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No Lack of Attention to ADHD

by Matt Nix, Manager, Core Analytics

Attention deficit-hyperactivity disorder (ADHD) continues to draw public attention, with articles appearing in the November New England Journal of Medicine and most recently in the New York Times. The Times article emphasized the rising use of ADHD drugs by both adults and children in 2012, based on a recent report issued by Express Scripts about ADHD medication trends. The Express Scripts study showed a steady growth in the number of children taking ADHD medication through 2012. Recently, athenaResearch examined diagnostic data coming in from physicians on the athenahealth network to see whether 2013 data indicate any slackening of growth in ADHD diagnoses.

The ADHD Diagnosis Debate
The public attention to ADHD includes intense debate about whether the large numbers of ADHD diagnoses and prescriptions are appropriate. Proponents of ADHD medication believe that drug treatment has conferred substantial benefits on numerous children and adults. In contrast, skeptics believe the increase in ADHD diagnosis and treatment is unnecessary, citing several factors that may have contributed to the increase. Among the skeptics’ contentions is that greater academic performance pressures on students may lead parents to push pediatricians for a medical solution to behavior that in past years would have been tolerated. Those questioning the current level of ADHD diagnosis also suggest that some pediatricians may lack the time for careful clinical interviews or the training for neuropsychological testing – both needed to make reliable ADHD diagnoses. As a result, some cases are possibly misdiagnosed as ADHD, rather than anxiety, mood or conduct disorders. Finally, some believe that because behavioral therapy for ADHD is fairly time consuming and expensive, parents and physicians may prefer medication (page 9 of Express Scripts report).

We are not in a position to judge the relative merits of arguments for and against current levels of medical treatment of ADHD. However, given the public focus on the issue, we thought it would be useful to examine recent practice patterns to determine whether pediatricians have become more conservative in their diagnosis and treatment of ADHD over the last year or so.

2013 ADHD Diagnosis Patterns
To shed light on more recent patterns, we examined a sample of 538 pediatricians across 31 states that have used athenahealth services between January 2010 and the end of 2013. Our sample consisted of roughly 3.5 million office visits over this three-year span.

Our Findings
Concerns about ADHD have not stemmed from the long-standing increase in ADHD diagnosis. For every subcategory we considered, the proportion of pediatrician visits resulting in an ADHD diagnosis increased at roughly the same rate as was evident between 2010 and 2012.

For girls, the proportion of visits with a diagnosis of ADHD increased from 3.6% in 2010 to 4.2% in 2012, and then to 4.6% in 2013. For boys, ADHD diagnoses increased from 9.1% in 2010 to 10% of all visits in 2012 and then to 10.5% in 2013. The same pattern was evident in all subgroups.



In short, at least for pediatricians within the athenahealth network, we have not yet seen an inflection point in which concerns about ADHD over-diagnosis and overtreatment have translated into a more conservative approach in clinical practice.

For those interested in scrutinizing the data more closely, figures are provided in the following table.



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