A Look Into the Rise of ADD and ADHD

East sophomore Lane Jacobson*, then nine, sat impatiently in his desk tapping his pencil against the metal armrest and ignoring a lecture over uppercase cursive letters. Two weeks later, due to this lack of interest in school, his teacher recommended he visit an ADHD Clinc. There, after interviews, he was diagnosed with Attention Deficit Hyperactivity Disorder and prescribed a low dose of Ritalin, a common drug used to increase stimulants in the brain.  

Over time, with no signs of improvement, a higher dose of Ritalin was prescribed and Jacobson’s grades and ability to pay attention dropped immensely. Six months after being diagnosed with ADHD, Lane was back in the clinic for re-evaluation. He scored within the normal range on the Test of Variables of Attention test. Jacobson’s behavior, his parents were told, was a result of boredom and excess energy, not ADHD.

“It was just hard to grasp,” Lane said.  “First they told me I had this disorder then they tell me it’s something I can control. For a 9-year-old, that’s tough.”

The Center for Disease Control’s national survey of Children’s Health reported an 830 percent increase in children diagnosed with ADD or ADHD from 1985 to 2011. Children’s Mercy Officials say this extreme increase is debated to be a result of misdiagnoses.

Psychologist Judyth Reichenberg believes attention disorders are being over-diagnosed.

“The inconsistency of diagnostic criteria and apparent over-diagnosing in this country has led many to question the diagnosis of ADD and ADHD,” Reichenberg said.  “I believe conditions mimicking ADD, such as developmental disorders, lead poisoning and epilepsy are commonly diagnosed as ADD, leading to improper treatment.”

Lisa Campbell, director of the  ADHD department at Children’s Mercy Center, believes the rise in diagnoses is not due to misdiagnosis, but to a rise in practitioner knowledge or a rise in the number of people with ADD and ADHD.  She believes there might be an under diagnosis of attention disorders.

“It is possible that this may even be an underestimate of ADHD prevalence,” Campbell said. “Given that one study that included clinical assessment of children for ADHD symptoms found that only one-half of children meeting the criteria for ADHD had received a diagnosis of ADHD or regular medication treatment.”

*Anne Jacobson, Lane’s mother, said Lane’s misdiagnosis has caused her to lack faith in medical professionals.

“Misdiagnosing [Lane] with ADHD and prescribing him meds ended up really hurting his grades,” Anne said.  “It makes me wonder what else is misdiagnosed and who is harmed in the process…You’d think doctors would be more careful when diagnosing.”

One of the main problems Lane faced with the diagnosis were the drugs prescribed to him

“I felt jittery all the time when I was on Ritalin,” Lane said, “It’s like it had the opposite effect on me. ”

According to Reichenberg that’s exactly what happens to non-ADD/ADHD patients while on the medication. Ritalin, Adderall and other ADD and ADHD medications are stimulants — meaning they stimulate and increase the release of certain neurotransmitters  such as dopamine that  attention disorder patients lack to a varying degree. People who do not have ADD or ADHD already have enough of these neurotransmitters, so putting them on stimulants will often cause an over-stimulation in their brain and a constant energetic or jittery feeling — thus creating the “opposite effect” Lane described.

Seven years after Lane’s misdiagnosis, he is an honor roll student who still gets bored in class. Lane wishes classes would be more engaging for students and thinks this might help to avoid more situations like his own.  Boredom and excess energy caused Lane to become disruptive and unfocused whereas chemical imbalances in the brain cause ADD and ADHD in patients.

“I think it’s important that doctors recognize the difference between bored or high-strung children and children with actual psychological problems,” Lane said. “[If we don’t], We could do more harm than good for children and their educations’.”

Senior Ryan McNeil said he was rightly diagnosed with ADHD at 4 years old, but he does believe other children who do not have ADD or ADHD are too often diagnosed with it.

“I think [the number of children diagnosed] is ridiculous,” McNeil said.  “Most kids have shortened attention spans and sometimes kids will act up — it’s part of life. I think some people in society use it as an excuse for their children’s behavior if they aren’t perfect kids.”

McNeil took medication including Vivance, Ritalin, Adderall and Stratera until his sophomore year when he decided he didn’t need the medication to deal with his ADHD.

“As a little kid I felt dependent on it.  It helped me concentrate but it gave me a scapegoat for when I would act up and get in trouble,” McNeil said.  “Being off of it has really helped me a lot. I can sleep better now, and it feels good to not have to depend on it.”

Studies such as the Multimodal Treatment Study of Children with ADHD, and research done by the CDC have proved that medications are effective in helping students with both weak and severe attention disorders. Reichenberg, however, thinks these mind-altering drugs should be used only when less intrusive forms of treatment such as therapy exercise, iron supplements and neurofeedback fail.

If patients are incorrectly diagnosed its unlikely they will be correctly treated.  Anne believes the main flaws lie not in the treatment of attention disorders but in the unreliable diagnostic system.  While Reichenberg and Campbell disagree about over diagnosis of ADD and ADD, all three agree the system used to diagnose ADD and ADHD is unreliable.

Multiple options are available to determine the prevalence and severity of attention disorders including interviews with the child and family member, audio/visual tests, child and parent written surveys, and other written exams such the TOVA test.  Methods of diagnosis vary with different medical professionals, but according to Reichenberg and Campbell there is no sure way to diagnose ADD or ADHD.  A child might take multiple tests, or just one test depending the methods of his or her personal medical professional.  A kid can score in the normal range on three out of four tests, but if they only take the one test that signifies they have the disorder, they can be diagnosed.

Reichenberg believes it is not helpful to group so many people with widely differing symptoms into one disorder and treat them all with similar therapy or drugs.   She has worked with children with mild to major behavior, learning and attitude problems and thinks children need to be handled as individuals and unique cases need to be looked at on a personal level rather than trying to fit the problems into a large category of psychological disorder.

“We need to either redefine ADHD and ADD, or reevaluate the severity of the cases and the severity of the medication needed,” Reichenberg said. “If we continue on this track, we will have the whole country medicated for minor behavior problems.”