Attention-deficit Hyperactivity Disorder Around the World: Global Attitudes Toward ADHD

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empty pill bottles

Do we really want to prescribe stimulants to children? Image by Penywise

Fidgeting, interrupting, lack of focus, and inability to sit still in the classroom all are signs of attention-deficit hyperactivity disorder or ADHD, according to many psychologists and physicians in the United States.

But do people in the rest of the world report the same rates of distracted hyper-activity in their children?

What accounts for variability in rates of diagnosis and medication rates?

Let’s explore these questions – and learn more about global attitudes toward ADHD.

ADHD Incidence Around the World

In 2003. Stephen Faraone, PhD, of Upstate Medical University, investigated the incidence of ADHD in children around the globe, examining 50 studies from various countries including Hong Kong, China, India, Britain, Canada, New Zealand and Australia. The author concluded the “[a]nalysis of these studies suggests that the prevalence of ADHD is at least as high in many non-US children as in US children, with the highest prevalence rates being seen when using DSM-IV diagnoses.” In other words, if the same criteria were used globally, ADHD rates were similar in all the nations he evaluated.

In 2014, researchers published another meta-analysis of 154 research studies of prevalence of ADHD  conducted over the last three decades in the International Journal of Epidemiology. As in Faraone’s study, Polanczyk concluded: “Confirming previous findings, variability in ADHD prevalence estimates is mostly explained by methodological characteristics of the studies...there has been no evidence to suggest an increase in the number of children in the community who meet criteria for ADHD when standardized diagnostic procedures are followed.” 

If rates of ADHD are generally similar in various countries when using the same diagnostic criteria, and there have been no increases over time, what accounts for diagnosis and treatment variability in the United States?

Children in the United States and ADHD

According to the U.S. Centers for Disease Control and Prevention, or CDC, doctors have diagnosed 11% of children aged 4 to 16 as having ADHD in 2011, despite the Diagnostic and Statistical Manual of Mental Health Disorders estimate that the percentage should be closer to 5%.

A review of data from 2007 to 2008 by Dr. Susanna Visser and her colleagues found the percentage of children diagnosed with ADHD in the United States who were were given prescription medication varied greatly by state as well.  “State-based rates of ADHD medication treatment ranged from 33% in Nevada to 79% in Mississippi; rates of medicated ADHD were higher among boys than girls at every age.”  Reasons for the variation cited included medication shortages and access to care.

Alternatives to Drugs and the DSM V

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Should classrooms accommodate more active children? Image by Darnok.

While ADHD appears to occur in a subset of children globally, the specific percentage of children in that subset may vary based on a number of diagnostic, genetic and environmental reasons.

Diagnosis using the DSM is not universal and neither is treatment with medication.  Marilyn Wedge, PhD, and author, writes that the French do not focus on the biology of ADHD, but rather look at the condition as “a medical condition that has psycho-social and situational causes.”  Family therapy is often prescribed in lieu of drugs.

The French use a different diagnostic criteria which results in fewer children being labeled as having ADHD.  Fewer children are then prescribed stimulant medications. According to Wedge, the rate of medication use for ADHD in children in France is less than half a percentage point or .5%  compared to 9% in the United States.

In contrast, the newest edition of the Diagnostic and Statistical Manual, the DSM V, casts a broader net as symptoms must now be present by age twelve instead of by age seven, in order for the child to qualify as having ADHD.

Rethinking Stimulant Use in Children

Managing behavior so that children are able to learn is vital to success in the classroom, but a good argument against routine medication exists.  The medications prescribed for ADHD are powerful, with many potential adverse side effects including poor growth, cardiac events, hypertension, and increased risk of suicide. Longitudinal research indicates children medicated with stimulants also have an increased risk of later substance abuse according to Chang in the Journal of Child Psychology and Psychiatry.

While medication of ADHD may be needed in many cases, psychologists might first attempt to address social factors that contribute to poor behavior with therapy.  Educators might learn to accommodate a wider range of behavior in the classroom,  Prescriptions may only, Wedge suggests, mask  problems.

 Treatment, Diagnosis, and Classrooms: ADHD Around the World

The number of kids with attention-deficit hyperactivity disorder differs between nations, but according to research, ADHD rates are similar when doctor use standardized diagnostic criteria. Research also shows that kids receive medication at different rates, even varying from state-to-state here in the United States. Do the benefits of these medications outweigh the side effects and risks? Doctors must answer this question on a case-by-case basis with every child they treat.

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