America is running low on Adderall. A shortage of the stimulant drug, commonly used to treat ADHD, is leaving many of its prescriptions unfilled. But why are so many people being diagnosed with ADHD in the first place?
“There are multiple studies, peer reviewed studies indicating that ADHD diagnoses have been increasing in the U.S. Including in childhood populations,” said Paul Morgan, professor and researcher at Penn State University.
A 2018 study published by University of Iowa researchers in JAMA shows a 4.1% increase in ADHD diagnoses among children from 1997 to 2016.
“And a particular focus of that work is trying to understand disparities in ADHD diagnosis and treatment,” said Morgan. He studies data on elementary school students nationwide. Morgan explains that one potential reason for more diagnoses is the growing awareness of ADHD and the treatments that come with it.
More teachers have been on the lookout for symptoms, particularly since 1991. That’s when the Department of Education released a memo saying that students with ADHD might qualify for special education services.
ADHD awareness has also spread through the media, though not all of the information about it is true. Doctors are speaking up about TikTok influencers spreading incorrect information regarding their supposed diagnoses.
And telehealth startups, like Done, are using the platform to advertise medications for better focus and time management.nWith knowledge of the disorder, people are more likely to seek medical help if they feel they need it. Morgan says the rising number of ADHD cases could also be the result of incorrect diagnoses.
“Usually the person that’s making the diagnosis in childhood is a pediatrician, or maybe a psychiatrist – some health professional. They’re typically asking parents to complete ratings of the kids’ behaviors. And they’ll usually give several sets, one for the parent and one for teachers to complete,” said Morgan.
The professional is looking for persistent patterns of inattention and hyperactivity or impulsivity. It’s a subjective process with room for error.
“Many other problems, like sleep disorders, anxiety, depression and certain types of learning disabilities, can have similar symptoms,” said the CDC, adding there is no single test to diagnose ADHD.
Studies show a child’s environment can also influence their behavior. In a 2012 article published in Psychological Science, researchers found that “noisy, crowded homes characterized by a lack of routines may undermine children’s ability to regulate emotions and behavior and may provide children with opportunities to act out.”
“So I would say there’s repeated evidence that some children are being overdiagnosed for ADHD,” said Morgan.
Researchers in Australia found “convincing evidence of ADHD overdiagnosis and overtreatment in children and adolescents.” Their study was published in 2021 using data from various countries.
Some experts prefer the term “misdiagnosis,” to “overdiagnosis,” as they say some people go undiagnosed.
Whether a child truly needs it or not, a drug like Adderall can introduce side effects. They include difficulty sleeping, aches and nausea, reduced appetite and fainting or dizziness. Less common side effects include things like suicidal thoughts and hallucinations.
“If the child truly has ADHD, I think that there’s lots of evidence for different types of treatments, medication but also treatments that don’t require medication, some version of behavioral therapy,” said Morgan. He adds that it’s unclear whether remote learning or telehealth opportunities during the pandemic had any effect on ADHD diagnoses. It’s likely too soon for research on that period of time to be published.
SHANNON LONGWORTH: AMERICA IS RUNNING LOW ON ADDERALL. A SHORTAGE OF THE STIMULANT DRUG, COMMONLY USED TO TREAT ADHD, IS LEAVING MANY OF ITS PRESCRIPTIONS UNFILLED. BUT WHY ARE SO MANY PEOPLE BEING DIAGNOSED WITH ADHD IN THE FIRST PLACE?
PAUL MORGAN | PROFESSOR, PENN STATE UNIVERSITY: “THERE ARE MULTIPLE STUDIES, PEER REVIEWED STUDIES INDICATING THAT ADHD DIAGNOSES HAVE BEEN INCREASING IN THE US, INCLUDING IN CHILDHOOD POPULATIONS.”
LONGWORTH: A 2018 STUDY PUBLISHED BY IOWA CITY RESEARCHERS IN JAMA SHOWS A 4.1% INCREASE IN ADHD DIAGNOSES AMONG CHILDREN FROM 1997 TO 2016.
MORGAN: “AND A PARTICULAR FOCUS OF THAT WORK IS TRYING TO UNDERSTAND DISPARITIES IN ADHD DIAGNOSIS AND TREATMENT.”
LONGWORTH: MORGAN STUDIES DATA ON ELEMENTARY SCHOOL STUDENTS NATIONWIDE. HE EXPLAINS THAT ONE POTENTIAL REASON FOR MORE DIAGNOSES IS THE GROWING AWARENESS OF ADHD AND THE TREATMENTS THAT COME WITH IT.
MORE TEACHERS HAVE BEEN ON THE LOOKOUT FOR SYMPTOMS, PARTICULARLY SINCE 1991. THAT’S WHEN THE DEPARTMENT OF EDUCATION RELEASED A MEMO SAYING THAT STUDENTS WITH ADHD MIGHT QUALIFY FOR SPECIAL EDUCATION SERVICES.
