Shooting the Messenger: The Case of ADHD

Abstract

Medicating ADHD is a controversial subject that was acutely inflamed in 1995 when high rates of ADHD diagnosis and treatment were documented in southeastern Virginia. Psychologists in southeastern Virginia formed a regional school health coalition to implement and evaluate interventions to address the problem. Other professionals with strong ties to the pharmaceutical industry launched ad hominem attacks on the coalition’s research and work. These attacks contributed to the work being terminated in 2005. In the ensuing years, ADHD drug treatment continued to escalate. Today, the national rate of ADHD diagnosis exceeds all reasonable estimates of the disorder’s true prevalence, with 14 % of American children being diagnosed before reaching young adulthood. Notable key opinion leaders continue to claim that there is no cause for concern, but with a message shift from “the prevalence is not too high” to “high prevalence is not too concerning.” This paper provides an object lesson about how innovative research can be derailed to the detriment of sound medical and mental health care of children when industry interests are threatened. Tenure may be the only option for protecting innovative research from specious attacks. The authors offer a summary of the data on ADHD drug treatments, suggest judicious use of such treatments, and add their voices to others who are once again sounding a cautionary alarm.

A discursive analysis concerning information on “ADHD” presented to parents by the National Institute of Mental Health (USA)

“…Instead, deviance is medicalized and even if the individual child may not suffer the problem becomes primarily a problem for other people and for the social system. To be observed is that the rate of children being diagnosed with “ADHD” is increasing (Lefever Watson, Arcona, Antonuccio, & Healy, 2014 ; Moncrieff & Timimi, 2011 ; Polanczyk, Willcutt, Salum, Kieling, & Rohde, 2014 ). Pajo and Stuart ( 2012 ) in an analysis of self-help books for parents, whose children are perceived as having “ADHD,” 1 show how these books tend to influence parents to approach their children from a disability perspective.…”

A population-based study of prescribing trends in a potentially vulnerable paediatric population from 1999 to 2012

“…This is comparable to Ireland, where regulatory changes that removed restrictions on the dispensing of amphetamine‐related medications, combined with the marketing of a sustained‐release methylphenidate formulation, contributed to a significant increase in psychostimulant prescribing among General Medical Services children and adolescents between the years 2002 and 2011 . The literature on ADHD suggests that the apparent increase in ADHD observed in this study in 2009 is in part attributable to over‐diagnosis or misdiagnosis of this condition . A study in Australia demonstrated an increase in overall diagnosis of developmental and behavioural problems from 2008 to 2013, with the diagnosis of ADHD rising in new consults from 10% to 14% and review consults from 22% to 28% .…”

“…In an aim to advance medication safety for children, an understanding of paediatric prescribing trends is required to identify the type and prevalence of medications prescribed, particularly those that are associated with high‐risk adverse events. To date, most studies on prescribing trends in children have focused on the inpatient setting or on specific drug categories, such as antipsychotics, antidepressants and medications used to treat attention‐deficit/hyperactivity disorder (ADHD) . These studies have revealed important changes in paediatric prescribing over time; however, most reflect a narrow examination of specific drug classes, producing a gap in understanding overall prescribing trends.…”

Unmet needs in paediatric psychopharmacology: Present scenario and future perspectives

“…First, the steep increase in prescription rates has led to worries of possible overdiagnosis and overtreatment, fuelled initially by a purported lack of clear-cut boundaries between health and disease in psychiatric disorders and, more recently, by the introduction of DSM-5 (Batstra and Frances, 2012;Pierre, 2012). Second, this potential overtreatment has been viewed by some as having been driven more by commercial pressure from pharmaceutical companies than by real medical need (Watson et al, 2014). Third, long-term treatment duration is often not supported by sufficient data on effectiveness and safety (Molina et al, 2009).…”