The over Diagnosis of Adhd and the Abuse of Ritalin Essay

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The over Diagnosis of Adhd and the Abuse of Ritalin Essay

The Over diagnosis of ADHD and the Abuse of Ritalin Attention Deficit Hyperactivity disorder was unheard of in the generation previous to us. ADHD as it is now more commonly known as is one of the most frequently diagnosed psychiatric disorders occurring in children. This condition is characterized by inattention, fidgeting, lack of organization, or squirming when seated.Such children often have difficulty paying attention to details and are easily distracted by other events that are occurring at the same time; they find it difficult and unpleasant to finish their schoolwork; they put off anything that requires a sustained mental effort; they are prone to make careless mistakes, and are disorganized; they appear to listen when spoken to and often fail to follow through on tasks. ”These symptoms usually become evident in preschool or when entering elementary school but can continue into adolescence and adulthood” (Mental Health). Many of these symptoms though, appear in normal children from time to time. The over Diagnosis of Adhd and the Abuse of Ritalin Essay.

For the reason that there is no fixed test that will give an accurate reoccurring indication that the child in fact has ADHD, over diagnosis has become hard to avoid. Doctors now prescribe Methylphenidate or Ritalin to regulate attention and impulse control (Schwarzbeck). Ritalin is said to help students concentrate more in school, improves alertness, and ultimately helps the being to control the disorder thyself. In some cases, children do benefit from the medicine. Too many medicated children, however, do not accept the other forms of help they need if they are too become aware of their difficulties and learn to compensate.This leads to the overuse of the prescribed drug to counterweigh for the other forms of help they did not receive.

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Being that there is no evidence shown in any precise tests such as, brain tests or blood tests, it is difficult to identify if the young person truly should be diagnosed with the disorder (NClive). Many careful diagnostic examinations are overlooked when examining a child. Instead, physicians have begun to rely on questionnaires, which are not intended to be absolute diagnostic instruments and cannot establish a reliable diagnosis (Shwarzbeck). The danger in depending on these hazy questionnaires and psychological tests is that children don’t always react the same.There could be a different diagnosis each time. There is real danger in over diagnosing children.Which has resulted in discussions about the over diagnosis of ADHD and the abuse of Ritalin being one in the same. Over diagnosis is a major problem with Attention Deficit Hyperactivity Disorder. An estimated three to five percent of adolescents suffer from this disorder. “Boys are affected four times as often as girls” (Brazelton). Numerous children appear to be antsy, quick to anger, impatient and inattentive. Just because a child shows these indications does not mean he or she certainly has ADHD.

Mental illness, like other illness, can get worse if left untreated and lead to other chronic problems. It’s easy to be quick to diagnose a child with ADHD because the disorder and symptoms are so familiar, but for the most part it is an easier way to just deal with the problem. Attention Deficit Hyperactivity Disorder is not something a child wants to live with for the rest of their life. Although many children do adjust and learn to control the effects, other may suffer more turmoil.

About six percent of children ages five to eighteen are prescribed to Ritalin for relief from attention and hyperactivity disorders” (Monson). The over Diagnosis of Adhd and the Abuse of Ritalin Essay. ”In a recent study, in Seattle, it was found that sixty eight percent of the three hundred and twelve children who had received an ADHD diagnosis and had been prescribed stimulant medication did not have the disorder” (Schwarzbeck). Ritalin is an amphetamine like drug that activates the brain stem and causes a calming effect. Due to the drug being a central nervous system stimulant, it may be habit forming when used in doses higher then recommended dosage or for extended periods of time (Monson).Abuse had increased in Ritalin use, especially to those misdiagnosed with the disorder. A growing number of child care experts believe there are ongoing problems with the drug.

Some doctors are even referring to it as “ kiddy cocaine. ” In fact, Ritalin is a drug closely related to cocaine, it goes to the same receptor in the brain, causing the same high if taken in the same manner. Stimulants such as Ritalin are also known as uppers and beanies, along with a variety of other names. There are many reasons why Ritalin is abused. The main reason being the “high” it gives a person.

It can increase energy, alertness and attention, which are accompanied by increases in blood pressure, heart rate, and breathing. The drug is also commonly known to be abused throughout college students. They feel as if it helps them to perform better in school. It is also helpful when they need to pull those late night study sessions. Because Ritalin is so commonly prescribed, it is usually not difficult to find ways to obtain the drug, legally or illegally. Medications can be effective when they are used properly, but some can become addictive and dangerous when misused, or convenient(Monson).

