No Child Left Undiagnosed
Unless we soon come to our senses, the United States may become a dystopia of overdiagnosed mental illness, starting with early childhood. Already, one in five adults takes psychotropic medication on a daily basis. One in four of us has qualified for a psychiatric diagnosis in the last year, and half of us will have been diagnosed with a mental disorder at some point in our lifetime.
The statistics for children and teenagers are even more alarming: a recent study found that by age 21, 81 percent of American kids could be labeled with a mental disorder – if they are evaluated often enough and with insufficient diagnostic ardor.
In the past 20 years, the rate of attention deficit hyperactivity disorder (ADHD) diagnoses has tripled: 11 percent of all kids in this country now have a diagnosis of ADHD, and 6 percent are on daily medication for it. The situation is particularly extreme among teenage boys – one in five diagnosed, one in ten medicated. Diagnoses of developmental disorders and childhood bipolar disorder have increased 40-fold over the same time period. We are turning childhood into a disease.
A recent study of 1 million Canadian children proved that much of this shift comes from wild and unwarranted diagnoses of normal childhood behavior. Remarkably, in that study, the best predictor of an eventual ADHD diagnosis was a child’s birthday – the youngest boy in a class was almost twice as likely as the oldest to be diagnosed. There can be only one way to interpret this result: perfectly appropriate developmental immaturity is being mislabeled as a mental disorder and treated with unnecessary, expensive, and potentially harmful pills.
The short-term side effects of ADHD medication can include anxiety, insomnia, reduced appetite, weight loss, stunted growth, and increased blood pressure. But no one really knows what the long-term impact on the developing brain may be.
ADHD can be a useful diagnosis, when made carefully, for the approximately 3 percent of kids whose impairment – abnormal levels of hyperactivity, impulsivity, and difficulty focusing attention – is significant enough to require treatment, although no bright line separates a child with ADHD from one who is normally active. ADHD can be a harmful diagnosis, however, when applied carelessly to normal, active kids who will likely fare better if left alone.
The pharmaceutical industry has played a role in this epidemic of diagnoses. In 1997, its lobbying brought it permission to advertise directly to consumers, a practice allowed only in the United States and New Zealand. The result? A sector delivering annual sales close to \10$ billion – and thousands of kids taking medicine they probably don’t need.
Some child psychologists have now proposed a wholly new condition, closely related to ADHD, that could potentially subject millions more children, especially younger kids, to reckless diagnosis and treatment. “Sluggish cognitive tempo” (SCT) may be the most ill-informed invention I have encountered in my 40 years of evaluating diagnostic wish lists.
To date, SCT’s main characteristics are vaguely described and still under discussion, but include some combination of daydreaming, mind wandering, lethargy, and slow mental processing. Although no scientific consensus exists, its proponents claim that up to 2 million children may already qualify for the diagnosis, which, improbably, appears to be racing toward clinical recognition. This can only be described as a public health experiment seeking to mislabel millions more kids as “patients.”
Such shaky diagnostic suggestions typically come from “experts” brimming with confidence. Sometimes they are well-meaning, sincerely seeking to aid struggling families. Sometimes they are overly influenced by drug company support of their research. But rarely are they guided by common sense or an appropriate fear of unintended consequences. Unsurprisingly, some of the same experts who succeeded in expanding ADHD diagnosis are now advancing this new disorder, a potential disaster for the kids who would be misdiagnosed and then overmedicated.
It is time for policymakers to restrict drug company influence and for clinicians to realize that an accurate diagnosis requires time and watchful waiting. It is time for parents to step up and protect their kids, to become informed consumers, to get second opinions, and to try other approaches before resorting to medication. Finally, it is time that we improve our school systems rather than medicate our students. Instead of spending billions a year on drugs, how about providing kids with smaller classes and more gym periods so that they can blow off steam more naturally, without prescription?
ALLEN FRANCES, M.D., PSYCHOLOGY TODAY