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TOPIC: The Sensationalism of ADHD

The Sensationalism of ADHD 23 Apr 2014 13:17 #331

Listen to the interview with the author of this article on The Price of ADHD Business here!

The Sensationalism of ADHD
By Dr. Marilyn Benoit, Chief Clinical Officer and SVP of Clinical & Professional Affairs of Devereux

For decades we have undergone an intense debate about the “reality” of ADHD. The issue was polarizing—is this a true medical condition, or an excuse to dismiss or mediate rambunctious kids? Today experts agree that ADHD is a real, brain-based chronic biological disorder, affecting five to 10 percent of children in the United States. But a new debate has emerged, concerning the prevalence, or over-diagnosis, of the disorder. The issue remains hotly contested, frustrating parents, educators and physicians alike. Proper education and understanding of this disorder is the first and most important step in ensuring appropriate and effective treatment.

Experts know that ADHD is a complex disorder, often involving a number of variables. Best practices for the diagnosis and treatment of ADHD include conducting a clinical diagnostic evaluation as well as considering observations and input from multiple respondents across a child’s environments, including home, school and child care settings. Diligent clinicians will dive deep into a child’s background and medical history during their evaluation. ADHD often does not exist alone; children with ADHD may also experience depression, anxiety, conduct disorders, or learning disabilities. Assessments, commonly used by clinicians in the diagnosis of ADHD, are valuable diagnostic tools but should not stand alone.

Psychiatrists know that children who have been traumatized, either through witnessing violence or experiencing it themselves, are more likely to present with symptoms of ADHD. For example, I once examined a child who had received the diagnosis of ADHD, and after my evaluation, suspected he had suffered a traumatic brain injury. A neurologist later confirmed my suspicion. Indeed, that was a significant piece of information for the child’s treatment. Physicians should also evaluate children for risk factors associated with ADHD including: prenatal exposure to cigarette smoking, drugs or alcohol, low birth weight, fetal distress or perinatal complications, post natal attachment or relational problems, and environmental factors such as exposure to toxins, and genetic predisposition. When ADHD is diagnosed and properly treated, the impulsivity and distractibility that can impair a child’s functioning in school and social settings, can diminish. For most children in the U.S. with the classic ADHD diagnosis, proper treatment can include the use of behavior management techniques and prescription medications, which have proven effective in curbing their distractibility, impulsivity and hyperactivity.

An important study released last year by the Centers for Disease Control and Prevention reported an alarming rise in the number of children diagnosed with ADHD and receiving prescription medication for it. The data reported that in 2011, 11 percent of children and adolescents ages four to 17 had at some time, received a diagnosis of ADHD.1 Of those diagnosed with ADHD, 69 percent were taking medication for it—approximately 3.5 million children.2 That number is up significantly from 1990, when only 600,000 children were prescribed ADHD medication.3 These numbers are startling, because they reflect a higher prevalence than previously recognized. As reported in The New York Times in December, “the rise of A.D.H.D diagnoses and prescriptions for stimulants over the years coincided with a remarkably successful two-decade campaign by pharmaceutical companies to publicize the syndrome and promote the pills to doctors, educators and parents.”4 Critics of the pharmaceutical companies’ aggressive marketing campaigns point out that some diagnostic criteria—jitteriness, impatience, distractibility—are so subjective that the companies can exploit their meaning in order to appeal to a much wider population. All of this information, and often sensationalized rhetoric, can be confusing to parents, physicians and teachers who only want to see our children succeed to the best of their ability.

Thorough education and understanding is the answer. ADHD is a real brain disorder affecting children, adolescents and adults. Full and proper treatment must include a thorough evaluation of children’s medical history, backgrounds and specific needs. Parents, teachers and child care staff can provide valuable knowledge to physicians who evaluate and treat. Prescription medications can be extremely effective for individuals who struggle socially and at work or school due to the effects of this disorder. However, just as assessments alone are insufficient diagnostic tools, prescription medication should not stand alone either. While greater awareness and acceptance of ADHD has been a positive development, sensationalism surrounding ADHD and other mental health disorders, persists. This is a disservice to our children. Shifting the manner in which we, as a society, understand ADHD and other disorders—as a matter of healthy brain development—will help us in the medical field to design more holistic and efficient interventions and treatment.

Dr. Marilyn Benoit is the Chief Medical Officer, Chief Clinical Officer and Senior Vice President of Clinical & Professional Affairs of Devereux. Dr. Benoit is a Past President of the American Academy of Child & Adolescent Psychiatry (2001-2003). She has been on the faculties of Howard University and George Washington University medical schools, and is a Clinical Associate Professor of Psychiatry at Georgetown University Medical Center. She was Director of Outpatient Child and Adolescent Psychiatry at Children’s National Medical Center in Washington, D.C., where she also served as Vice Chairman and Interim Chairman. Dr. Benoit has treated individuals across the range of Autism Spectrum Disorders and coordinated parent groups during her career of more than thirty years. She is a nationally known advocate for children, best demonstrated by her presidential initiative for the American Academy of Child & Adolescent Psychiatry (AACAP) she founded in collaboration with the Child Welfare League of America (CWLA), a national coalition of stakeholders involved with children in out-of-home placement. Dr. Benoit has lectured internationally, and has published widely on several issues pertinent to children’s behavioral health. Dr. Benoit holds a graduate degree in Health Services, Management & Policy from The George Washington University school of Public Health.

1. Visser, Susanna N., Melissa L. Danielson, Rebecca H. Bitsko, Joseph R. Holbrook, Michael D. Kogan, Reem M. Ghandour, Ruth Perou, Stephen J. Blumberg. “Trends in the Parent-Report of Health Care Provider-Diagnosed and Medicated Attention-Deficit/Hyperactivity Disorder: United States, 2003-2011.”Journal of the American Academy of Child & Adolescent Psychiatry; November 2013.
2. Ibid.
3. Schwartz, Alan, “The Selling of Attention Deficit Disorder,” The New York Times, December 14, 2013.
4. Ibid.
Last Edit: 06 May 2014 22:26 by michael.bailey. Reason: added interview link
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