So much for the adult ADD epidemic

[Altostrata]

Faking It: Why Nearly 1 in 4 Adults Who Seek Treatment Don't Have ADHD

 

By Meredith Melnick Thursday, April 28, 2011 Time Healthland

 

A new survey of patients' medical records finds that nearly a quarter of adults who seek treatment for attention deficit hyperactivity disorder may be exaggerating or faking their symptoms. Why would someone fake a psychological disorder? In a word, Adderall.

 

The authors of the study, published in The Clinical Neuropsychologist, said there were actually a variety of reasons people exaggerated their symptoms: some legitimately had ADHD, but just wanted to make sure their doctor gave them the diagnosis; others really thought they had ADHD, but didn't (rather they were stressed or depressed). But in many cases, the reason for claiming symptoms of ADHD was to obtain the drugs — like Adderall and Ritalin — that are used to treat it.

 

These drugs are stimulants, which work by boosting levels of the neurotransmitters dopamine and norepinephrine in the brain. In people who have ADHD, the drugs calm behavior and help maintain focus. In healthy people, the drugs serve as performance enhancers. College students, journalists, scientists and baseball players, among others, have been known to use the drugs to increase their ability to concentrate, improve attention, memory and learning, and get ahead.

 

....

A doctor in [an MSNBC-commissioned] Truth On Call poll summarized the fakers like this: "Patients try to describe typical symptoms with a request for specific ADHD drugs. With standard symptom questionnaires, they will push the responses to the extreme and try to request specific medications when prescribed alternatives."

The problem is that there is no single guaranteed test for ADHD. Diagnoses depend on individual physicians' assessments. So how reliable are doctors — and the measures they use — generally?

 

A study by University of Kentucky psychologists, published in June 2010 in Psychological Assessment, sought an answer by asking college kids to try to fake ADHD symptoms on a series of tests. There were actually three groups of students who took the tests: some who legitimately had ADHD and were temporarily off their medication, others who didn't have ADHD and weren't asked to fake it, and those who didn't have ADHD but were told they'd get $45 if they could convince the assessor they did. To prepare, they were given five minutes to look over ADHD information obtained from Google.

 

Regarding the assessment measures, Psychology Today reported:

 

Tests for detecting ADHD fall into two broad categories. Firstly, and most simply, there is self-report, where the patient describes their symptoms in response to structured questioning. Second there are neuropsychological tests, where the patient is asked to perform a particular task. These often appear much like a simple computer game and are structured such that persons with ADHD will make certain types of mistakes on the game due to impulsivity, inattention or other ADHD symptoms.

The self-reports couldn't tell the real ADHD sufferers from the fakers, and the computer tests weren't much more effective either, the study found.

 

ADHD diagnoses in adults may be trickier than in kids. For children, there are at least multiple sources of information and observation — parents, teachers, doctors. With adults, physicians can rely only on self-reporting. The Centers for Disease Control and Prevention estimates that 2% to 4% of adults actually have ADHD, many of whom were initially diagnosed as children.

 

....as the MSNBC story points out, if misused the medications could become habit forming — and a surefire way to ruin performance is misusing prescription drugs.

 

http://healthland.time.com/2011/04/28/faking-it-why-nearly-1-in-4-adults-who-seek-treatment-dont-have-adhd/

[cinephile]

It's utterly eerie how my assumptions and observations are coming true in newsprint. I KNEW that eventually some enterprising researchers would employ ye olde malingering con for ADHD to see if the participants could score some Adderrall. I know this because when I was in college (2002-2006) I began to hear about recreational Adderall use. I'd heard of the lunkhead students faking ADHD at their family doctors to score some Addies that they could crush up and snort either for purely recreational use or to engage in marathon last-minute cramming sessions. I knew of at least one student who had a full-blown psychotic break after binging on it for days and getting no sleep. He was eventually admitted to a psych ward against his will. I hope for his sake his psychosis wasn't diagnosed as "organic" and merely "uncovered" by the Adderall like so many poor unsuspecting kids and thus misdiagnosed as bipolar and then set on a merry-go-round of psych meds all for a bogus diagnosis.

 

I told this to my nursing class a couple years ago and the over-40 set in the class (read: parents) were horrified. I was perversely amused at their horrified faces as they started to, however tentatively, realize that a so-called "wonder drug" they may have their kids on is really just speed and really not that chemically different from "evil" street drugs like meth or coke. If I had told them EVERYTHING I/we know about the psychiatric profession, I think their heads would have exploded.

 

Also, this isn't the first time such an experiment has been conducted to see if healthy individuals can fool psychiatrists into diagnosing them. In lapsed psychiatrist John Sorboro's must-read Skeptic Magazine article, "Prognosis Negative," (volume 15, number 3, 2010), he speaks of a famous experiment conducted by psychologist David Rosehan where "eight experimenters, including a psychology graduate student, three psychologists, a pediatrician, a psychiatrist, a painter, and a housewife were instructed to attempt to gain a psychiatric hospital admission by feigning symptoms during psychiatric assessment. Each claimed to be hearing voices that were often unclear but which seemed to say the words, 'hollow,' 'empty,' and 'thud.' No other psychiatric symptoms were claimed and apart from giving false names and employment particulars, further biographical details were truthfully reported. If admitted, the pseudopatients were asked to 'act normally' and report that they felt fine and no longer heard voices. None had a history of mental illness. All eight of Rosenhan's subjects were admitted, seven with a diagnosis of schizophrenia and the last with manic depression. Once admitted and diagnosed, the pseudopatients were not able to obtain their release until they agreed with the psychiatrists that they were mentally ill and took antipsychotic medications. Rosenhan's article exploded the controversy that ultimately led to the publication of the DSM III in 1980. With it, the essential focus of psychiatric nosology changed to a research-based atheoretical descriptive model. A new paradigm was born."

 

But here's the key point: at least in the ADHD example, the DSM STILL fails to improve patient screening and diagnostic accuracy after all these years (jeezus, all the participants needed to fool the psychiatrists was five minutes of research on google?). The diagnoses are as politically (and monetarily) motivated as ever, and they remain mushy even in this age of the so-called "biomedical model of psychiatry." The DSM was supposedly going to make it as hard to fake ADHD as it is to fake a heart attack, because just as a cardiologists could, in theory, check for the validity of the patient's story with an EKG and other medically sound tests, the psychiatrist could refer to their trusty DSM for an "evidence-based" description of the disorder. But, as evidenced by this recent article, that, of course, isn't necessarily true.

 

And, in fact, (mis)diagnosing could get even nuttier if the concept of prodromal disorders catches on, where psychiatrists could in the future make patients "qualify for diagnosis of a mental disorder just based on...[a] hunch." Yowza.

 

For reasons (and evidence) such as this, I have to agree with John Sorboro when he told me via email that "psychiatry will never get its sh*t together" because it's so "conceptually confused." Amen brother.

 

***PS: In quoting the article for this post, I saw that I had jotted down in the margins months ago this note to myself, "Kids today often fake ADD to get Adderall for recreational use." Like I said, eerie. And, once again, journalism is a 1000 years too late in reporting this. But at least it IS finally getting reported.

[Altostrata]

Oh, yeah, we've known for many years that college kids were on the cutting edge of scoring drugs for off-label purposes.

[cinephile]

Oh, yeah, we've known for many years that college kids were on the cutting edge of scoring drugs for off-label purposes.

Very true. But I think it's still a shock to many (especially parents) that their kid may be faking something like ADD to get high!