Q&A: ASD and ADHD Increases
The latest version of the Diagnostic & Statistical Manual of Mental Disorders (DSM) will be released soon, and contains updated criteria that may impact autism spectrum disorder and ADHD diagnoses. Clark A. McKown, PhD, Executive Director of Rush NeuroBehavioral Center, discussed these updates along with data from the CDC suggesting that such diagnoses are on the rise.
Q: Data released from the CDC shows that since 2007, prevalence of autism spectrum disorders (ASDs) has nearly doubled, while ADHD diagnoses rose 1.5% in school-aged children. What do you believe is the underlying reason(s) for these increases?
A: The big question is are these increases real or are they the result of a social or cultural phenomenon? In the case of ASDs, it seems to be a bit of both. A recent study suggests that older fathers are more likely than young fathers to have a child with an ASD. Men are having children later, increasing the likelihood that they’ll have a child with an ASD. However, I don’t believe that this alone created the explosion in diagnoses. Other contributors, in my opinion, are increased awareness, decreased stigmatization around having a neurobehavioral disorder, and improvements in diagnostic technology. These factors have compelled parents to seek out an evaluation when in years past they may have never considered that course of action. So really, what we are seeing is an increase in identification rates rather than a true increase in prevalence.
Q: The DSM‑V is set to include new criteria that would allow more adolescents and adults to qualify for an ADHD diagnosis. With recent studies showing that 11% of school-aged children are medically diagnosed, do you view the new criteria as positive or negative?
A: Whenever the criteria for a disorder change, there are potential benefits and drawbacks, and the outcome of this change remains to be seen. Assuming that the new criteria will expand the pool of kids diagnosed, time will tell whether those kids will have the same level of impairment as kids meeting stricter criteria. If they do, I’ll feel more comfortable that we’re finding kids who were going undiagnosed before, and we may find that those kids need and benefit from treatment as much as those with more severe forms of ADHD.
Q: Do you believe there are there effective measures in place to determine who among those diagnosed should receive medication?
A: No – we know that in general kids who meet diagnostic criteria for ADHD tend to benefit from medications. Our new medication assessment service can help parents and physicians find the medication and dose that has the most benefit and the fewest side effects. Kids with ADHD can also benefit from “super-parenting” at home and behavioral reward systems at school. The trick to modifying home and school environments is to stick with the program and apply it consistently. This means, among other things, that parents who consult with a behavioral parent coach need to hang in there. It often takes some time and tweaking to get it right.
Q: Why do you believe such a gap exists between school-aged boys and girls in regards to ADHD and ASD diagnoses?
A: No one really knows. The higher severity and prevalence in boys may be a caused, in part, by sex differences genetic makeup. Girls have the good fortune of having a spare X chromosome, which may confer protection against some problems. It also seems likely that cultural factors, such as expectations about what is appropriate behavior for boys and girls, play a role. In some ways, ADHD is an extreme version of “boys being boys.”