COMMENTARY

Explaining the Rise in ADHD

Jeffrey A. Lieberman. MD

Disclosures

January 17, 2014

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Marketing Attention-Deficit/Hyperactivity Disorder

Hello. This is Dr. Jeffrey Lieberman of Columbia University, speaking to you today for Medscape.

I want to comment on an article that appeared in the New York Times on December 14, 2013, and has attracted a great deal of attention and comment. The article is "The Selling of Attention Deficit Disorder"[1] and it was written by a journalist by the name of Alan Schwarz. It was quite a long piece, and a lot of research over a long period of time went into it.

This was followed on December 18 by an editorial in the New York Times, "An Epidemic of Attention Deficit Disorder."[2] The article and the editorial were based on concerns about the burgeoning rate of the diagnosis of attention-deficit/hyperactivity disorder (ADHD) and the use of stimulant drugs to treat it in our country.

The Centers for Disease Control and Prevention reports, as quoted in the article, that 15% of all high school students carry a diagnosis of ADHD. The article also says that the marketing of psychostimulant drugs has resulted in an increase in the number of children treated for ADHD in the United States from 600,000 children in 1990 to 3.5 million last year.

Those figures seem very high compared with the rates of ADHD diagnosis and treatment with stimulant drugs in other developed societies such as Western Europe and Asia. One wouldn't expect such enormous differences based on population frequency and practice patterns.

The articles point the finger at drug company advertising and marketing, including aggressive marketing to doctors and direct-to-consumer marketing. They suggest that doctors, to the extent that they are susceptible to marketing, are complicit in making these diagnoses and prescribing these treatments.

It is hard to know how much of the increase is attributable to marketing, but other factors contributing to the increased rate in the United States must be considered. These reasons are more sociological than financial or clinical.

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