Is ADHD Really on the Rise?

The other day I was meandering around online and came across an article on USA Today.  The headline was:  A new report shows that diagnosis rates for ADHD have risen 30% in 8 years.

The article is based on a comprehensive study by Blue Cross and Blue Shield Association and utilizes data from actual diagnosis rates instead of self-report surveys.  Consequently it’s one of the more reliable studies on ADHD rates ever conducted.

The overall findings, as summarized in the article, are:

  • ADHD diagnoses have risen more than 30% in the past 8 years
  • Middle school students are the most diagnosed subset of students
  • Boys are diagnosed nearly twice as frequently as girls
  • Diagnoses are highest in the South and lowest in the West
  • Co-diagnoses include anxiety and depression
  • Behavioral therapy is important and effective

I highly encourage you to read the article and, if you have the bandwidth, to read the study.  The findings are interesting, and I have a few thoughts myself.

1.  Diagnosing ADHD is difficult

There is no definitive “test” for ADHD.  Rather, clinicians piece together evidence to get a clear picture of a child’s attention, focus, and hyperactivity.  For instance, when I diagnose ADHD, I rely on behavioral history (especially before age 5), teacher and parent input, and personal observations during an evaluation.  I also rely on a computerized test called the IVA-2 that is widely used in such situations.

However, there are no clear guidelines for how to test for ADHD.  I’ve seen diagnoses assigned based on a short self-report questionnaire or a brief observation of the child.  This hardly seems comprehensive, and I strongly urge you to seek additional information if this is all you are offered.

2.  It may not even be ADHD

I’ve written previously on the similarities between ADHD and Auditory Processing Disorder (APD).  Both of these have remarkably similar signs and symptoms, particularly the inattentive tendencies.  However, very few people actually test for APD to rule it out before assigning a diagnosis of ADHD.  And really only a highly-trained audiologist can test reliably for APD.

This is the same for other neuro-cognitive disorders.  Oppositional Defiant Disorder (ODD) also presents similar to ADHD.  Both tend to involve difficulties following directions.  And often these two are co-diagnosed.  Just because it looks like ADHD doesn’t necessarily mean it is.  It is quite possible a student diagnosed with ADHD may actually have a different condition altogether.  As such, this may be contributing to the rise in ADHD diagnosis, as reported in the study.

3.  Behavioral therapy helps

One of the first questions I get from the parents of a newly diagnosed student is, “Does my child need medication?”  For some children the obvious answer is “yes.”  I’ve seen firsthand the benefit of medication for some kids.  However, in my experience, the majority of children can learn to function sufficiently without medication.

Perhaps the most encouraging statistic from the study is the rise in behavioral therapy and decrease in medication over the past 8 years.  More significant is the increase in children who are incorporating behavioral therapy with the use of medication.  While EdPsyched is not a “therapy” service, we do provide academic intervention.  The purpose is to teach kids the skills they need in the classroom to function efficiently despite their attention and focus deficiencies.  It is possible to do this without medication, and medication should be a last resort.

I’m certainly glad that large companies such as Blue Cross and Blue Shield are investigating the rise of ADHD.  Understanding how it is diagnosed and the implications of a diagnosis are critical to mediating its effects.  And identifying kids early on who struggle with ADHD also gives them a leg up in developing appropriate compensatory skills.

However, any study involving ADHD must be taken with a grain of salt.  Identifying and diagnosing ADHD can be tricky, and I’ve seen too many students diagnosed without proper testing.  If you suspect your child may struggle with attention, focus, and impulsivity, make sure you are working with a properly-trained clinician to obtain a diagnosis.  Licensed psychologists, diagnosticians, and psychological associates are the best resources for such testing.