New Study Provides Evidence Hyperactivity Overdiagnosed

September 13, 1992|By RICHARD E. VATZ and LEE S. WEINBERG

Does your child's restlessness, disruptiveness, and shor attention span drive you crazy? Do you worry that your child may be "hyperactive;" that is, have a mental "disease," called Attention-Deficit Hyperactivity Disorder (ADHD)?

Well, you are not alone. But that doesn't mean that your fears are accurate. For about 30 years, many medical and nonmedical researchers have readily agreed -- wrongly and irresponsibly, some say -- that many such children suffer from a mental #F disorder, that their numbers are legion, and that they need to be medicated.

The controversy over diagnosing and treating "Attention-Deficit Hyperactivity Disorder" (ADHD) in children ballooned several years ago, when it was revealed that there was a tremendous, exponential increase in the use of medication for children diagnosed as having the "disorder."

Early in 1987, Georgia's Composite State Board of Medical Examiners and the federal Drug Enforcement Administration became aware of a tremendous increase in the amount of Ritalin being used in certain areas of Georgia. Investigations led to suspicions that Ritalin has been used for control of marginal behavioral problems in children. The medical danger, as was pointed out by Andy Watry, executive director of the board, is that "We're concerned we may be creating a bunch of little addicts."

Similar situations and concerns have subsequently been arising in many other states across the country. A highly-publicized study in the Journal of the American Medical Association (JAMA) revealed three years ago that in Baltimore County, there had been "a consistent doubling of the rate of medication treatment for hyperactive/inattentive students every four to seven years" between 1971 and 1987. Such revelations led to tremendous media focus and an upsurge of Ritalin-related lawsuits against doctors, teachers and school districts.

Results of a follow-up survey published in JAMA last month (August 26, 1992) indicate that the rate of such stimulant treatment in Baltimore County "declined 39% in the 1989 and 1991 surveys from its 1987 peak." The article attributes this significant decline in the use of Ritalin to the general negative publicity (repeatedly called a "media blitz" in this ostensibly scientific report) regarding the drug after 1987 and the growing threat of lawsuits, including a prominent one in Baltimore.

As to the consquences of this precipitous drop in Ritalin usage, the study concludes that 36 percent of the children taken off medication experienced "school maladjustment," but makes no effort to explain why 64 percent of the children taken off medication apparently experienced no major problems.

Thus, the study unwittingly provides evidence that significant over-medication likely had been taking place in Baltimore County.

Contrary to what parents are often told by psychiatrists and some educators, the diagnosis of ADHD rarely indicates the presence of brain disease. The American Psychiatric Association's own diagnostic manual defines ADHD in strictly nonmedical terms.

The criteria for "diagnosing" ADHD include such measures as "often talks excessively" and "has difficulty awaiting turn in games or group situations," and the problem behavior must be "considerably more frequent than that of most people of the same mental age." Finally, the assessment of the behaviors constituting this "disease" is made largely through teachers' and parents' observations, what the journal Clinical Pediatrics calls the "recognized mainstay in the diagnosis of ADHD."

The upshot is that many very normal children might be -- and are -- labelled as "hyperactive." Because ADHD remains, as the Journal of Child Psychology and Psychiatry put it a few years ago, "ill-defined," estimates of its incidence vary tremendously. In fact, researchers' estimates over the last 20 years can be found ranging from as low as 1 to 2 percent to as high as 20 to 40 percent of children. The current "acceptable" estimates usually range from 3 to 5 percent.

Of course, as with other questionable mental "diseases," the rate of diagnosis varies with the eagerness to diagnose it. So whether you suffer from ADHD -- and whether you are treated with medication -- may be determined, as the New England Journal of Medicine points out, "by cultural factors . . . [and in] some countries, including Britain, stimulants are rarely or never used" for such alleged disorders.

A widely heralded article in 1989 in the New England Journal maintained that ADHD was correlated with reduced glucose metabolism in various areas of the brain, providing hope that there could at last be found a neurobiologic cause of ADHD, which, the authors conceded, "researchers have been unable to demonstrate."

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