'Heading towards an epidemic of over-diagnosis' - psychiatrist on ADHD

A leading psychiatrist has warned Malta is heading towards an “epidemic of over-diagnosis” of attention deficit hyperactivity disorder, or ADHD.

Nigel Camilleri said he was increasingly seeing patients who suspect they are suffering from the condition after reading about it online.

Stressing the condition was genuine and that legitimate sufferers might be more likely to seek treatment due to heightened awareness of the condition, he warned against unnecessary diagnoses.

Fellow psychiatrist Anton Grech agreed that, while more genuine patients were seeking help, over-diagnoses were on the rise, pointing to online ADHD tests as helping to fuel the issue.

A pharmacist said he had seen a “sharp increase” in prescriptions for drugs to treat the condition, adding it was common for customers to ask how to get them.

Camilleri, a consultant psychiatrist and University of Malta visiting professor, said there had been an “increase in the number of people reading up online, coming in and fishing for a diagnosis”.

Stressing it was important to thoroughly assess potential sufferers of the condition, which, he emphasised, was genuine and, in severe cases, potentially “debilitating”, he cautioned that “some specialists might take shortcuts and more easily diagnose”.

“We’re going towards an epidemic of over-diagnosis,” he said.

ADHD is a mental disorder characterised by difficulty concentrating on tasks for prolonged periods of time, excessive activity and difficulty regulating behaviour and emotions, among other symptoms.

It is the most commonly diagnosed mental disorder among children but, in recent years, there have been an explosion of interest from adults concerned they might be suffering from the condition.

Camilleri noted “ADHD doesn’t tend to surface in people in their 20s and 30s; it comes on in childhood... [so] people coming in are more likely to be overworked”.

Stressing that people were “not machines” and should steer away from unrealistic expectations, the psychiatrist noted that factors such as gaps in people’s learning could lead to ADHD-like symptoms such as difficulty concentrating on a problem.

Other affecting factors could include complex post-traumatic stress disorder (PTSD) brought on by early detachment or early trauma, he said.

Drugs

ADHD is commonly treated using methylphenidate, sold under brand names such as Ritalin and Concerta which, while not curing the condition, aim to control its symptoms.

In recent years, however, such drugs have made headlines round the world for their use as so-called “study drugs”, used by university students seeking to enhance their ability to concentrate for longer periods of time.

Warning of “serious side effects” of such drugs if used by non-ADHD sufferers, however, Camilleri called for thorough assessments of the condition, a call echoed by Grech.

“There is more awareness [of ADHD], so more people are coming forward, but I think we’re using the term too much,” said Grech, adding there was an “overlap” in symptoms of ADHD and those of anxiety.

Warning against the use of online ADHD quizzes advertised as tests for the condition, he said such tools were over-diagnosing internet users while advocating for “non-medical interventions” instead of treatment in many cases.

Surge

One pharmacist said there had “definitely been a sharp increase” in the number of ADHD medication prescriptions and enquiries about such drugs.

“It’s been ramping up exponentially in the last two years,” said the pharmacist who spoke on condition of anonymity.

“Back in the day, we would only have a handful of boxes [of treatment drugs]; now we keep a good supply,” he said, adding that both the number of patients prescribed such drugs and the dosages had increased.

The pharmacist said he had noticed a surge in the number of customers in their mid-20s to mid-30s collecting prescriptions, adding it was “not uncommon for people to come in asking how they can get them [treatment drugs]”.  Noting that many such customers appeared to be in demanding jobs, he said he had heard them describing ADHD treatment drugs as a “lifesaver”.

He joined calls for more judicious treatment of the condition, noting that, with prescriptions for treatment drugs typically filled out by psychiatrists, urgent one-week prescriptions issued by GPs “ideally should not be done”.

UK newspaper The Times last month reported a dramatic rise in ADHD prescriptions since the pandemic, with experts attributing the increase to influencers sharing information about the condition on social media platform TikTok.