Is ADHD on the rise?

Though several sources agree that attention deficit/hyperactivity disorder (ADHD) is is on the rise, new numbers question how much. According to a recent study published in JAMA Pediatrics, diagnoses of ADHD increased 24 percent in Southern California over the past 10 years, bringing to issue previous estimates.

 As part of the study, doctors reviewed the charts of children treated at the Kaiser Permanante Southern California physician’s group from 2001 to 2010 – 842,830 children in all. They found that in 2001, 2.5 percent of children age 5 to 11 were diagnosed with ADHD, but that number increased to 3.1 percent in 2010.

The Centers for Disease Control and Prevention (CDC) estimates that about 9.5 percent of children age 4 to 17 have ADHD. Researchers in the California study believe their estimate gives a more accurate picture of the rate of ADHD in Southern California because they reviewed actual medical records, rather than relying on parents to respond to telephone surveys, which is how the CDC got its number. Furthermore, the majority of ADHD diagnoses in the California study were made by specialists using strict Diagnostic and Statistic Manual of Mental Disorders (DSM-IV) diagnoses. This complicates previous estimates, as new research found that only 38 percent of primary care physicians actually use the DSM-IV for diagnosing ADHD.

Why Children Bully: New Research Links Bullying to Mental Health Problems

A great deal of research over the years has focused on the devastating effects of bullying on the mental health of its victims. However, a recent study also suggests that children with mental disorders such as attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and depression are much more likely to engage in bullying behavior toward others.

Lead author Dr. Frances Turcotte-Benedict, a Brown University masters of public health student and a fellow at Hasbro Children’s Hospital in Providence, presented the findings at the American Academy of Pediatrics’ national conference in New Orleans on October 22. Turcotte-Benedict and her colleagues reviewed data provided by parents and guardians on mental health and bullying in the 2007 National Survey of Children’s Health, which included nearly 64,000 children ages 6 to 17 years.

In the survey, 15.2 percent of children were identified as a bully by their parent or guardian. Children with a diagnosis of depression or ADHD were three times as likely to be identified as bullies; children diagnosed with ODD were identified as bullies six times more often than children with no mental health disorders. The study found no noticeable differences between boys and girls—both were at increased risk for bullying when a mental health disorder was present.

Traits associated with ODD, such as aggression and revenge-seeking, appear to be clear risk factors for bullying. The connection between bullying and ADHD may be less obvious. “Even though, by definition, these children [with ADHD] aren’t angry or aggressive toward their peers, they do display traits that would increase the likelihood of having impaired social interactions,” explains Dr. Steven Myers, a professor of psychology at Roosevelt University in Chicago, in an October 22 interview with the Huffington Post. “If you’re not really thinking through the consequences of your actions on the playground, you might not have the self-monitoring or restraint to hold back from bullying.”

“These findings highlight the importance of providing psychological support not only to victims of bullying, but to bullies as well,” concludes Turcotte-Benedict. “In order to create successful anti-bullying prevention and intervention programs, there certainly is a need for more research to understand the relationship more thoroughly, and especially, the risk profile of childhood bullies.”

What do you think? Should bullying prevention programs do more to address the mental health problems of the bully? PAR wants to hear from you, so leave a comment and join the conversation!

Does Birth Date Have an Impact on ADHD Diagnosis?

According to an eleven-year-long study by a group of Canadian researchers, it appears that the youngest students in a class are more likely to be diagnosed with attention deficit hyperactivity disorder (ADHD) than peers born at other points in the year.

The study, conducted by University of British Columbia researchers and headed up health research analyst Richard Morrow, finds that children born the month of the school’s cut-off date were more likely to receive an ADHD diagnosis than those born just a month later. After studying nearly 930,000 children in British Columbia, which has a cut-off date for enrollment of December 31, it was found that boys born in December were 30 percent more likely to be given an ADHD diagnosis than those born in January. Girls with December birthdays were 70 percent more likely to receive this diagnosis than those born in January. Furthermore, boys and girls with December birthdays were 41 percent and  77 percent more likely, respectively, to be treated with prescription medication for ADHD than those born the following month.

While researchers believe their analyses show a relative-age effect in the diagnosis and treatment of children age 6-12 years, they warn that these findings raise concerns about the potential for overdiagnosis and overprescribing in the youngest students because the lack of maturity in younger students may be misinterpreted as symptoms of ADHD. ADHD is currently the most commonly diagnosed neurobehavioral disorder in children.

For more information on this study, visit the Canadian Medical Association Journal.

Diagnosing and Treating ADHD in Younger Children: New Guidelines

Guidelines from the American Academy of Pediatrics released in October suggest that attention deficit hyperactivity disorder can be diagnosed and treated in children as young as age 4, two years younger than the previous minimum age set by AAP a decade ago.

Mark Wolraich, the lead author of the ADHD clinical practice guidelines and a professor of pediatrics at the University of Oklahoma Health Sciences Center, told the Wall Street Journal recently that ADHD in a preschool-aged child is very different from the typically active behavior seen in most young children (www.online.wsj.com, October 17). A child with ADHD often doesn’t play well with other children, is prone to accidents, and is overactive much of the time. “It’s not the environmental things like parties triggering it,” Dr. Wolraich says.

According to the new guidelines, behavior management should be the first approach for treating preschool-aged children. But when behavioral interventions aren’t enough, the guidelines suggest that doctors consider prescribing methylphenidate (commonly known by the brand name Ritalin) for preschool-aged children with moderate to severe symptoms.

Other key recommendations include assessing children for other conditions that might coexist with ADHD, such as oppositional defiant and conduct disorders, anxiety, and depression.

“Treating children at a young age is important,” asserts Dr. Wolraich, “because when we can identify them earlier and provide appropriate treatment, we can increase their chances of succeeding in school.”

For more information, or to request a complete copy of the guidelines, visit www.aap.org.

What do you think about the new ADHD guidelines? Will they affect your practice? Join the conversation—leave a comment now!