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ADHD cases, spending on rise

CDC analysis ranks Ohio high with ADHD cases

A recent analysis of federal health data indicates more than 12 percent of Ohio children have been diagnosed with attention deficit hyperactivity disorder — one of the highest rates in the nation.

A New York Times analysis of telephone survey data collected by the Centers for Disease Control and Prevention warned of an alarming increase in the number of adolescents with ADHD nationwide.

But local doctors questioned the efficacy of the report, which relied on responses from more than 76,000 U.S. parents, instead of medical records. The Times found that about 6.4 million children between ages 4 and 17 had been diagnosed with ADHD at some point over the past two years — up 16 percent from survey results reported in 2007 and 53 percent over the past decade.

Dr. Eileen Kasten, a behavioral pediatrician at The Children’s Medical Center of Dayton, said one of the problems with the survey data collected by the CDC is that it relies on parents’ memories and interpretations of their conversations with doctors.

“Sometimes as physicians, we see a child when they’re younger and they have a lot of behavioral problems, and we say maybe this is ADHD,’’ Kasten said. “We may be making a tentative diagnosis, but the parent may hear it as a formal diagnosis.

“When you use a parent report over a period of time, like this, without any chart review to see if it (ADHD) has been diagnosed in a standardized fashion, you’re going to get an increased number of parents feeling like their child has been diagnosed with ADHD,’’ she said. “That makes the accuracy of the data a little less firm.’’

The CDC did not participate in the Times’ analysis and is preparing its own report later this year on the findings of its National Survey of Children’s Health, which also included questions about autism and other conditions.

Kasten said it is difficult to come up with a comprehensive figure for the number of children who’ve been diagnoses with ADHD, because it can be diagnosed by a variety of doctors at different locations, and there is no central clearinghouse for those reports.

However, recent records-based studies indicate cases of ADHD range between 4 and 9 percent of the adolescent populations, she said. The Times estimate was closer to 11 percent.

The numbers may vary, but experts agree that ADHD remains one of the most common neurobehavioral disorders diagnosed in childhood, although scientists are not sure what causes the condition.

Critics say the condition has been over-diagnosed by doctors eager to solve parents’ frustrations with hyperactive children by prescribing stimulants, such as methylphenidate, or Ritalin, which are effective in treating inattention, disruptive behavior in school and other symptoms of ADHD.

But some doctors think ADHD diagnoses are up simply because parents, teachers and physicians have become more aware of the signs of ADHD; and the social stigma associated with bringing children in for treatment has begun to wane.

“Most pediatricians feel that it’s actually an underdiagnosed disease, rather than and overdiagnosed disease,” said Dr. David Roer of Pediatric Associates of Dayton. “There are probably a lot more kids out there that have ADHD. The parents are just reluctant to come in because of the fear of medical treatment and putting them on medicine.”

Roer said he frequently hears evidence of under-diagnosis while screening patients.

“When I do these evaluations on children, it’s very common for one of the parents to go, “I probably had this when I was a child and never got treated,” Roer said. “There is no doubt in my mind that the diagnosis of ADHD has gone up over the years. People are just more aware of it.”

He lamented the common “misperception” that most doctors are too quick to diagnose ADHD and prescribe medications to treat symptoms, noting that clinical practice guidelines from the American Academy of Pediatrics recommend behavior therapy as the first line of treatment.

“I think most pediatricians go through an extensive evaluation process, and we try not to use medicine if we don’t have to use medicine,” he said. “But the reality is, unfortunately, the only way to really know if medicine is an answer is to try medicine in those patients you determine that are likely to have ADHD.”

Medication therapy is often the most effective treatment for true cases of ADHD, although most children are weened off the drugs as they get older, Roer said.

As a result, there has been a dramatic increase in prescriptions for Ritalin and other stimulants used to treat ADHD over the past several decades.

Since 1990, prescriptions for Ritalin alone have increased by 700 percent and more than 5.1 million people in the U.S. — mostly children — are on it, according to IMS Health, a private prescription auditing firm, which notes that the United States consumes more than 90 percent of Ritalin produced in the world.

According to the Times analysis, about two-thirds of all school-age children diagnosed with ADHD receive prescribed stimulants, such as Ritalin and Adderall, that curb hyperactivity and boost attention “but can also lead to addiction, anxiety and occasionally psychosis.”

Frances Duncan, a Dayton-based clinical therapist who has dealt with children with ADHD for more than two decades, said part of the problem with medication therapy is that the medications are often prescribed by family doctors and others who may not be trained to distinguish ADHD from other associated conditions, such as depression.

“There are other types of problems that can be present that can present as ADHD,” Duncan said. “That’s why the assessment is so important by someone trained to do the assessment.

“Even if the child has ADHD, not all children with ADHD need medication,” she said. “There are clinical tools and treatments that can address ADHD and teach children some of the (coping) skills they need.”

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