Abstract
with an equation describing a chemical equilibrium reaction, the presence of an extremely effective treatment (or of readily available reimbursement for a treatment of unproven efficacy) will not unexpectedly contribute both to an increase in the use of that treatment and possibly to more accurate diagnosis. Although not every child who qualifies for a diagnosis of an attention disorder needs a trial of medication, the prescription rate would need to significantly exceed the 10% level before it can be interpreted as prima facie evidence of overuse. Several decades ago, there was an “epidemic” of learning disabilities, and more recently, there has been a “pandemic” of autistic spectrum disorders. For the most part, these increases do not reflect faddish overdiagnosis but rather a recognition of cases that were previously misdiagnosed or just plain missed. Although Goldman et al 10 found little evidence of any “widespread overdiagnosis or misdiagnosis of ADHD or of widespread overprescription of methylphenidate,” Angold et al 11 uncovered some confusing discrepancies between prescription practices and accurate diagnoses in a community setting. Commenting on the latter article, Jensen 12 interpreted this mismatch as not inconsistent with undertreatment as the primary phenomenon.
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