ADHD 'redefinition' underway?

The research team used the fairly new standard for ADHD diagnosis found in the fourth and latest edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV). This is the first study to use this standard to calculate ADHD's prevalence in the population. According to the researchers' application of the standard, 2.4 million children between the ages of eight and 15 have ADHD — 9% of all children in that age group. Only 48% of these have been diagnosed with ADHD, and only 32% receive drug treatment.

This hits the news now despite an increasingly popular sense that ADHD drugs are actually over-prescribed. As it turns out, this particular study was funded in part by a group with "close financial and policy ties with the pharmaceutical industry," and criticism of the research has quickly bubbled up, centering around how ADHD is potentially being "redefined" on essentially a semantic level, without a correlate in terms of actual biological evidence:

Since ADHD does not have any strictly biological markers the way diseases like diabetes and cancer do, its definition is — or was — based on statistical rarity. By definition, ADHD is a disorder in which children act more hyperactive, less attentive, etc., than other children their age.... "Unless a biological marker is identified, an agreed-upon gold standard diagnostic procedure is established, or ADHD is redefined, a population-based ADHD rate exceeding 3% to 5% by definition represents a problem of ADHD over-diagnosis." The recent study may indicate that just such a redefinition of ADHD is occurring.

Of course, an increase in diagnoses will mean an increase in prescriptions, but as this news report and others indicate, the current slate of ADHD drugs offers no magic bullet:

The study's authors also treated it as a given that stimulant drugs are the most effective treatment for ADHD. Recent scientific evidence tells a different story. Ritalin, the most popular ADHD drug, improves children's behavior in the short term, but the advantage compared to behavioral intervention wears off within three years. A major study demonstrated this in August's Journal of the American Academy of Child and Adolescent Psychiatry. After three years, children who receive only behavioral intervention are as well-behaved as those who take drugs, and have several advantages: they have learned to control their symptoms on their own, and have avoided the side effects of Ritalin, which include stunted growth. This news, however, made less of a splash than the 9% study. Just days after the study's publication, various researchers and practitioners called out for more children to go on ADHD drugs.

What's a reasonably well-read parent to do in circumstances like these? I've included a round-up of DoseNation posts on the topic which, cumulatively, all seem to point toward "steer very clear," but as a diligent non-parent, that's pretty easy for me to say without having to worry about any impact.