Like autism, ADHD lies on a spectrum, and some children should not be treated.
- ADHD is an extremely contentious disorder in terms of diagnosis and treatment.
- A research team examined 334 studies on ADHD published between 1979 and 2020.
- The team concluded that ADHD is being overdiagnosed and overtreated in children with milder symptoms.
Attention deficit hyperactivity disorder (ADHD) has long been a controversial topic. While the term "mental restlessness" dates back to 1798, English pediatrician George Still described the disorder in front of the Royal College of Physicians of London in 1902. The condition is attributed to both nature and nurture, with a recent study suggesting the disorder is 75 percent genetic.
According to DSM-IV criteria, ADHD affects five to seven percent of children; but according to ICD-10, only between one and two percent are afflicted. Global estimates state that nearly 85 million people suffer from ADHD, which, like autism, exists on a spectrum.
Treatment is perhaps the most contentious issue. While a holistic approach includes counseling, lifestyle changes, and medication, due to insurance requirements and other factors, many children only receive the latter. And now a new systematic scoping review published in the journal JAMA Network Open that investigated 334 studies conducted between 1979 and 2020 found that ADHD is being both overdiagnosed and overtreated in children and adolescents.
ADHD: An epidemic of overdiagnosis
Researchers from the University of Sydney and the Institute for Evidence-Based Healthcare in Australia initially retrieved 12,267 relevant studies before using a set of criteria that whittled the list down to 334. Only five studies critically investigated the costs and benefits of treating milder cases of ADHD, prompting the team to focus on knowledge gaps in side effects.
The team writes that public scrutiny has increased along with the increase in diagnoses. The numbers are startling: between 1997 and 2016, the number of children reported to be suffering from ADHD doubled. While the symptoms of ADHD include fidgeting, inattention, and impulsivity, Dr. Stephen Hinshaw compared this disorder to depression, as neither condition has "unequivocal biological markers." He continues, "It's probably not a true epidemic of ADHD. It might be an epidemic of diagnosing it."
The Australian researchers write that ambiguous or mild symptoms might contribute to diagnostic inflation and the subsequent rise in the prevalence of ADHD. They compare this to cancer, a field that has established protocols for overdiagnosis. ADHD is still understudied in this regard.
Photo: fizkes / Adobe Stock
Overdiagnosis is harmful
This has contributed to an increase in potential harm, not just to children's health (such as the long-term pharmacological impact on developing brains) but to parents' finances. As of 2018, ADHD is a $16.4 billion global industry, with continued revenue growth predicted — ensured by future ADHD diagnoses.
The costs and benefits of ADHD treatment are mixed. The authors write:
"We found evidence of benefits for academic outcomes, injuries, hospital admissions, criminal behavior, and quality of life. In addition, harmful outcomes were evident for heart rate and cardiovascular events, growth and weight, risk for psychosis and tics, and stimulant misuse or poisoning."
For most of these studies, the benefits outweighed the risks in children suffering from more severe ADHD. But this is not true for children with milder symptoms.
Across the studies, the team noticed that four themes emerged. The first two were positive, and the second two were negative:
- For some people, an ADHD diagnosis was shown to create a sense of empowerment because a biological explanation provided a sense of legitimacy.
- Feelings of empowerment enabled help-seeking behavior.
- For others, a biomedical explanation led to disempowerment because it served as an excuse and provided a way to shirk responsibility.
- An ADHD diagnosis was linked to stigmatization and social isolation.
The unfortunate reality is that ADHD is a real condition that should be treated in some children. But for many, the harm of treatment outweighs the benefits.
Stay in touch with Derek on Twitter and Facebook. His most recent book is "Hero's Dose: The Case For Psychedelics in Ritual and Therapy."
A new drug derived from scorpion venom reversed developmental damage in mice exposed to alcohol during pregnancy.
- Scientists tested a drug derived of scorpion venom on mice exposed to alcohol during pregnancy.
- The drug was able to reverse specific developmental damage caused by alcohol and will next be tested on humans.
- Researchers pinpointed specific molecular mechanisms causing developmental problems.
Scorpions, sporting eight legs and a venomous stinger, can be quite dangerous for humans to encounter. They also may hold the key to treating developmental issues in kids whose moms drank alcohol during pregnancy. A new study found that a novel drug made from scorpion venom was able to reverse motor deficits in mice with the fetal alcohol spectrum disorder (FASD).
FASD is caused by alcohol consumption of pregnant mothers and is characterized by learning disabilities, causing cognitive, intellectual and motor skills deficits. Among humans, 119,000 kids are born with this condition around the world every year. Undeveloped motor skills, in particular, are among the first signs of trouble noticed by parents and caregivers.
The research was carried out by a team from Children's National Hospital, led by Kazue Hashimoto-Torii, Ph.D., who is the principal investigator at the Center for Neuroscience Research and has been studying this topic for years over a series of studies. Her team was able to pinpoint the molecular changes responsible for the developmental delays by focusing on gestating mouse fetuses that had exposure to alcohol on their embryonic days 16 and 17. As the press release from the Children's National Hospital explains, that's when brain cells grow mainly in the upper cortex – the part of the brain responsible for motor abilities.
Per two exams taken 30 days after birth, these baby mice exhibited strong deficits in both large and small-muscle motor skills. Looking for differences at the molecular level, the scientists were able to figure out that the fetus's exposure to alcohol activated a signaling pathway known as "heat shock." This, in turn made cells produce protective proteins, doing so randomly just in some cells rather than consistently throughout all the cells.
The researchers tracked the diving neurons precisely, spotting differences in 93 genes. One, specifically, known as Kcnn2, was clearly over-expressed in the cells that made heat shock proteins. These cells also showed firing patterns that were out of the ordinary. What's notable about that is that this gene encodes a potassium channel activated by calcium and has been linked to learning and memory.
To remedy this, the scientists tested Tamapin, a drug that blocked this channel. It is derived from the venom of Indian red scorpions.
The drug was successful in returning the firing patterns of the cells back to normal. The baby mice, you'd be happy to hear, also showed clear improvement in their muscle motor skills.
Dan Massey, a 2010 PharmD graduate of the University of Arizona's College of Pharmacy, shows how he milked scorpions. Don't try this at your home!
To see how this drug can help human babies, Hashimoto-Torii and her colleagues now set up a biotech company.
"Usually investigators looking for the molecular mechanisms behind disease stop there, but we want to move forward to have a real impact on public health," she said. "We really want to give patients the hope of having a better life through treating the neurodevelopmental problems caused by FASD."
Other scientists working on the study included Shahid Mohammad, Stephen J. Page, Li Wang, Seiji Ishii, Peijun Li, Toru Sasaki, Aiesha Basha, Zenaide Quezado, Joshua Corbin, and Masaaki Torii of the Children's National Hospital.
You can read the new study published in Nature Neuroscience.