B. C. ‘ not making grade’ for treating ADHD

December kids more likely to be diagnosed than classmates

A massive study on the rates of attention deficit and hyperactivity disorders in B. C. shows the province isn’t adequately dealing with the problem, says a leading Vancouver psychiatrist.

Dr. Margaret Weiss, former head of the ADHD program at B. C.’ s Children’s Hospital, says the government is failing to set rigorous standards for diagnosis and provide enough help in the classroom.

A University of B. C. study published Monday in the Canadian Medical Association Journal found the youngest kids in the class are more likely than the oldest to be diagnosed with ADHD.

The study looked at the prescription records of almost one million B. C. schoolchildren over an 11- year period and found that kids born in December were 39- per- cent more likely to be diagnosed with ADHD than classmates born the previous January.

“There is a relatively obvious explanation and that is that one of the ways in which we diagnose ADHD … is with a teacher rating scale, which is comparing the child’s level of attention and behaviour against the rest of the class,” said Weiss.

“In other words, against children who may be older and may have developed other skills with time.”

The age differences in the classroom arise because five-year-olds are allowed to start Grade 1 as long as they turn six by Dec. 31 of their first school year. Those students are almost a year younger than classmates whose birthdays occur just after the cut- off for enrolment.

According to the study’s lead author, when kids act out or can’t follow the class program, they may be diagnosed and treated for ADHD when in reality they’re just immature. “At times a lack of maturity among some children is leading to a diagnosis for a neurobehavioural disorder of ADHD,” said Richard Morrow, a researcher in the university’s department of anesthesiology, pharmacology and therapeutics. “It does raise a concern about medicalizing a normal range of childhood behaviour.”

Children who receive a misdiagnosis may be prescribed unnecessary medication causing “adverse effects on sleep, appetite and growth and increased risk of cardiovascular events,” the report concludes. Additionally, kids may be stigmatized by receiving the label at a young age.

However, Weiss says focusing on the age difference ignores the fact that problems caused by legitimate cases of ADHD continue into adulthood.

What’s more important to address is why B. C. — along with Ontario and Quebec — received a “fail” rating in 2010 from Canada’s national ADHD advocacy group, the Centre for ADHD Awareness Canada. That review criticized the province for not providing extra school help for kids with ADHD unless they were also diagnosed with another learning disorder.

Children with attention deficit hyperactivity disorder have trouble concentrating, controlling their behaviour and sitting still.

While those effects are challenging for kids, in adults the untreated condition can lead to serious social and health issues, says Vancouver- based ADHD counsellor Pete Quily. For him, the chance that children will go undiagnosed presents a bigger risk than the adverse effects of a misdiagnosis.

Quily works with adults with ADHD and says they often end up using street drugs if their problems go unrecognized.

“If you don’t diagnose and treat ADHD, you have higher risks of your child self- treating with drugs — 30 per cent of addicts have ADHD; 21 to 45 per cent of prisoners in jail have ADHD,” he said.

The UBC study looked at 937,943 children in B. C. who were between the ages of six and 12 from 1997 to 2008. It also took data on prescriptions for drugs used to treat ADHD from Pharmanet and B. C.’ s Medical Services Plan, including Ritalin, Dexedrine, Adderall and Strattera. The study is the most comprehensive of its type in North America because of the access to public health files, said Morrow.

In general, boys are three times more likely to be treated for ADHD than girls. The rates for all children rose slowly, but steadily throughout the study period. In 1997- 98, 2.6 per cent of boys and 0.7 per cent of girls were diagnosed with ADHD. Those figures increased to 3.7 per cent and 1.2 per cent, respectively, 10 years later.

See the full text of the report at vancouversun. com.