"I think there is both under-diagnosis and over-diagnosis in certain groups, in certain populations, and in certain regions of the country. For example, in an age of managed care, where primary care physicians only have 15 or 20 minutes to see a patient and render a diagnosis, you're going to sometimes end up with people getting a label of ADHD and other diagnoses that may be non-mental health-related, when they shouldn't. . . .
"Unfortunately, sometimes health care providers might write a prescription for Ritalin or Adderall or another stimulant medication, just as a test to see if the behavior improves. And if it does, viola: ADHD. But we can't use those medications to confirm a diagnosis.. So the diagnosis takes some time, and in our managed care system, time is something that doctors often don't have. So in some areas of the country, there can be over-diagnosis.
"On the other hand, the diagnosis of ADHD is sometimes missed, because there's either a lack of awareness about ADHD, or a lack of time taken to properly make the diagnosis. For example, one out of six children in our country comes to a doctor's office with a diagnosable behavior or mental health disorder. Parents often don't report these symptoms to their primary care doctor, their pediatrician, or the family practitioner. Those doctors often don't have the tools. . .
A lot of doctors say that, in this world of limited resources, a pill is good enough.
"Is a pill good enough? No. A pill is not a skill. We need to teach appropriate skills--social skills, so they can get along with others; academic skills so they can read, write, spell, do math; as well as organizational skills, so that they can complete their work and have it done in a systematic way. Some children won't be able to learn these skills without those pills, because their brain won't be ready to accept that learning."
Those medications are pretty powerful. They are under the Schedule II label. Do you think that sort of warning is warranted?
"One wonders whether these medications should be under Schedule II. There are some potential problems with abuse of stimulant medications."