ADHD Conspiracy-Scam: Million US Kids Misdiagnosed
by SCIENCE DAILY
(Aug. 17, 2010) Nearly 1 million children in the United States are
potentially misdiagnosed with attention deficit hyperactivity disorder simply
because they are the youngest -- and most immature -- in their kindergarten
class, according to new research by a Michigan State University economist.
These children are significantly more likely than their older classmates to be
prescribed behavior-modifying stimulants such as Ritalin, said Todd Elder, whose
study will appear in a forthcoming issue of the Journal of Health Economics.
Such inappropriate treatment is particularly worrisome because of the unknown
impacts of long-term stimulant use on children's health, Elder said.
It also wastes an estimated $320 million-$500 million a year on unnecessary
medication -- some $80 million-$90 million of it paid by Medicaid, he said.
Elder said the "smoking gun" of the study is that ADHD diagnoses depend on a
child's age relative to classmates and the teacher's perceptions of whether the
child has symptoms.
"If a child is behaving poorly, if he's inattentive, if he can't sit still,
it may simply be because he's 5 and the other kids are 6," said Elder, assistant
professor of economics. "There's a big difference between a 5-year-old and a
6-year-old, and teachers and medical practitioners need to take that into
account when evaluating whether children have ADHD."
ADHD is the most commonly diagnosed behavioral disorder for kids in the United
States, with at least 4.5 million diagnoses among children under age 18,
according to the Centers for Disease Control and Prevention.
However, there are no neurological markers for ADHD (such as a blood test), and
experts disagree on its prevalence, fueling intense public debate about whether
ADHD is under-diagnosed or over-diagnosed, Elder said.
Using a sample of nearly 12,000 children, Elder examined the difference in ADHD
diagnosis and medication rates between the youngest and oldest children in a
grade. The data is from the Early Childhood Longitudinal Study Kindergarten
Cohort, which is funded by the National Center for Education Statistics.
According to Elder's study, the youngest kindergartners were 60 percent more
likely to be diagnosed with ADHD than the oldest children in the same grade.
Similarly, when that group of classmates reached the fifth and eighth grades,
the youngest were more than twice as likely to be prescribed stimulants.
Overall, the study found that about 20 percent -- or 900,000 -- of the 4.5
million children currently identified as having ADHD likely have been
misdiagnosed.
Elder used the students' birth dates and the states' kindergarten eligibility
cutoff dates to determine the youngest and oldest students in a grade. The most
popular cutoff date in the nation is Sept. 1, with 15 states mandating that
children must turn 5 on or before that date to attend kindergarten.
The results -- both from individual states and when compared across states --
were definitive. For instance, in Michigan -- where the kindergarten cutoff date
is Dec. 1 -- students born Dec. 1 had much higher rates of ADHD than children
born Dec. 2. (The students born Dec. 1 were the youngest in their grade; the
students born Dec. 2 enrolled a year later and were the oldest in their grade.)
Thus, even though the students were a single day apart in age, they were
assessed differently simply because they were compared against classmates of a
different age set, Elder said.
In another example, August-born kindergartners in Illinois were much more likely
to be diagnosed with ADHD than Michigan kindergartners born in August of the
same year as their Illinois counterparts. That's because Illinois' kindergarten
cutoff date is Sept. 1, meaning those August-born children were the youngest in
their grade, whereas the Michigan students were not.
According to the study, a diagnosis of ADHD requires evidence of multiple
symptoms of inattention or hyperactivity, with these symptoms persisting for six
or more months -- and in at least two settings -- before the age of seven. The
settings include home and school.
Although teachers cannot diagnose ADHD, their opinions are instrumental in
decisions to send a child to be evaluated by a mental health professional, Elder
said.
"Many ADHD diagnoses may be driven by teachers' perceptions of poor behavior
among the youngest children in a kindergarten classroom," he said. "But these
'symptoms' may merely reflect emotional or intellectual immaturity among the
youngest students."
The paper will be published in the Journal of Health Economics in conjunction
with a related paper by researchers at North Carolina State University, Notre
Dame and the University of Minnesota that arrives at similar conclusions as the
result of a separate study.
Story Source:
The above story is reprinted (with editorial adaptations by ScienceDaily staff)
from materials provided by Michigan State University.
Journal Reference:
1. Elder et al. The importance of relative standards in ADHD diagnoses: Evidence
based on exact birth dates. Journal of Health Economics, 2010; DOI:
10.1016/j.jhealeco.2010.06.003
http://www.sciencedaily.com/releases/2010/08/100817103342.htm?sms_ss=reddit