Explaining the Rise in ADHD

Jeffrey A. Lieberman. MD


January 17, 2014

It Comes Back to the Gatekeepers

In any event, it ultimately comes back to the doctors, who are the gatekeepers or arbiters of diagnosis and treatment. Particularly in this era of increased information flow, 24/7 news cycles, media blitz, and exposure to marketing in many different forms, clinicians must resist marketing pressures, as well as parental pressures, to ensure that diagnoses are made in a rigorous way and that treatments are prescribed judiciously.

It is understandable that in our competitive society where everybody wants an edge, people might see this as a way of gaining some benefit beyond having an illness with untreated symptoms. Not too long ago I saw a movie called Limitless, starring Bradley Cooper, who plays a young man and aspiring writer who is offered a medication that enables him to use an expanded portion of his mental capacity. He takes the drug and finds that he is able to do things incredibly well and to retain things and work more effectively. His capacity becomes limitless and he becomes dependent on taking the drug regularly to perform at this level. The end doesn't turn out so well because a drug that gives this kind of performance enhancement ultimately has downsides. In human biology there is, as in so many other areas of life, no "free lunch," and if you boost something artificially, then there is ultimately a price to be paid.

Particularly now with the emphasis on being competitive and the increased exposure to different influences, we need to be mindful of this. Coming back to the articles in the New York Times, there is something amiss in these high rates of ADHD diagnosis and prescription of psychostimulant drugs. Psychostimulant drugs are effective for people who genuinely need them, but at the same time they can be dangerous and are associated with a high risk for abuse when they are used inappropriately. It is up to doctors to be extremely rigorous in their evaluation and establishment of the diagnosis and in their use of these treatments.

With these articles elevating the public debate, this is more incumbent on us, as physicians, than ever. Thank you for listening. This is Dr. Jeffrey Lieberman at Columbia University, speaking to you for Medscape.


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