ADHD Diagnoses, Stimulant Use Surge Outside U.S.

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The growing “medicalization” of attention deficit/hyperactivity disorder (ADHD) has led to a dramatic rise in prescriptions for stimulants used to treat the condition around the world.

For example, until the 1990s, the United States used 90% of all of the methylphenidate HCl (Ritalin), one of the most popular stimulants prescribed for ADHD. Today, that figure is down to 75%.

Peter Conrad, PhD, a sociologist at Brandeis University, Waltham, Massachusetts, says that the reason isn’t that fewer kids in the U.S. are being diagnosed. Rather, ADHD diagnoses are rising and prescriptions of stimulants are surging in other countries, particularly the United Kingdom and Germany.

Conrad examined the incidence of ADHD in five countries: Brazil, France, Germany, Italy and the United Kingdom. In the 1990s, fewer than 1% of children in the U.K. had been diagnosed with ADHD. Today, that figure is about 5%. And in Germany, prescriptions for ADHD drugs rose 500% between 1998 and 2008, from 10 million daily doses to 53 million.

Writing in the journal Social Science and Medicine, Conrad attributes the growth of ADHD globally to five trends. He says that pharmaceutical companies have been effective in marketing ADHD drugs and convincing regulators to relax restrictions on them. Also, talk therapy is taking a back seat to using medications to treat psychiatric conditions in general. Third, mental health professionals around the world are adopting DSM standards for ADHD, which have a lower threshold for diagnosis.

Conrad also accused ADHD advocacy groups of aligning closely with drug makers to promote medication as treatment. And the widespread availability of information on ADHD and self-diagnosis tools available online lead people to ask their clinicians for a prescription.

ADHD pandemic causes researchers to fidget | BrandeisNOW
ADHD pandemic causes researchers to fidget | BrandeisNOW

Attention deficit/hyperactivity disorder (ADHD) has been medicalized in the United States since the 1960s. Primarily used in North America until the 1990s, ADHD diagnosis and treatment have increasingly been applied internationally.

After documenting the expansion of ADHD in a global context, this paper presents five brief international examples examining ADHD usage and expansion: the United Kingdom, Germany, France, Italy and Brazil. We then identify and describe several vehicles that facilitate the migration of the ADHD diagnosis: the transnational pharmaceutical industry; the influence of western psychiatry; moving from ICD to DSM diagnostic criteria; the role of the Internet including the related advent of easily accessible online screening checklists; and advocacy groups.

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