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Study: Rates of ADHD diagnosis and medication treatment continue to increase substantially

Begin­ning in about 1990, sub­stan­tial increas­es in the rates of ADHD diag­no­sis and med­ical treat­ment were found in sev­er­al nation­al­ly rep­re­sen­ta­tive sam­ples of US physi­cian office vis­its. For exam­ple, between 1995–96 and 2007-08, the num­ber of office vis­its at which an ADHD diag­no­sis was made increased by over 400% in adults — from 3.1 per 1000 vis­its to 14.5 per 1000 vis­its. And, the per­cent of adult office vis­its includ­ing both ADHD diag­no­sis and med­ica­tion increased from 1.9 to 11.4 per 1000 vis­its.

Among chil­dren aged 5 to 18, between 1991–92 and 2008-09, rates of ADHD diag­no­sis increased near­ly 4‑fold among boys — from 39.5 to 144.6 per 1000 — and near­ly 6‑fold for girls — from 12.3 and 68.5 per 1000 vis­its. Dur­ing this time, the rate of vis­its that also involved med­ica­tion treat­ment increased by sim­i­lar rates. Read the rest of this entry »

Study finds large gaps between research and practice in ADHD diagnosis and treatment

doctor-office-illustration

Most chil­dren with ADHD receive their care from com­mu­ni­ty-based pedi­a­tri­cians. Giv­en the large num­ber of school-age chil­dren who require eval­u­a­tion and treat­ment ser­vices for ADHD, and the adverse impact that poor qual­i­ty care can have on chil­dren’s devel­op­ment, it is impor­tant for chil­dren to rou­tine­ly receive care in the com­mu­ni­ty that is con­sis­tent with best-prac­tice guide­lines.

The Amer­i­can Acad­e­my of Pedi­atrics has clear­ly rec­og­nized this and pub­lished guide­lines for Read the rest of this entry »

Sensible and perplexing changes in ADHD diagnostic criteria (DSM‑V)

Taking a Closer Look at ADHD Attention Deficit DisorderThe Amer­i­can Psy­chi­atric Asso­ci­a­tion recent­ly pub­lished DSM‑V, the first major revi­sion to the diag­nos­tic man­u­al for psy­chi­atric dis­or­ders since 1994. In DSM‑V, ADHD is includ­ed in the sec­tion on Neu­rode­vel­op­men­tal Dis­or­ders, rather than being grouped with the dis­rup­tive behav­ior dis­or­ders, i.e., Oppo­si­tion­al Defi­ant Dis­or­der and Con­duct Dis­or­der. This change bet­ter reflects the way ADHD is cur­rent­ly con­cep­tu­al­ized.

Below I review changes that have been made to the actu­al diag­nos­tic cri­te­ria for ADHD. Read the rest of this entry »

Rethinking the Classification of Mental Illness

The new Diag­nos­tic and Sta­tis­ti­cal Man­u­al of Men­tal Dis­or­ders (DSM-5) is sched­uled to be released in May 2013. This recent Dana Foun­da­tion arti­cle points out the need of a fun­da­men­tal­ly dif­fer­ent approach based on the new ways researchers use to study and under­stand men­tal ill­ness.

The prob­lem with the DSM-IV, our cur­rent shared diag­nos­tic lan­guage, is that a large and grow­ing body of evi­dence demon­strates that it does a poor job of cap­tur­ing either clin­i­cal and bio­log­i­cal real­i­ties. In the clin­ic, the lim­i­ta­tions of the cur­rent DSM-IV approach can be illus­trat­ed in three salient areas: (1) the prob­lem of comor­bid­i­ty, (2) the wide­spread need for “not oth­er­wise spe­cif­ic (NOS)” diag­noses, and (3) the arbi­trari­ness of diag­nos­tic thresh­olds.

What­ev­er the ulti­mate approach to the DSM‑5, it is crit­i­cal that the sci­en­tif­ic com­mu­ni­ty escape the arti­fi­cial diag­nos­tic silos that con­trol so much research, ulti­mate­ly to our detri­ment.

Key ques­tions: How can we give the research com­mu­ni­ty not only per­mis­sion but also encour­age­ment to rethink the clas­si­fi­ca­tion of psy­chopathol­o­gy? How can we encour­age sci­en­tif­ic inno­va­tion while ensur­ing that clin­i­cians can still com­mu­ni­cate with patients and families—and also with insur­ance com­pa­nies, schools, and courts?

Shall we question the brand new book of human troubles

With three years still left until pub­li­ca­tion, the fights over the new ver­sion of the psy­chi­atric diag­nos­tic man­u­al, the DSM‑V, are hot­ting up and The New York Times has a bookcon­cise arti­cle that cov­ers most of the main point of con­tention.

- “What you have in the end,  Mr. Short­er said, “is this process of sort­ing the deck of symp­toms into syn­dromes, and the out­come all depends on how the cards fall.

- Psy­chi­a­trists involved in prepar­ing the new man­u­al con­tend that it is too ear­ly to say for sure which cards will be added and which dropped.

Although I doubt the DSM com­mit­tee are using that exact metaphor, it cer­tain­ly illus­trates the point that the process requires a cer­tain degree of val­ue-judge­ment.

It’s inter­est­ing, how­ev­er, that the pub­lic debate is cur­rent­ly focused on whether cer­tain diag­noses should be includ­ed or not, rather than whether diag­no­sis itself is use­ful for psy­chi­a­try.

We’ve had psy­cho­met­rics for a good 100 years that allow us to mea­sure dimen­sions of human expe­ri­ence and per­for­mance with a much greater degree of accu­ra­cy than Read the rest of this entry »

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As seen in The New York Times, The Wall Street Journal, BBC News, CNN, Reuters,  SharpBrains is an independent market research firm tracking how brain science can improve our health and our lives.

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