User:Mcschs/KIN ADHD debate

Diagnostic Criteria

The criteria for being diagnosed ADHD come from the DSM-IV-TR which classifies ADHD as having six or more of the symptoms listed under the categories of inattention, hyperactivity and impulsivity for up to six months to a point where it is becoming disturbing in daily life. The diagnostic criteria also divides diagnosis into three different types: inattentive, hyperactivity-impulsivity, and combined.

Treatment Options

Finding empirically-based treatment methods for ADHD is important and research is currently being done to further our knowledge on this topic. Current empirically based treatments for ADHD include behavior modification techniques as well as the use of prescription medications. Combination therapy that includes behavioral therapy as well as prescription medication is the best method to manage the symptoms of ADHD, followed by medication only, then behavioral therapy only. ADHD is still not fully understood today and research is still being done to determine the causes, diagnostic criteria, and most effective treatment options for various individuals across the lifespan.

Medication Classes

There are two common classes of ADHD medications that both fall under the category of central nervous stimulants. ADHD medications can be further separated into two categories: Methylphenidates and Amphetamines. Psychopharmacological treatments have been shown to improve individual’s self-efficacy, work output, and life-skill techniques and some studies have associates the medications with little cognitive adverse effects. However, others have suggested significant side-effects associated with the drug. For example, information from an Adderall prescription states, "Tolerance, extreme psychological dependence and severe social disability have occurred; abrupt cessation following prolonged high dosage administration results in extreme fatigue and mental depression.” Negative social side-effects may also occur as a result of stimulant medications. One study found that boys taking medications experienced a social dampening effect resulting in dysphoria and decreases in social involvement. Despite these possible side-effects, The National Institute of Mental Health, or NIMH, states that, “stimulant drugs, when used with medical supervision, are usually considered quite safe.”

Epidemiology

The possible over-diagnosis of ADHD and accompanying over-prescription of stimulant medication has been a topic of controversy in many public forums. As of 2007, nearly 5.5 million children under the age of 18 were diagnosed with ADHD, whereas just over 2.5 million children under the age of 18 actually received medication as treatment, suggesting that many individuals with an ADHD diagnosis are not prescribed stimulant medication. However, according to Monczunski (2010), about 1.1 million children may have received an incorrect diagnosis of ADHD, and about 800,000 children were given stimulant medication to treat ADHD without a thorough evaluation to determine diagnosis. The study determined that children who were born right after a school’s cut-off date and who were older for their grade, were less likely to be treated for ADHD, suggesting simply a lack of maturity resulting in inaccurate diagnosis. Although over-diagnosis may be a problem, there is also significant risk associated with not providing a diagnosis early in a child’s life when they may in fact have ADHD. Early detection and, with the help of teachers and parents, providing empirically-based early interventions (including medication), can actually positively influence a child and increase the likelihood of positive outcomes later in life,. For example, one experiment compared children with ADHD both with and without medication by asking the medicated children to abstain from their medicine for 24 hours. They then administered a test to both groups that measured the executive functioning levels. The medicated group performed better than the non medicated group in areas such as attention, inhibition, working memory, and organization.

Economic Impact on Society

The controversy of over prescription of stimulants also has an economical impact on society. Each child and adult on ADHD medication is associated with a cost to individuals, health care providers, or insurance agencies with the average family with a child with ADHD or adult with ADHD spending significantly more money on pharmaceuticals then the average family or adult. Worldwide spending has also become an increasing issue. In 2002, estimated costs for those filling prescriptions were €21.8 (about $30.67) and it is expected to be about €310 ($436.17) by 2012, which is a 2.3-9.5 times increase in costs. The average cost of ADHD is about $2636 annually with a range from $719‐$5518. This price range includes all prescriptions, doctor visits, and procedures, such as therapy.

Summary

While some may be taking advantage of drug therapy, some individuals only take medication to provide a sense of “normalcy” in their life. With the growing numbers of children diagnosed with ADHD and receiving stimulant medication, the increase in research in the field, and the publicity received by the issue, over-prescription is a debate likely to continue into the future.