COMMENTARY

Explaining the Rise in ADHD

Jeffrey A. Lieberman. MD

Disclosures

January 17, 2014

On-Demand Diagnosis and Treatment?

Specifically, it has been apparent to me from reading the scientific medical literature, as well as the lay literature, that there is increased pressure from parents and schools, which influences doctors when they see patients and attempt to determine whether a child has a diagnosable condition or whether a specific treatment should be used. When students aren't performing up to their family's expectations, there is a desire to find out why. Is there some clear medical reason? Is there a treatment that can remedy this if schools are having difficulty controlling the student's behavior or if students are not meeting expectations? There is also a readiness to refer children for evaluation, either for neuropsychological testing or to be seen by a pediatric neurologist or psychiatrist. In our competitive society, we know that people desire a competitive edge to improve their chances of doing well in school, getting into the best colleges, and so forth. If having a diagnosis and taking stimulant medications can enhance performance in addition to procuring for the student extra time on tests, this is seen as desirable, and doctors may be subject to the pleas or requests of parents to see their children in ways that encourage the diagnosis and treatment of ADHD.

To some degree, this may pertain to more affluent families and those in the higher strata of our socioeconomic spectrum, but it is not limited to that group because sociologic incentives exist in lower socioeconomic populations as well. Public schools can receive financial incentives to have students in special education or remedial education programs, and families with lower incomes can receive subsidies and disability support if their children have diagnoses of cognitive problems, whether it is a learning disability or ADHD, that result in the need for special education. There are economic incentives for schools to have more students in these programs, as well as for parents to have their children seen as diagnosed and eligible for these programs. This issue doesn't get much attention. I am sure that it is a contributory factor, although we don't know how much it accounts for the increase in ADHD diagnosis and treatment.

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