ADHD: How Did It Leap from Classroom to Boardroom?
Written by Editor   
Tuesday, June 21, 2016 12:00 AM

In 2006, interest in attention deficit hyperactivity disorder (ADHD) reached new heights after a major study found that 4.4% of adults in America had the condition.  For decades, ADHD primarily had been a diagnosis in children, but the new study found it also affected as many as 10 million adults.  What happened next followed a familiar pattern: more research papers were published and many of them were based on research funded by drug companies.  What happened?

The 2013 edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, relaxed the definition for adult ADHD.  The previous definition, in effect since 1994, said adults needed to have at least six of a possible nine symptoms from either of two categories. The symptoms include the inability to focus on tasks, fidgeting, and interrupting others. The new definition reduced it to five of the nine.  It also increased the age at which some of those symptoms first must have been present — from before age 7 to before age 12.  Seventy-eight percent of those among the work group of experts who oversaw the changes had financial ties to the pharmaceutical industry, according to a 2012 analysis

Finally, the cumulative result of these factors was as expected: Prescriptions spiked.  And, since many of those drugs are amphetamines and stimulants that can lead to abuse, thousands more people began showing up in hospital emergency rooms.

A 2010 study found that 22% of adults tested for ADHD exaggerated their symptoms, exaggeration often made easier by the wide availability of online symptom check lists.  According to the medical literature, the prevalence of ADHD in adults is about half that in children.

For years, the legitimacy of the adult ADHD was based on the belief that it was a condition that started in childhood and, for some, persisted into adulthood.  But last year that hypothesis was shaken by the publication of a long-term study that began in the early 1970s and followed more than 1,000 New Zealand children until age 38.  In that study researchers found that in childhood, 6% of those in the study had ADHD. At age 38, that number had dropped to 3%.  And the biggest surprise was the lack of evidence of significant overlap between the two groups.  Only 5% of those with ADHD in childhood still met the criteria at age 38. And only 10% of those who met the definition at age 38 were among those with the condition in childhood.

Researchers noted that while childhood ADHD is considered a brain development condition, adult ADHD patients in the study scored normally on neuropsychological tests.  “It seems to be a different disorder,” researchers said.  Researchers speculate that some of the adult patients were substance abusers who had attention problems stemming from drugs and alcohol, and that others may have had a personality disorder and were trying to game the system to obtain stimulants to abuse.

In 2014, the pharmaceutical company Shire paid $56 million to settle a U.S. Department of Justice allegation that it illegally promoted ADHD drugs when between 2007 and 2010 company sales representatives claimed the drugs would prevent car accidents, divorce, arrests, and unemployment.

Drug industry exuberance for the budding adult ADHD market was highlighted in a 2008 report:  “Estimated to be twice the size of the pediatric ADHD population, the highly prevalent, yet largely untapped, adult ADHD population continues to represent an attractive niche to target,” the report said.  From 2008 to 2012, prescriptions of ADHD drugs to adults increased 53%, and overall, ADHD drugs now are one of the most lucrative sectors of the U.S. drug market, totalling more than $10 billion in sales and 83 million prescriptions in 2014.

One psychiatrist says that while there may be a small number of adults who are hyperactive and find it difficult to concentrate, the “diagnostic criteria are so loose that anyone could qualify.”  Another said the boom in adult ADHD cases increases the likelihood of a repeat of the prescription stimulant epidemic in the 1960s, when the pills were marketed for weight loss.  For decades, stimulants have been known for the ability to improve alertness and focus for users ranging from pilots to college students.  But they also are powerful enough to produce a sense of euphoria in adults, making them a popular for drug abusers.

In 2014, about 1 million people 26 and older used prescription stimulants for nonmedical purposes, which includes using a drug without a prescription or using a drug for the feeling it causes, according to data from the most recent National Survey on Drug Use and Health survey.  Between 2005 and 2010, emergency room visits involving ADHD drugs more than doubled, from 13,379 to 31,244, according to data from Substance Abuse and Mental Health Services Administration.