ADHD AWARENESS HAS ALSO SPREAD THROUGH THE MEDIA, THOUGH NOT ALL OF THE INFORMATION ABOUT IT IS TRUE. DOCTORS ARE SPEAKING UP ABOUT TIKTOK INFLUENCERS SPREADING INCORRECT INFORMATION REGARDING THEIR SUPPOSED DIAGNOSES.
AND TELEHEALTH STARTUPS, LIKE DONE., ARE USING THE PLATFORM TO ADVERTISE MEDICATIONS FOR BETTER FOCUS AND TIME MANAGEMENT.
WITH KNOWLEDGE OF THE DISORDER, PEOPLE ARE MORE LIKELY TO SEEK MEDICAL HELP IF THEY FEEL THEY NEED IT.
MORGAN SAYS THE RISING NUMBER OF ADHD CASES COULD ALSO BE THE RESULT OF INCORRECT DIAGNOSES.
MORGAN: “USUALLY THE PERSON THAT’S MAKING THE DIAGNOSIS IN CHILDHOOD IS A PEDIATRICIAN, OR MAYBE A PSYCHIATRIST– SOME HEALTH PROFESSIONAL. THEY’RE TYPICALLY ASKING PARENTS TO COMPLETE RATINGS OF THE KIDS’ BEHAVIORS. AND THEY’LL USUALLY GIVE SEVERAL SETS, ONE FOR THE PARENT AND ONE FOR TEACHERS TO COMPLETE.”
LONGWORTH: THE PROFESSIONAL IS LOOKING FOR PERSISTENT PATTERNS OF INATTENTION AND HYPERACTIVITY OR IMPULSIVITY. IT’S A SUBJECTIVE PROCESS WITH ROOM FOR ERROR.
THE CDC: “MANY OTHER PROBLEMS, LIKE SLEEP DISORDERS, ANXIETY, DEPRESSION, AND CERTAIN TYPES OF LEARNING DISABILITIES, CAN HAVE SIMILAR SYMPTOMS.” THE CDC ADDING THAT THERE IS NO SINGLE TEST TO DIAGNOSE ADHD.
LONGWORTH: STUDIES SHOW A CHILD’S ENVIRONMENT CAN ALSO INFLUENCE THEIR BEHAVIOR. IN A 2012 ARTICLE PUBLISHED IN PSYCHOLOGICAL SCIENCE, RESEARCHERS FOUND THAT “NOISY, CROWDED HOMES CHARACTERIZED BY A LACK OF ROUTINES MAY UNDERMINE CHILDREN’S ABILITY TO REGULATE EMOTIONS AND BEHAVIOR AND MAY PROVIDE CHILDREN WITH OPPORTUNITIES TO ACT OUT.”
MORGAN: “SO I WOULD SAY THERE’S REPEATED EVIDENCE THAT SOME CHILDREN ARE BEING OVER DIAGNOSED FOR ADHD.”
LONGWORTH: RESEARCHERS IN AUSTRALIA FOUND “CONVINCING EVIDENCE OF ADHD OVERDIAGNOSIS AND OVERTREATMENT IN CHILDREN AND ADOLESCENTS.” THEIR STUDY WAS PUBLISHED IN 2021 USING DATA FROM VARIOUS COUNTRIES.
NOTE THAT SOME EXPERTS PREFER THE TERM “MISDIAGNOSIS,” TO “OVERDIAGNOSIS,” AS THEY SAY SOME PEOPLE GO UNDIAGNOSED.
WHETHER A CHILD TRULY NEEDS IT OR NOT, A DRUG LIKE ADDERALL CAN INTRODUCE SIDE EFFECTS SUCH AS DIFFICULTY SLEEPING, ACHES AND NAUSEA, REDUCED APPETITE, AND FAINTING OR DIZZINESS. LESS COMMON SIDE EFFECTS INCLUDE THINGS LIKE SUICIDAL THOUGHTS AND HALLUCINATIONS.
MORGAN: “IF THE CHILD TRULY HAS ADHD, I THINK THAT THERE’S LOTS OF EVIDENCE FOR DIFFERENT TYPES OF TREATMENTS, MEDICATION BUT ALSO TREATMENTS THAT DON’T REQUIRE MEDICATION, SOME VERSION OF BEHAVIORAL THERAPY.”
MORGAN SAID IT’S UNCLEAR WHETHER REMOTE LEARNING OR TELEHEALTH OPPORTUNITIES DURING THE PANDEMIC HAD ANY EFFECT ON ADHD DIAGNOSES. IT’S LIKELY TOO SOON FOR RESEARCH ON THAT PERIOD OF TIME TO BE PUBLISHED.