ADHD Over-Diagnosis and Treatment Options

When I was a kid, as far as I was aware, not one of my classmates had Attention Deficit Hyperactivity Disorder (ADHD). In fact, it wasn’t until high school that I realized lots of grade school children had this condition. Now, many years later, it seems ADHD is everywhere.

In Disease-Proof Your Child Dr. Fuhrman says, “The diagnosis and treatment of Attention Deficit Hyperactivity Disorder has skyrocketed in recent years, with a tremendous increase in the percentage of our elementary school children who are taking amphetamines and stimulants such as Ritalin, Adderall, Concerta, Cylert, and others.” So as a layman, I wonder—what's going on here? Is this some kind of epidemic?

Dr. Flea, a doctor-blogger offers some evidence for the over-diagnosis of ADHD. He references an article in The Scientific Review of Mental Health Practice (SRMHP):
ADHD is diagnosed and treated differently in communities across the United States, as evidenced by the 30-fold variation in per capita rates of Ritalin use. The probability that ADHD is diagnosed appropriately in some communities should not serve to dismiss concerns about overdiagnosis in all communities. Rates of treatment are consistently highest among younger (i.e., under age 10), nonminority, and male school-age children. The evidence of ADHD overdiagnosis is obscured when findings are reported without respect to geographic location, race, gender, and age. The fact that ADHD is clearly overdiagnosed in some communities and among some groups of children (e.g., one in every three white elementary-aged boys in southeastern Virginia) is lost in nationwide estimates of ADHD drug treatment. It is essential that mechanisms be established to track rates of child mental health diagnoses and psychotropic drug treatment and its outcomes among American children. Until we have a better understanding of these issues, it is appropriate to be judicious in our use of psychotropic medications and cautious about dismissal of concern about ADHD overdiagnosis.
In Disease-Proof Your Child Dr. Fuhrman explains that, “As many as 9 percent of school-age children show symptoms of ADHD such as inattention, hyperactivity, impulsivity, academic underachievement, or behavioral problems.”1 He goes on further to explain that stimulants and amphetamines are unnecessary for treating these children, and that nutritional excellence is a better option:
These medications with their reported adverse effects and potential dangers were simply unnecessary for so many children whom I have seen as patients. I have witnessed consistently positive results when these children followed my comprehensive program of nutritional excellence. The scientific studies lending support to a comprehensive nutritional approach to treating ADHD are ignored by physicians, and drugs are generally the only method offered.

Most new cases of ADHD are of the inattentive subtype. Inattentive ADHD are the children who have a short attention span, are easily distracted, and can appear to be a brain fog; they do not have hyperactivity. Research on the use of psychostimulants in these patients has shown high rate of nonresponders, and although medications showed a short-term decrease in symptoms, they did not improve grade point averages.2

Before a parent begins to consider the pros and cons of starting their inattentive child on stimulants such as Ritalin, they should give nutritional excellence a trial. Nobody knows for sure the long-term dangers of these stimulant drugs or if taking them for a long period of time during childhood increases one’s later life risk of cancer. There certainly is some risk, especially because they can cause cancerous tumors in mice.3

What has been shown to be highly effective in some recent studies is high-nutrient eating, removal of processed foods, and supplementation with omega-3 fatty acids.4 The difference between my approach and others is that it changes a poor diet into an excellent one, supplying an adequate amount of thousands of important nutrients that work synergistically as well as removing those noxious substances such as chemical additives, trans fat, saturated fats, and empty-calorie food that place a nutritional stress on our brain cells. I believe this comprehensive approach is more effective; the scientific literature suggests this, and I have observed this in my practice with hundreds of ADHD children who have see me as patients.
Check out this previous post for George Grant’s success story: Children, ADHD, and Nutrition
1. Shatin D; Drinkard CR. Ambulatory use of psychotropics by employer-insured children and adolescents in a national managed care organization. Ambul Pediatr 2002;2(2):111-119.

2. McCormick LH. ADHD treatment and academic performance: A case series. J Family Practice 2003; 52(8):620-624. Cantwell DP, Baker L. Attention deficit disorder with and without hyperactivity; a review and comparison of matched groups. J Am Acad Child Adolesc Psychiatry 1992;31:432-438. Barkley RA, DuPaul GJ, McMurray MB. Attention deficit disorder with and without hyperactivity: clinical response to three dose levels of methylphendiate. Pediatrics 1991;87:519-531. Safer DJ. Major treatment consideration for attention hyperactivity disorder. Curr Probl Pediatr 1995;25:137-143.

3. Dunnick JK, Hailey JR. Experimental studies on the long-term effects of methylphenidate hydrochloride. Toxicology 1995;103(2):77-84.

4. Breakey J. The role of diet and behavior in childhood. J Paediatr Child Health 1997;33(3):190-194. Schnoll R, Burshteyn D, Cea-Aravena J. Nutrition in the treatment of attention-deficit hyperactivity disorder: a neglected but important aspect. Appl Psychophysiol Biofeedback 2003;28(1):63-75. Richardso AJ; Puri BK. A randomized double-blind, placebo-controlled study of the effects of supplementation with highly unsaturated fatty acids on ADHD-related symptoms in children with specific learning difficulties. Prog Neuropsychopharmacol Biol Psychiarty 2002;26(2):233-239. Kidd PM. Attention deficit/hyperactivity disorder (ADHD) in children: rationale for its integrative management. Altern Med Rev 2000;5(5):402-428.
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Diane Toby - January 12, 2007 12:54 PM

ADHD is vastly UNDER diagnosed in women. We know that because when clinic samples are compared with community samples (people not referred); the male female ratio of ADHD is much higher in the clinic population. Thus, the reason ADHD is supposedly overdiagnosed, is that the majority of people referred to clinics and diagnosed as ADHD are males, and far more males are referred to clinics than females. Perhaps Dr. Fuhrman would like to do a review of the relevant literature on gender differences in the diagnosis of ADHD.

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