For the past decade, discussions about the over diagnosis of ADHD and the abuse of Ritalin have been one in the same. Children across America are being diagnosed with this disease everyday. Most of which do not truly have the disease. Most children between the ages of one and twelve are inattentive and hyperactive, and usually pitch a fit when they do not get their way.

Doctors are overlooking the important details when diagnosing these adolescence. They are quick to prescribe Ritalin, or other stimulants, to help “solve” the child’s problem.These stimulants are very addictive if taken in the wrong manner, and are very commonly abused. Whether it be by children, teens, or adults, who may or may not have Attention Deficit Hyperactivity Disorder.

Works Cited Greene, Alan. “ADHD. ” Heathline. com.

26 Mar. 2007. 23 Sep. 2008 http://www. healthline.

com/adamcontent/attention-deficit-hyperactivity-disorder-adhd Kissinger, Meg. “Is ADHD being over diagnosed. ” www2jsonline. com.

16 Nov 2006. 23 Sep 2008. http://www2. jsonline.

com/alive/family/1116sadkid. stm “Ritalin Abuse. ” CoolNurse. com. 1 Jan 2007. 24 Sep 2008.

<http://www. coolnurse. com/adhd. htm

ADHD is the most extensively studied pediatric mental health disorder, yet controversy and public debate over the diagnosis and medication treatment of the disorder continue to exist.¹ Questions and concerns are raised by professionals, media commentators, and the public about the possibility of overdiagnosis of ADHD in youths and the possibility of overprescribing stimulant medications. Fueled by sensational media coverage that emphasizes controversy over rationality, the debate can at times become quite heated, leading to a general public assumption that ADHD is overdiagnosed and that stimulant drugs are overused and overprescribed in children and adolescents with and without ADHD.²

Trends in ADHD diagnosis and stimulant treatment

ADHD is a psychiatric disorder with a long history. It was first described by the English pediatrician Sir George Frederick Still in 1902, and initial diagnostic classifications emphasized the symptoms of hyperactivity and impulsivity. The diagnostic terms used to describe children with this disorder changed frequently in the 20th century. With the introduction of DSM-III in 1980, the symptom of inattention gained ascendancy and the condition was officially listed as attention-deficit disorder. DSM-IV contains the diagnosis of ADHD with 3 subtypes: combined, inattentive, and hyperactive-impulsive. Further modifications of the criteria for the disorder are expected when DSM-5 is introduced.

Before 1970, the diagnosis of ADHD was relatively rare for schoolchildren and almost nonexistent for adolescents and adults. Between 1980 and 2007, there was an almost 8-fold increase of ADHD prevalence in the United States compared with rates of 40 years ago. Considering the prevalence of school-administered stimulants as synonymous with the prevalence of ADHD, Safer and colleagues^3,4 estimated the prevalence of ADHD in American schoolchildren as 1% in the 1970s, 3% to 5% in the 1980s, and 4% to 5% in the mid to late 1990s. The over Diagnosis of Adhd and the Abuse of Ritalin Essay. In 2007, using data from the National Survey of Children’s Health, Visser and colleagues⁵ reported that 7.8% of youths aged 4 to 17 years had a diagnosis of ADHD and 4.3% reported current use of a medication for the disorder.

The rise in prevalence stemmed from a complex confluence of forces and events that came together in the first half of the 1990s and permitted a dramatic expansion of ADHD diagnosis and treatment.⁶ The growing political strength of children’s welfare advocates and the mental health consumer’s movement associated with decreasing stigma resulted in changes to federally funded special education programs. The Individuals with Disabilities Education Act recognized ADHD as a disability, and children with ADHD became eligible for school accommodations.

Beginning in the 1990s, Congress expanded eligibility criteria for Medicaid, especially for children. This fueled a rapid increase in coverage for psychotropic medications, including stimulants.⁶ At the same time, scientific knowledge about the longitudinal course of ADHD and its lifetime morbidity, heritability, and neurobiology was rapidly increasing, This provided empiric evidence as well as a scientific and neurobiological rationale for medication intervention.^7,8 Also, the managed care psychiatric carve-out health insurance industry sought to rein in the costs associated with psychiatric illness and supported pharmacological interventions for complex psychiatric disorders, including pediatric disorders.

