distraction. Clinicians should also try other interventions, like counseling or having kids work for 20 minute intervals without access to television or other technological distractions, before prescribing ADHD medication.

This research is published in the British Medical Journal.

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