The number of young American adults taking medications for attention deficit hyperactivity disorder nearly doubled from 2008 to 2012, according to a report to be released Wednesday by the nation’s largest prescription drug manager.
The drug manager, Express Scripts, which processes prescriptions for 90 million Americans, also found that almost one in 10 adolescent boys were taking medications for the disorder, usually stimulants such as Adderall or Concerta.
Some experts said the report provided the clearest evidence to date that the disorder is being diagnosed and treated with medication in children far beyond reasonable rates, and that steeply rising diagnoses among adults might portend similar problems. These drugs can temper hallmark symptoms like severe inattention and hyperactivity but also carry risks like sleep deprivation, appetite suppression and, more rarely, addiction and hallucinations.
In examining actual prescriptions filled, the report also strongly corroborated data from several government surveys that many prominent mental health experts had discredited for relying on parents’ recollections of their children’s health care.
“It’s hard to dismiss the data in this report,” said Brooke Molina, an associate professor of psychiatry at the University of Pittsburgh School of Medicine and one of the disorder’s leading researchers. “There are limitations with every study, but it’s hard to do anything here but conclude that we have a continually forward-marching increase.”
Dr. Lawrence Diller, a behavioral pediatrician in Walnut Creek, Calif., said that he hoped the Express Scripts report would extinguish questions of how many children are taking A.D.H.D. medications, and direct attention toward possible solutions.
“How long will experts’ heads remain in the sand on this epidemic?” Dr. Diller said.
Express Scripts, which is based in St. Louis, said it analyzed a nationally representative sample of 400,000 people ages 4 to 64 who filled at least one prescription for an A.D.H.D. medication from 2008 to 2012.
Medications included stimulants like Adderall and Concerta, as well as newer nonstimulant formulations such as Strattera. Express Scripts reported that the number of American adults receiving prescriptions for A.D.H.D. drugs had risen 53 percent, to an estimated 2.6 million in 2012 from 1.7 million in 2008. Use among young adults ages 26 to 34 almost doubled, to 640,000 from 340,000, during the four years.
Several mental health experts ascribed the steep rises among adults to better medical and societal understanding that the disorder affects more than just children. Some studies estimate that about 10 million adults have it, suggesting that medication use still has plenty of room to grow.
“We still know that a majority of adults with A.D.H.D. are untreated,” said Dr. Lenard A. Adler, director of the adult A.D.H.D. program at NYU Langone Medical Center.
Paula Rudofsky, a 56-year-old resident of Chappaqua, N.Y., was among the adults who received a diagnosis of the disorder and began taking Adderall in 2010. “We always felt that it was something for children,” she said. “It’s almost a relief to be told there’s something you can do to help.”
Express Scripts reported that use of medication among children, already much higher than among adults, rose less — about 19 percent over the four years — but still reached levels that many experts found troublesome.
In 2012, 5.7 percent of all children ages 4 to 18 were being prescribed A.D.H.D. medications, 7.8 percent of boys and 3.5 percent of girls. (More boys receive the diagnosis because they tend to appear more hyperactive.) Among adolescents 12 to 18, however, the rates reached 9.3 percent of boys and 4.4 percent of girls.
Adjusting for age ranges and insurance coverage, these rates and others confirm those reported last year by the federal Centers for Disease Control and Prevention through its telephone survey of 76,000 parents nationwide. While some onlookers said those data demonstrated over medication of the condition in children, most influential experts dismissed the evidence as lacking scientific rigor.
An article published by the American Medical Association stated that such studies “overestimate true prevalence” of A.D.H.D. diagnoses, while Dr. Sanjay Gupta of CNN reported, “There’s not a lot of value in these studies.”
In an interview last year, Dr. Peter Jensen, then of the Mayo Clinic in Rochester, Minn., said: “Single-question surveys based on yes-no parent report are notoriously inaccurate. You simply can’t make scientific statements based on them.” In a follow-up interview on Tuesday, Dr. Jensen said that the C.D.C. survey probably was more accurate than he originally thought.
The agency had conducted similar surveys since 2003, to similar skepticism. In reporting prescriptions actually filled, however, the Express Scripts report strongly supported the C.D.C.’s data as accurate, Dr. Molina and Dr. Diller said.
Susanna Visser, the C.D.C.’s lead epidemiologist for the disorder since 2006, said that experts’ consistently discrediting the agency’s survey data over many years had cost the public not just understanding of the issue but also the consideration of possible solutions.
Children’s inattention can be caused by many factors beyond A.D.H.D. — inadequate sleep, anxiety and more — that stimulants not only do not address, but can also exacerbate. Improper prescriptions for stimulants have fueled the sharing and selling of pills, particularly among high school and college students who use them to improve focus and perhaps achieve better grades.
A Partnership at Drugfree.org study last year reported that almost one in 10 teenagers admitted having misused or abused stimulants, with that number believed to be higher in high-pressure schools.
“It’s difficult to respond to the patterns that we see if the patterns in diagnosis and medication are not taken seriously,” Dr. Visser said, adding that she was not involved in the Express Scripts report. “We need to look at these patterns as a whole public health need in order to appropriately respond, and not snipe over the prevalence estimates.”
Dr. Visser pointed to increasing evidence that young adults are abusing stimulants as well, with significant health costs. A report last year by the federal Substance Abuse and Mental Health Administration found that emergency room visits related to nonmedical use of stimulants among adults tripled from 2005 to 2010, to more than 22,000.
Dr. Adler said that those signs need to be heeded as increasing numbers of adults visit their doctors for A.D.H.D. evaluations.
“As we move forward, we want to make sure that people who have the disorder get the prescription,” he said. “And that people who don’t have the disorder don’t.”
By ALAN SCHWARZ
MARCH 12, 2014
The Newhawks Crew