In 1997, Congress passed the FDA Modernization Act, which encouraged the pharmaceutical industry to develop and test drugs for children by extending patent exclusivity. This resulted in a dramatic increase in randomized controlled trials in children that involved stimulant compounds for ADHD and further supported an evidence-based rationale for medication intervention in ADHD. As a result, the prescribing of stimulants for children with ADHD increased 4-fold between 1987 and 1996, with a further increase of 9.5% between 2000 and 2005. Currently, slightly more than 4% of children and adolescents in the United States use ADHD medications.^5,9

Doubt and confusion as to where this disorder fits into the general spectrum of illness further feeds the general perception that ADHD is a socially constructed disorder rather than a valid neurobiological disorder.

The rise in stimulant prescribing for youths must be taken in context. Between 1990 and 2005 there was a rapid rise in pediatric prescriptions for many psychiatric medications-not only stimulants. There was a 5-fold increase for antipsychotics between 1993 and 2002, and a 3-fold increase for antidepressants between 1997 and 2002.^10,11 Thus, the rise in stimulant prescribing for pediatric ADHD was only part of a larger shift to an emphasis on medication interventions for the treatment of children with early-onset and complex behavioral and mental health disorders. The over Diagnosis of Adhd and the Abuse of Ritalin Essay.

Stimulant overprescribing

Public perception of stimulant overprescribing is driven by concerns over the rapid rise in the amount of available stimulants produced in the United States over the past 3 decades. For sale stimulant production quotas are published yearly by the Drug Enforcement Administration.¹² The rapid rise in the production quota of for-sale methylphenidate (excluding amphetamine) is seen in the Figure. With the production of more stimulants every year, worries about the increased availability of stimulants for abuse and diversion rise as well. Rising production rates are cited as proof of stimulant overprescribing by physicians and indirect evidence of the overdiagnosis of ADHD among children.²

The extant scientific research suggests a much more complicated and nuanced picture of stimulant prescribing. Comparisons of the prevalence of ADHD among youths aged 4 to 17 years (7.8%) with stimulant prescription rates of between 4.3% and 4.4% do not support the idea of a culture of permissive stimulant overprescribing.^5,9 Moreover, recent data from the National Health and Nutrition Examination Survey, a nationally representative probability sample of children aged 8 to 15 years living in the community, indicated an ADHD prevalence rate of 7.8%. However, only 48% of the ADHD sample had received any mental health care over the past 12 months.¹³

Clearly, not every person who meets criteria for ADHD is in need of a medication intervention. A discrepancy between ADHD prevalence and rates of stimulant prescriptions does not automatically prove that medications are underprescribed in the population. Nor do data support a conclusion that an epidemic of ADHD med-ication overprescribing is occurring.

Stimulant prescription rates are complex and vary by geographic location, age, and gender.¹⁴Studies have found overprescribing in some regions of the United States and underprescribing in others. As reported by the CDC in 2003, ADHD prevalence ranged from a low of 5.0% in Colorado to a high of 11.1% in Alabama. Rates of medication treatment for ADHD ranged from 40.6% of patients in California to 68.5% in Nebraska.¹⁴These data do not sug-gest a pattern of overprescribing of stimulants. However, in an 11-county epidemiological study of mental health status among children in western North Carolina, Angold and colleagues¹⁵found that 7.3% of children were receiving stimulants but only 3.4% of children met an unequivocal diagnosis of ADHD, which suggests that pockets of overprescribing do exist. The over Diagnosis of Adhd and the Abuse of Ritalin Essay.

In addition, stimulant prescription rates vary by sex and age. ADHD diagnostic rates and stimulant treatment rates are higher in boys than in girls younger than 20 years.⁹ Rates of stimulant treatment are highest among boys aged 12 years and girls aged 11 years, and they decline with age.¹⁴ The National Survey of Children’s Health showed that the factors associated with medication treatment for ADHD included younger age, the burden of impairment from symptoms, and a recent health care contact.⁵ Some factors associated with possible ADHD misdiagnosis and stimulant misprescribing are listed inTable 1.

Simple pronouncements of the overmedication of youth with ADHD based on temporal trends in the absolute rate of rise of stimulant quota production and stimulant prescriptions cannot be supported. The majority of the literature published to date does not support the general idea that ADHD is overdiagnosed nor does it support the idea that stimulants are overprescribed in children and adolescents in the United States. However, the data also suggest that there continue to be geographic areas of stimulant overprescribing or inappropriate prescribing.

