Problems of Overdiagnosis and Overprescribing in ADHD
By Daniel F. Connor, MD |
August 11, 2011
Dr Connor is Lockean Distinguished Professor of Psychiatry and Chief, Division of Child and Adolescent Psychiatry at the University of Connecticut School of Medicine in Farmington. Dr Connor reports that he receives grant support from Shire Pharmaceuticals, Inc, and is a consultant for Shire and Supernus Pharmaceuticals, Inc. He receives royalties from the Guilford Press and WW Norton and Co. He also receives support from the NIMH and contracts for the state of Connecticut.
Continued controversy over whether ADHD is overdiagnosed and stimulants overprescribed despite much scientific data to the contrary reflects ongoing public discomfort about ADHD as a valid and legitimate disorder. For example, the public perceives that children and adults with a medical disorder should look and act sick, whereas many of the core ADHD symptoms are seen in lively, willful, and exuberant persons. Moreover, the general perception is that medications prescribed to treat illness (ie, antibiotics) are supposed to act differently in sick persons than in healthy individuals and that stimulants work the same way in children and adults to enhance sustained vigilance whether they have a diagnosis of ADHD or not. Furthermore, the definition of ADHD seems to change frequently. If the definition of ADHD keeps changing, is it a genuine medical disorder?
Despite overwhelming scientific evidence of the legitimacy of ADHD as a CNS neurobiological disorder, the general public appears confused about ADHD: is it a medical illness, a psychiatric syndrome, a mental disorder, a behavioral health disorder, a behavioral problem, a motivational problem, or a school-based learning and socialization problem?1,7,8 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. This increases the public’s concern that ADHD is overdiagnosed and stimulants are overprescribed.
The public’s fear that ADHD is overdiagnosed and that stimulants are overprescribed is not generally supported by the current scientific research. Reasons for the continued controversy include fears of stimulant abuse and diversion, physician overprescribing, limited payer resources to support evidence-based standards of ADHD evaluation and treatment, and continuing unease as to the legitimacy of the ADHD diagnosis. Comprehensive physician ADHD evaluation practices are essential to accomplishing evidence-based stimulant prescribing and to reduce unwanted variation in stimulant prescribing rates that should, in turn, reassure the public that management is accomplished consistently and with due expertise.
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