Lowering the Bar: Adult ADHD, a Risky Diagnosis?

The above headline comes from a September 10, 2016, article on MedPage Today that calls into question the growing numbers of adults taking ADHD medications. The article begins by noting that opioid abuse has recently been the focus of much public attention, but less talked about is the growing problem of abuse and the growing numbers of people using ADHD drugs.

The article notes that since 2013, the FDA has received 19,000 reports of complications from ADHD drugs. The vast majority of these come from stimulants like Adderall, Concerta, Ritalin, and Vyvanse. Adults seem to be far more likely to suffer adverse events involving hospitalization or death than are children.

According to the latest federal estimates, Adderall has led the way for increased usage going from 345,000 people in 2006 to 1.4 million in 2014. The number of emergency room visits due to Adderall and Ritalin have increased fivefold over the past 7 years. Between the years 2010 and 2015, sales of ADHD drugs increased from $7.9 billion to $11.2 billion.

One concern is that ADHD drug testing on adults lasts only several weeks or months and falls far short of the years that many other drugs are tested. This means that the long-term effects of these drugs are not known.

The article gives two basic reasons for the jump in usage. First is the aggressive marketing by the drug companies that produce these drugs. Second, they note that the diagnostic criteria for prescribing these drugs has been greatly relaxed allowing more people to fall within the diagnosis that is treated with these drugs. In other words, “The bar has been lowered.”

A panel from the American Psychiatric Association made the recommendations to lower the criteria in 2013. The article noted that 78% of the experts making the recommendations had financial ties to drug companies who benefited from the panel’s recommendations.

The article notes that some of the symptoms needed to reach an adult ADHD diagnosis include such vague items as an inability to focus on tasks, fidgeting, or interrupting others. Additionally the article reported that, “One study published in 2010 found that 22% of adults tested for ADHD had exaggerated their symptoms.”

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