What is causing the global surge in ADHD diagnoses?

What is causing the global surge in ADHD diagnoses? This article believes it has to do more with marketing than medicine.

You can't catch attention deficit hyperactivity disorder (ADHD). Yet the diagnosis and treatment of this behavioral condition is spreading like a contagion -- surging as much as tenfold in some countries.

Call it an economic and cultural plague, but not necessarily a medical one, says Brandeis professor Peter Conrad. In a recent paper in the journal Social Science and Medicine, Conrad and coauthor Meredith Bergey examined the growth of ADHD in the United Kingdom, Germany, France, Italy and Brazil.

Until recently, North America tallied by far the most ADHD diagnoses, and the United States consumed 90 percent of all Ritalin, one of the most common ADHD drugs. ADHD diagnoses continue to grow in the U.S., but Americans account for only 75 percent of Ritalin users today.

Conrad and Bergey attribute ADHD's growth to five trends. Drug companies are effective lobbyists, and have spurred some countries to relax marketing restrictions on stimulants. Psychoanalytic treatment with talk therapy is giving way to biological psychiatry -- treating psychological problems with drugs. More European and South American psychologists and psychiatrists are adopting the American-based Diagnostic and Statistical Manual (DSM) standards, which are broader and have a lower threshold for diagnosing ADHD. Vocal ADHD advocacy groups work closely with drug companies to promote pharmaceutical treatment. Lastly, the easy availability of ADHD information and self-diagnosis via the Internet empowers consumers to ask for prescription treatment.

Many websites promoting ADHD drugs offer checklists with questions like these:

• Do you fidget a lot?
• Is it hard for you to concentrate?
• Are you disorganized at work and home?
• Do you start projects and then abandon them?

"These checklists turn all kinds of different behaviors into medical problems," Conrad says. "The checklists don't distinguish what is part of the human condition and what is a disease."

According to the study, in the U.K., diagnosis of the disorder in school-age children grew from less than one percent in the 1990s to about five percent today. In Germany, prescription ADHD drugs rose from 10 million daily doses in 1998 to 53 million in 2008.

Growth in Italy and France has been slower, in part due to those countries' more restrictive pharmaceutical drug laws. However, even those nations are becoming more lax, says Conrad. In Brazil, a rising number of ADHD advocacy groups, many with close ties to the pharmaceutical industry, are raising awareness of the disorder.

"There is no pharmacological magic bullet," says Conrad. No drug can account for nonmedical factors that may contribute to behavior. A fidgety student may be responding to the one-size-fits-all compulsory education system, Conrad says, not a flaw in his brain chemistry.

ADHD continues a long history of medicalizing behaviors, especially in the U.S., Conrad says. A century ago, masturbation was considered a disease. Men and women diagnosed with masturbatory insanity were institutionalized or subjected to surgical treatment.

"I think we may look back on this time in 50 years and ask, what did we do to these kids?" Conrad says.

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Epilepsy & Global Health - A New Priority

An article from BBC discusses how epilepsy is turning into a global health issue.

Epilepsy is twice as common in low and middle-income countries as it is in the developed world, according to an international team of researchers.

They say the higher incidence is linked to increased risk factors, including head injuries and infections such as pork tapeworm and river blindness.

And more than 60% of sufferers in those countries receive no appropriate treatment, they say in the Lancet.

A Lancet editorial said epilepsy had to be a global health priority.

Epilepsy is a condition in which disturbances to the brain's normal electrical activity cause recurring seizures or brief episodes of altered consciousness.

There are about 40 different types. Epilepsy is not a mental illness, but can develop after injury or damage to the brain.

About 85% of the global burden of epilepsy occurs in low and middle-income countries.

'Bewitched'

Writing in the Lancet, researchers led by Prof Charles Newton, of the University of Oxford, say the death rate in developing countries is much higher than in developed ones - and that the reason for this is likely to be a failure to treat people with the condition.

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Prof Newton said: "The burden of epilepsy in these regions is at least double that found in high-income countries, and sadly, adequate facilities for diagnosis, treatment and ongoing management of epilepsy are virtually non-existent in many of the world's poorest regions."

He added: "Many people with epilepsy or their families do not even know that they have a disorder that can be controlled with biomedical treatment, so it is vitally important that awareness is raised and medical care improved in these regions."

Medications are available - but there can be problems distributing them, especially to remote areas.

The researchers say there are low-cost ways of improving the situation and of reducing the stigma often faced by people with epilepsy and their families - such as working with traditional healers and awareness campaigns to increase understanding of the condition.

In some countries, traditional beliefs about the causes of the condition, including bewitchment, spiritual causes and curses, lead to stigma and increase the chance that a person with epilepsy will not get the treatment they need.

A Lancet editorial adds: "Given the prevalence of epilepsy globally, it should be included as a priority on the public health agenda, and access to treatment should be greatly improved in developing countries.

"It is time for all governments to take epilepsy more seriously."

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