VIRGINIA BEACH, Va.

WHEN THE PORTSMOUTH School Board in southeastern Virginia sent a flier home to parents warning them about the epidemic of children misdiagnosed with attention deficit/hyperactivity disorder (ADHD) and prescribed unnecessary psychiatric drugs, six national and eight local organizations responded in protest, according to an Oct. 19 story in The Virginian-Pilot.

But the Oct. 27 follow-up story indicated that the board chair received hundreds of mostly favorable e-mails.

The board deserves to be commended for sounding an alarm. Published research (e.g., http://www.srmhp.org/0201/adhd.html) has documented that ADHD treatment among children in Portsmouth exceeds all national estimates and guidelines. Up to 14 percent of the region’s elementary-school children (27 percent of black boys and 33 percent of white boys) have been diagnosed with ADHD.

Improper ADHD care is a national concern. Because basic questions about ADHD are controversial, the National Institutes of Health (NIH) convened an expert panel of unbiased scientists to review ADHD research. The 1998 panel concluded that there was strong evidence that the disorder probably does exist, but that it affects only 3-5 percent of children. It also concluded that there are serious problems with how ADHD is diagnosed. According to a pediatric NIH panel member Mark Vonnegut, M.D. (son of the late Kurt Vonnegut, the writer), “The diagnosis of ADHD is a mess.”

More recently, national research has documented that less than one-third of primary-care physicians adhere to established diagnostic criteria. As previously reported in The Virginian-Pilot, two-thirds of pediatric providers in southeastern Virginia acknowledged that children in the area do not receive adequate diagnostic evaluations. Nationally, rates of treatment have increased, but not necessarily the number of disordered children.

According to the CDC, as of 2003, up to 14 percent of American boys had been diagnosed with ADHD, and treatment patterns varied considerably across states. The rate of ADHD diagnosis was 5 percent for California and 11 percent for Alabama. Treatment rates vary even more widely across communities. In 1999, for example, the relative rate of Ritalin use was 100 times greater in some U.S. cities than in others.

When a 2006 Food and Drug Administration (FDA) advisory committee recommended use of “black-box warning” labels for ADHD drugs, prominent groups such as the American Academy of Pediatrics protested. Nonetheless, the FDA warning was upheld. Dr. Steven Nissen, cardiologist and FDA panel member, expressed worry that stimulant drugs are vastly overprescribed for ADHD and that the cardiovascular risks are under-appreciated. He also noted that he was not surprised by the reaction of pediatric groups: “It’s difficult to find physicians willing to stand up to industry.”

The FDA was able to withstand intense opposition. Will Portsmouth school administrators be able to resist pressure from the Tidewater chapter of Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD), the Virginia Academy of Pediatrics, the American Academy of Child & Adolescent Psychiatry, and others who suggest distributing materials that advocate for more of the same standard (i.e., problematic) practices?

In any event, parents should be warned that professionals who argue that ADHD is under-medicated may be motivated by money tied to the industry or lucrative “ADHD” clinical practices.

Gretchen B. LeFever is a clinical psychologist and a professor of education at Regent University.