What is already known about overdiagnosis and overprescribing in ADHD?

? ADHD is the most extensively studied pediatric mental health disorder, yet controversy and public debate over the diagnosis and medication treatment of the disorder continue. Questions and concerns continue to be raised by professionals, media commentators, and the public about the possibility that ADHD is overdiagnosed in youths and that stimulants are overprescribed.

What new information does this article provide?

? This article reviews what is known about the prevalence of ADHD and stimulant prescribing rates in children and adolescents in the United States. While the data do not suggest a general problem with ADHD overdiagnosis and stimulant overprescribing, there continues to be variability in diagnosis and prescribing rates. Reasons for the continued controversy include fears of stimulant abuse and diversion, physician overprescribing, limited managed care carve-out payer resources to support evidence-based standards of ADHD evaluation and treatment, and continuing unease as to the legitimacy of the ADHD diagnosis. The over Diagnosis of Adhd and the Abuse of Ritalin Essay.

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What are the implications for psychiatric practice?

? Comprehensive physician ADHD evaluation practices are essential for accomplishing evidence-based stimulant prescribing and for reducing unwanted variation in stimulant prescribing rates. This, in turn, should help reassure the public that management is accomplished consistently and with due expertise.

Stimulant abuse and diversion

Despite more than 250 randomized controlled medication trials attesting to the efficacy and safety of stimulant use in patients with ADHD, there continues to be controversy, especially regarding abuse and diversion. It is important to distinguish between these issues. Stimulant abuse refers to the continued use of a drug that leads to significant impairment in daily functioning characterized by recurrent use under hazardous conditions, such as while driving an automobile or operating machinery, and by legal and interpersonal problems.¹⁶ Diversion is the practice by which legitimate stimulant prescriptions for ADHD are diverted for reasons other than treating ADHD.¹⁷

Methylphenidate and amphetamine used to treat the core ADHD symptoms of inattention, impulsivity, and hyperactivity have an established potential for abuse. Preclinical and clinical studies show that both types of stimulants have reinforcing effects that are similar to each other and to drugs of abuse, such as cocaine.^16,18Findings from a study by Biederman and colleagues¹⁹ indicate that a diagnosis of ADHD increases the risk of early-onset substance use disorders that have an aggressive course. These data suggest a potential relationship between ADHD, stimulant treatment, and later substance use disorders.

However, despite the established abuse potential of stimulants, the evidence that methylphenidate and amphetamine are readily abused in the ADHD population in the formulations and doses used clinically is limited.¹⁶ Rather than abusing stimulants, patients with ADHD frequently take less medication than prescribed.²⁰ The reinforcing effects of stimulants in ADHD patients may be associated more with clinical efficacy than with abuse liability.

Neuroimaging research demonstrates both pharmacokinetic and pharmacodynamic differences in the euphoric and abuse liability effects of methylphenidate and cocaine in humans.²¹ Agents such as cocaine that demonstrate rapid absorption and rapid turnover at CNS synaptic dopamine receptors are associated with euphoric and abuse liability effects. The over Diagnosis of Adhd and the Abuse of Ritalin Essay. The same rapid changes in drug concentration can be achieved through intranasal or intravenous, rather than oral, immediate-release (IR) stimulants. Drugs such as oral methylphenidate demonstrate slower absorption and longer temporal CNS dopamine receptor binding and release properties and are associated more with therapeutic effects than with abuse liability effects.

The drug release technology of long-acting stimulants that have a beaded or osmotic release mechanism or that are covalently bonded to an amino acid that mimics the pharmacokinetic properties of IR methylphenidate or IR amphetamine given 2 or 3 times daily makes intranasal and intravenous use difficult.¹⁷ Thus, while stimulants have properties consistent with abuse liability, their clinical use in ADHD patients does not suggest widespread abuse.

Stimulants are not without some abuse risk in clinical populations. Abuse rates rise in persons with ADHD comorbid with substance use disorders and/or other disruptive behavior diagnoses, such as oppositional defiant disorder and conduct disorder.²²Coexisting bipolar disorder increases the risk of stimulant abuse. A family history of substance use disorders increases risk. In such cases, careful monitoring and follow-up are recommended. The over Diagnosis of Adhd and the Abuse of Ritalin Essay.

The over Diagnosis of Adhd and the Abuse of Ritalin Essay

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