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Child in mind

Rise in ADHD diagnoses causes concern

Adapted from the Child in Mind blog on Boston.com.

“I know it’s my ADHD acting up,” a mother of three young children recently said to me as an explanation for her inability to recall a particular piece of information. My observation, in the setting of my behavioral pediatrics practice, of increasing numbers of mothers of young children being diagnosed with ADHD is in keeping with a recent report from Express Scripts. This report, based on pharmacy claims data, showed a 53 percent rise in writing of prescriptions for ADHD in adults from 2008-2012, with “the largest gains seen in women age 26-34, climbing 85%.”

A psychiatrist colleague took this data at face value, saying that “ADHD is genetic” so with the rise in diagnosis in children, it makes sense that there should be a parallel rise in diagnosis in adults.

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But there are big holes in this argument. Certainly problems of regulation of attention, behavior, and emotion, that are all called “ADHD,” have a familial component. But we are far from identifying a specific genetic cause. These qualities, both in children and adults, represent a complex interplay between genetic vulnerability and environmental effects.

So how else might we explain this rise in writing of prescriptions for this group, many of whom are young mothers? In today’s fast-paced society, parents of young children are often overextended and overwhelmed. In my practice many fathers work very long hours, leaving mothers alone to manage everything. In the absence of extended family this can be highly stressful. Physical activities such as yoga, running, or even walking have a calming, organizing effect on the brain, but often these mothers are unable to carve out time for themselves during the day. Sleep deprivation plays a huge role. There is a well-established link between sleep deprivation and symptoms of distractibility, inattention, and hyperactivity. This may be an inevitable part of parenting young children. But often there are ways to improve sleep if parents have the opportunity to make sense of the situation and take the time to fix it. But often there is not this time, so families get stuck in a reactive mode, with a vicious cycle setting in as lack of sleep makes them increasingly less able to think clearly.

I have concerns about this trend of diagnosing and treating ADHD, particularly in this population of young mothers. If we label this behavior as a disorder and prescribe a pill, are we placing responsibility (blame) squarely on the mother? Do we not have a responsibility as a society to care for mothers to support their efforts to care for the next generation? Will the motivation to find more creative solutions, such as flexible parental leave, and valuing of self-care be lost?

Read more of this blog at Boston.com/ChildinMind.

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