Attention-Deficit Expansion Merits Monitoring: Analysis

Expanding the criteria used to diagnose attention-deficit hyperactivity disorder led to a surge in drug prescriptions that may be “unnecessary and possibly harmful” for some children, researchers said.

The broadening of diagnostic criteria in The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, known as the DSM, has been an “important contributor” to the growing prevalence of ADHD, according to an analysis led by Rae Thomas, a senior research fellow at Bond University in Australia and a psychologist who has worked with children and families for more than 20 years.

The looser definition in the most recent edition of the DSM, used in many parts of the world to classify mental disorders, is “likely to increase what is already a significant concern about over-diagnosis,” Thomas and her colleagues wrote today in the British Medical Journal.

Mental-health disorders are susceptible to over-diagnosis because interpretations of observed or self-reported behavior are subjective, and prevalence can vary widely, the researchers said. In the U.S., the majority of children diagnosed with ADHD receive medication. Prescriptions in the U.S. for stimulants have increased steadily from 1996 to 2008.

In Australia, prescribing rates rose 73 percent from 2000 to 2011, while U.K. ADHD pill prescriptions from 2003 to 2008 doubled among children while gaining fourfold among adults.

“Despite this, there is very little data on the long-term benefits of treatment,” the researchers said.

ADHD medications can cause weight loss, liver damage and suicidal thoughts, and may suppress growth during puberty, while the long-term effects of the treatments are unknown, they said. Meanwhile, drug costs resulting from inappropriately diagnosed ADHD in the U.S. are estimated to be as high as $500 million, they said.

For mild and moderate cases, the researchers propose “a stepped, diagnostic approach to reduce unnecessary diagnoses without risking under-treatment of those who really need psychiatric help.”

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