After more than 50 years leading the fight to legitimize attention deficit hyperactivity disorder, Keith Conners could be celebrating.
Severely hyperactive and impulsive children, once shunned as bad seeds, are now recognized as having a real neurobehavioral problem. Doctors and parents have largely accepted drugs like Adderall and Concerta to temper the traits of classic ADHD, helping youngsters succeed in school and beyond.
But Conners did not feel triumphant this fall as he addressed a group of fellow ADHD specialists in Washington. He noted that recent data from the Centers for Disease Control and Prevention show that the diagnosis has been made in 15 percent of high school-age children, and that the number of children on medication for the disorder has soared to 3.5 million from 600,000 in 1990. He questioned the rising rates of diagnosis and called them “a national disaster of dangerous proportions.”
“The numbers make it look like an epidemic. Well, it’s not. It’s preposterous,” Conners, a psychologist and professor emeritus at Duke University, said in a subsequent interview. “This is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels.”
The rise of ADHD diagnoses and prescriptions for stimulants over the years has coincided with a remarkably successful two-decade campaign by pharmaceutical companies to publicize the syndrome and promote the pills to doctors, educators and parents.
With the children’s market booming, the industry is now employing similar marketing techniques as it focuses on adult ADHD, which could become even more profitable.
Few dispute that classic ADHD, historically estimated to affect 5 percent of children, is a legitimate disability that impedes success at school, at work and in personal lives. Medication often assuages the severe impulsiveness and inability to concentrate, allowing a person’s underlying drive and intelligence to emerge.
But even some of the field’s longtime advocates say the zeal to find and treat every ADHD child has led to too many people with scant symptoms receiving the diagnosis and medication. The disorder is the second most frequent long-term diagnosis in children, narrowly trailing asthma, according to a New York Times analysis of CDC data.
Behind that growth has been drug company marketing that has stretched the image of classic ADHD to include relatively normal behavior like carelessness and impatience, and has often overstated the pills’ benefits. Advertising on television and in magazines like People and Good Housekeeping has cast common childhood forgetfulness and poor grades as grounds for medication that, among other benefits, can result in “schoolwork that matches his intelligence” and ease family tension.
The Food and Drug Administration has cited every major ADHD drug — stimulants like Adderall, Concerta, Focalin and Vyvanse, and nonstimulants like Intuniv and Strattera — for false and misleading advertising since 2000, some multiple times.
Sources of information that would seem neutral also delivered messages from the pharmaceutical industry. Doctors paid by drug companies have published research and delivered presentations that encourage physicians to make diagnoses more often and that discredit growing concerns about overdiagnosis.
Many doctors have portrayed the medications as benign – “safer than aspirin,” some say – even though they can have significant side effects and are regulated in the same class as morphine and oxycodone because of their potential for abuse and addiction.
Patient advocacy groups tried to get the government to loosen regulation of stimulants while having sizable portions of their operating budgets covered by pharmaceutical interests.
Profits for the ADHD drug industry have soared. Sales of stimulant medication in 2012 were nearly $9 billion, more than five times the $1.7 billion a decade before, according to the data company IMS Health.
Tom Casola, the Shire vice president who oversees the ADHD division, said in an interview that the company aims to provide effective treatment for those with the disorder, and that ultimately doctors were responsible for proper evaluations and prescriptions. He added that he understood some of the concerns voiced by the Food and Drug Administration and others about aggressive ads, and said that materials that run afoul of guidelines are replaced.
“Shire – and I think the vast majority of pharmaceutical companies – intend to market in a way that’s responsible and in a way that is compliant with the regulations,” Casola said. “Again, I like to think we come at it from a higher order. We are dealing with patients’ health.”
But Roger Griggs, the pharmaceutical executive who introduced Adderall in 1994, said he strongly opposes marketing stimulants to the general public because of their dangers. He calls them “nuclear bombs,” warranted only under extreme circumstances and when carefully overseen by a physician.
Severely hyperactive and impulsive children, once shunned as bad seeds, are now recognized as having a real neurobehavioral problem. Doctors and parents have largely accepted drugs like Adderall and Concerta to temper the traits of classic ADHD, helping youngsters succeed in school and beyond.
But Conners did not feel triumphant this fall as he addressed a group of fellow ADHD specialists in Washington. He noted that recent data from the Centers for Disease Control and Prevention show that the diagnosis has been made in 15 percent of high school-age children, and that the number of children on medication for the disorder has soared to 3.5 million from 600,000 in 1990. He questioned the rising rates of diagnosis and called them “a national disaster of dangerous proportions.”
“The numbers make it look like an epidemic. Well, it’s not. It’s preposterous,” Conners, a psychologist and professor emeritus at Duke University, said in a subsequent interview. “This is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels.”
The rise of ADHD diagnoses and prescriptions for stimulants over the years has coincided with a remarkably successful two-decade campaign by pharmaceutical companies to publicize the syndrome and promote the pills to doctors, educators and parents.
With the children’s market booming, the industry is now employing similar marketing techniques as it focuses on adult ADHD, which could become even more profitable.
Few dispute that classic ADHD, historically estimated to affect 5 percent of children, is a legitimate disability that impedes success at school, at work and in personal lives. Medication often assuages the severe impulsiveness and inability to concentrate, allowing a person’s underlying drive and intelligence to emerge.
But even some of the field’s longtime advocates say the zeal to find and treat every ADHD child has led to too many people with scant symptoms receiving the diagnosis and medication. The disorder is the second most frequent long-term diagnosis in children, narrowly trailing asthma, according to a New York Times analysis of CDC data.
Behind that growth has been drug company marketing that has stretched the image of classic ADHD to include relatively normal behavior like carelessness and impatience, and has often overstated the pills’ benefits. Advertising on television and in magazines like People and Good Housekeeping has cast common childhood forgetfulness and poor grades as grounds for medication that, among other benefits, can result in “schoolwork that matches his intelligence” and ease family tension.
The Food and Drug Administration has cited every major ADHD drug — stimulants like Adderall, Concerta, Focalin and Vyvanse, and nonstimulants like Intuniv and Strattera — for false and misleading advertising since 2000, some multiple times.
Sources of information that would seem neutral also delivered messages from the pharmaceutical industry. Doctors paid by drug companies have published research and delivered presentations that encourage physicians to make diagnoses more often and that discredit growing concerns about overdiagnosis.
Many doctors have portrayed the medications as benign – “safer than aspirin,” some say – even though they can have significant side effects and are regulated in the same class as morphine and oxycodone because of their potential for abuse and addiction.
Patient advocacy groups tried to get the government to loosen regulation of stimulants while having sizable portions of their operating budgets covered by pharmaceutical interests.
Profits for the ADHD drug industry have soared. Sales of stimulant medication in 2012 were nearly $9 billion, more than five times the $1.7 billion a decade before, according to the data company IMS Health.
Tom Casola, the Shire vice president who oversees the ADHD division, said in an interview that the company aims to provide effective treatment for those with the disorder, and that ultimately doctors were responsible for proper evaluations and prescriptions. He added that he understood some of the concerns voiced by the Food and Drug Administration and others about aggressive ads, and said that materials that run afoul of guidelines are replaced.
“Shire – and I think the vast majority of pharmaceutical companies – intend to market in a way that’s responsible and in a way that is compliant with the regulations,” Casola said. “Again, I like to think we come at it from a higher order. We are dealing with patients’ health.”
But Roger Griggs, the pharmaceutical executive who introduced Adderall in 1994, said he strongly opposes marketing stimulants to the general public because of their dangers. He calls them “nuclear bombs,” warranted only under extreme circumstances and when carefully overseen by a physician.