Up To A Million Kids Misdiagnosed!

[Rick Green – Founder of TotallyADD]

A big headline in the Life/Family section of the newspaper today. Up to a million American kids may have been misdiagnosed with ADHD simply because their birthday falls late in the year and they are immature compared to their peers who were born in the first part of the year.

In childhood the difference in development 8 to 12 months can be dramatic. In his book, Outlier’s Malcolm Gladwell shows that statistically the number of professional athletes who were born in the first half of the year is far higher than those born in the second half. A child born in December will have a distinct size and weight disadvantage to a peer who was born in January.

And the ADHD study is finding that kids born in the later part of the year (Yo, that’s me) are more likely to be diagnosed with ADHD. But what looks like restlessness and hyperactivity and impulsivity may simply be a child who is younger and has less developed self control. (Less developed pre-frontal lobes, etc..)

While the authors of the study say it doesn’t prove anything, and you shouldn’t dash about madly screaming my child has been misdiagnosed, it does strongly suggest that Doctor’s may be over-diagnosing ADHD amongst kids born in the last half of the year. When you consider that a huge percentage of kids who have ADHD have not been diagnosed, it adds real weight to a phrase we’ve heard from a lot of experts–that ADHD is both over-diagnosed and under-diagnosed. In adults, it’s estimated that about 4 percent of the population have ADHD. Or ADD, since the hyperactivity becomes more internalized in adulthood. And yet only about 1% of adults know they have it.

I’m left with three things.

First…. this is a complicated disorder and more is being learned all the time.

Second… getting a reliable diagnosis is crucial, and obviously difficult. (See the videos in the Diagnosis section)

And Third… there is a real shortage of people who are qualified to diagnosis this.

Interesting eh?

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[Patte Rosebank]

My mom was a teacher before I was born, so she seems to have noticed the difference between the oldest and the youngest kids in a class. She decided that her kids would be born as early in the year as possible, so we’d be the oldest, most mature ones in our classes. The downside was that, since our birthdays are in the winter, we never had ice cream at our parties, because we always seemed to have colds at that time of year. (Curiously, now that we have our own places, we both ALWAYS have ice cream on hand.)

Of course, being deliberately born early in the year won’t make you the oldest, most mature kid in the class if you skip a grade. Or if your socio-emotional age is 30% younger than your physical age—as seems to be the case when you have ADHD.

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[Rick Green – Founder of TotallyADD]

The danger is that you have a ‘preemie’ and your child is born at the end of the year, and then has a double whammy of being behind his or her peers because of timing and being premature. By the way, Dr. Jain’s wife is a pediatrician and she deals with premature babies. And generally, ‘preemies’ have a very high rate of ADHD.

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[Anonymous]

Author Malcolm Gladwell has some interesting thoughts on the effects of the age variations in classrooms in his book Outliers. I believe the chapter is called “The Trouble with Geniuses”.

http://search.barnesandnoble.com/Outliers/Malcolm-Gladwell/e/9780316017923#TOC

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[Anonymous]

That’s really interesting and makes a lot of sense. However, from my personal experience, I was born in December and also started school a year early. I was always at least a year younger than everyone else but was always the fastest/smartest [if I may say so myself].

But, like I said, that makes a lotttttt of sense!

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[Wgreen]

Interesting indeed.

But consider: A parent, armed with information gleaned online, walks into a pediatrician’s office and says, “I think my child may have ADD.” The pediatrician has, what?, seven-ten minutes to spend with a patient? So he/she asks a few questions and says, “Hmmmm. Maybe you’re right. I’ll prescribe some ‘XYZ,’ and we’ll see if that helps.” At that point the doctor moves on and it becomes up to the parent to make (in many instances, confirm) his/her own diagnosis based on what she observes at home, or thinks she observes, after the child starts taking a medication (the trial-and-error approach). With doctors overwhelmed by patient workload, forced to prioritize based on the severity of illness, and staggered by the vast quantity of new medical research/information coming at them like a freight train (information that needs to be assimilated), it’s amazing they can function at all. Frankly, under these circumstances, it’s hard for me to imagine that millions of patients aren’t misdiagnosed annually for all sorts of things.

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[Wgreen]

After reflection, another observation:

Perhaps these stats reveal something more fundamental about the way American healthcare works today.

Until the 1980s, pharmaceuticals in the U.S were promoted exclusively to doctors. Then something happened. The following excerpt is from a piece on NPR (America’s National Public Radio) in October 2009:

“… [Until the 1980s] doctors exclusively held the keys to the kingdom, drug companies spent enormous amounts of time and money trying to get their attention. To give you a sense, the average doctor got around 3,000 pieces of mail a year from the drug industry, and to break through this noise often took years.

And so [Joe] Davis, who had previously only sold packaged goods, approached William Castagnoli, the then-president of a large medical advertising company. The two came up with a solution: They would advertise directly to the patient. They’d get the patient to go in and ask the doctor for the drug. “Pull the drug through the system,” Davis says with a certain amount of glee.

There was only one small problem with this solution: It was almost impossible to do.

In the early 1980s, FDA [the Food and Drug Administration that oversees all prescription medications in the US] regulations required that drug ads include both the name of a drug and its purpose, as well as information about all the side effects. But side-effect information often took two or three magazine pages of mouse print to catalog, and this wouldn’t do for a major television campaign. As Castagnoli says, “We couldn’t scroll the whole disclosure information over the television screen — OK?”

But then, in 1986, while designing an ad for a new allergy medication called Seldane, Davis hit on a way around the fine print. He checked with the Food and Drug Administration to see if it would be OK.

“We didn’t give the drug’s name, Seldane,” he says. “All we said was: ‘Your doctor now has treatment which won’t make you drowsy. See your doctor.’

This was one of the very first national direct-to-consumer television ad campaigns. The results were nothing short of astounding. Before the ads, Davis says, Seldane made about $34 million in sales a year, which at the time was considered pretty good.

“Our goal was maybe to get this drug up to $100 million in sales. But we went through $100 million,” Davis says. “And we said, ‘Holy smokes.’ And then it went through $300 million. Then $400 million. Then $500 million. $600 [million]! It was unbelievable. We were flabbergasted. And eventually it went to $800 million.””

Clearly, the introduction of pharma TV advertising had enormous implications for drug companies’ bottom lines, but it also revealed something interesting about the doctor-patient relationship: Clinicians were willing to give their patients what THEY wanted. All they had to do was ask.

So, if up to a million kids are being “over-diagnosed,” it’s likely—in large part— because parents are ASKING for the diagnosis, and therefore for the meds, hoping that their youngsters will sit still and do better in school.

If adults are being under-diagnosed, it’s probably because pharma giants haven’t yet figured out how to get information that resonates out to that demographic.

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