Diagnoses are the on the rise, but the disorder has more than one form, and the symptoms aren't always obvious.
The rate at which kids are being diagnosed with ADHD is on the rise. It grew 5 percent every year between 2003 and 2011, according to the CDC.
Experts cite several possible explanations for the increase. Teachers are better trained to spot the signs for ADHD, parents have access to more information on the internet, and intensified academic demands on students have turned a spotlight on those who struggle to keep up. With this awareness, some of the stigmas associated with the disorder have been lifted. Not long ago, the medical term for what we now call ADHD was “minimal brain dysfunction”—not exactly a label a parent wants for their child.
Ronald S. Bashian, an Arlington pediatrician and ADHD coach, still remembers seeing a classmate picked up by the collar and thrown from the classroom for making students laugh. “People thought children [with ADHD] were stupid or unmotivated,” says the physician, now 70. “There’s more awareness [today].”
At the same time, the recent uptick in diagnoses has prompted a few skeptics to wonder aloud whether ADHD’s prevalence is partly a function of overambitious parents wanting an edge—through medication or other special accommodations—for their children.
“We live in a very competitive environment here in Arlington,” says Nellie Grant*, whose son James* has ADHD. “[For him] it was never about getting straight A’s or being the best in the class.” In kindergarten, when other students lined up to go inside after recess, James would be off on his own, lining up bugs to examine. He’d forget to bring his homework—every day. When he got to fourth grade, an astute teacher urged his parents to have him privately tested. Specialists at Children’s National Health System in Rockville, Maryland, diagnosed him as being gifted in intelligence, but also having the inattentive form of ADHD.
Though schools can help coordinate certain kinds of testing, educators and administrators cannot make a formal diagnosis. That’s more often left to a neuropsychologist, who gathers information through interviews with the family, a battery of tests (which takes four to six hours) and questionnaires for teachers and parents. These developmental specialists often look for learning disabilities like dyslexia, which can come in tandem with ADHD. From there, parents go to a psychiatrist or pediatrician to discuss medication and other options. The cost of diagnosis and treatment is difficult to ballpark, given that insurance plans vary, as do the symptoms from one person to the next.
Coming to terms with a diagnosis can be a challenge for some parents. “Parents too often see their kids’ success being a reflection of their good parenting,” Grant says. “You have to let go of that. There’s only so much control you have over another human being.”
Kirk Martin, founder of the parent resource website CelebrateCalm.com, offers a similar view: “It’s the hyperfocus on trying to create the perfect, successful child who can compete with everyone else’s children. And now you have a child who’s different, who learns differently, who struggles academically, who may have impulse-control issues.” Martin’s son has ADHD, and Martin believes he may have it himself as well.
There may indeed be a genetic correlation. Citing multiple studies, Keith Saylor, a clinical psychologist in Herndon, estimates that some 75 percent of children with ADHD likely have a parent with ADHD, though the parent may not have ever been diagnosed. That could explain, at least in part, why the number of kids with ADHD nationwide hovers around 11 percent, while the rate among adults is 3 to 4 percent.
Cases among adults may also be lower, McCarthy says, because some children outgrow their symptoms by the time they reach their 20s as their brains’ frontal lobes become more fully developed.