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Speeding Through Life

2242538593_0fcd685a61_mLast month, the American Psychiatric Association released the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, DSM-V. In it, they changed the diagnosis criteria for Attention Deficit Hyperactive Disorder (ADHD) which actually made it slightly easier for physicians to make a diagnosis. Previously, if the symptoms were observed before the age of 7, the diagnosis could be made. Now that age has been moved to 12.

Here’s a sample of the criteria:

  1. Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
  2. Often has trouble keeping attention on tasks or play activities.
  3. Often does not seem to listen when spoken to directly.
  4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
  5. Often has trouble organizing activities.
  6. Often avoids, dislikes, or doesn’t want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
  7. Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
  8. Is often easily distracted.
  9. Is often forgetful in daily activities.

If a child exhibits six or more of these consistently and it could be said that you have an attention deficit. (See the full criteria at the CDC website) But if you’re an adult, you now just have to exhibit five of these criteria.

What’s the impact?

Changing the age from 7 to 12 for kids, and from 6 criteria to 5 in adults, makes it easier to make an ADHD diagnosis. And, as Pieter Cohen of the Wall Street Journal points out, it sets up a whole lot more people to be prescribed various forms of amphetamine. (Forms of this drug have been abused for generations.)

He writes:

Even before DSM-5, doctors were already on track to prescribe enough stimulants this year for each American man, woman and child to receive the equivalent of 130 mg of amphetamine (about 40 five-mg pills of Adderall) and an even greater amount of the very similar drug Ritalin. In this era of excessive prescribing, we seem to have forgotten the cautionary history of amphetamines in America—a history that shows how overprescribing stimulants leads to widespread dependence and addiction.


Did you catch that? 40 pills of Adderall for every person in America. That’s a lot of drugs.

What do you think? Was changing the criteria a good thing or a bad thing? 

Photo credit: Light blue by hipsxxhearts via Flickr (Creative Commons)
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The Battle for ADD

As an outsider, I would guess that the annual conference for the American Psychiatric Association is pretty benign. Therapists present papers, take a few questions, and attend meetings to review the latest research. In the evening, in the conference late night activity guide in my imagination, I can see a few thousand therapists spend the evening looking at new couches in the exhibit hall. Perhaps there are active debates on the appropriateness of the smoking jacket while attending to a patient?

I don’t think of psychiatrists as fiesty. Nor do I think of them as looking for a fight.

But there is a fight brewing among the nations psychiatrists. And it could be both costly and damaging to our nations children. Specifically, the battle is over the hyper-medication of our children diagnosed with attention deficit disorder. More specifically, the new volume of DSM may lower the standards and create several sub-sets of hyperactivity, making it even easier to give children psychiatric drugs for… being children.

“We are gravely concerned that if this is published as is in 2013, it will create false epidemics where hundreds of thousands of children and the elderly who really are normal will be diagnosed with a mental disorder and given powerful psychiatric medications that have dangerous side effects,” Elkins says. “That is not tolerable.”


A December 27th article in Salon reports that nearly 10,000 therapists have signed on against lowering the bar for ADD diagnosis.

You read that right. 10,000 therapists are arguing against permission to write more prescriptions, schedule more therapy sessions, and make more money. The 2013 edition of DSM is trying to make it easier for them to diagnos ADD in children and adolescents and the professions are revolting.

What do you think? Are there more kids who are ADD than are being diagnosed? Or is ADD already too easily identified/treated?