Amid what some claim is a growing epidemic of ADHD diagnoses, a study finds that almost one in four adults who show up in doctors' offices seeking treatment may be exaggerating — or even faking — their symptoms.
Twenty-two percent of adults in the study who claimed they suffered from attention-deficit/hyperactivity disorder tried to skew test results to make their symptoms look worse, according to a new report based on the medical records of 268 patients and published in the journal The Clinical Neuropsychologist.
Some of those who exaggerated their symptoms actually had ADHD, but embellished their reports to ensure they got diagnosed, said the study's lead author, Paul Marshall, a clinical neuropsychologist with Hennepin Faculty Associates, a medical group that provides services at Hennepin County Medical Center in Minneapolis.Others didn't have the disorder at all, but were having a tough time dealing with their workloads and lives.
"A lot of people think they have it because they are struggling, but it's not because of ADHD," Marshall said. "Often times, it's simply depression, anxiety or lack of sleep."
Other patients may have been faking symptoms to get access to stimulant medications, Marshall said. In some cases, college and graduate school students want to be diagnosed with ADHD in hopes of gaining access to medications that boost concentration and focus, as well as accommodations such as longer times for tests, he added.
And some just want the meds for an inexpensive high, Marshall said.
In poll, doctors suspect faking
Marshall's findings dovetail with an informal poll of 100 primary care physicians conducted by the group Truth On Call for msnbc.com.
Responding to the text message survey, 38 percent of doctors said they suspected a patient of exaggerating or faking symptoms to get a prescription for ADHD drugs.
Some said that a red flag would go up when patients got the symptoms right, but seemed to be exaggerating their severity.
“I had a patient who was prescribed Adderall by another doctor,” one physician wrote. “I asked her [for] her medical history pertaining to ADD. She explained how she had difficulty concentrating at home and how the meds had helped her maintain the A grades she had been having all along.”
In the United States, between 2 percent and 4 percent of the adult population is estimated to have ADHD, or 4 million to 8 million people, health experts say. Many adults are first diagnosed as children, with up to 60 percent continuing symptoms into later life. About 5.4 million children ages 4 to 17 have ever been diagnosed with ADHD, according to the Centers for Disease Control and Prevention.
But because there is no real test for ADHD, it can be tricky to diagnose the condition in adults, said Dr. L. Eugene Arnold, an ADHD expert unaffiliated with the new report and a professor emeritus of psychiatry at Ohio State University. When it comes to children you have to have two sources — generally parents and teachers — to make a diagnosis. In adults, you just have the patient’s word, he said.
Questionnaires reveal exaggeration
To get an idea of how many people might be trying to game the system to get drugs and other benefits, Marshall and his colleagues scrutinized patient interviews and questionnaires. The questionnaires came with an extra bit of information. Embedded throughout were little tests designed to ferret out people who might be cheating or exaggerating their symptoms.
Ultimately, Marshall and his colleagues found patients who not only exaggerated their symptoms but also scored much more poorly on the embedded tests than people with actual ADHD symptoms would have.
A doctor in the 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.”
Why would someone want ADHD medications so badly?
“There are big cultural pressures to get these drugs,” said Dr. Anjan Chatterjee, a professor of neurology at the University of Pennsylvania. “That’s because everyone is in an arms race of accomplishment.”
People want the drugs to get an extra edge, Chatterjee said. Just as athletes have sought out steroids, students — especially those at competitive colleges and graduate schools — try to enhance academic performance with drugs like Ritalin and Adderall.
The medications appear to work by stimulating the brain, boosting levels of dopamine and norepinephrine, chemicals associated with attention and behavior, according to the National Institute on Drug Abuse. In people with ADHD, these drugs have a calming effect. However, in people without the disorder, the drugs can be dangerous.
Chatterjee and others are at the forefront of a new field called cosmetic pharmacology, which studies people who take medications not to treat illness, but rather to improve performance.
“As best as we can tell from survey data, there’s a fairly large number of students who are getting Ritalin and Adderall from underground markets at college campuses,” Chatterjee said.
Worrisome trend, experts say
There are several downsides to the trend, not the least of which is that people who actually do have ADHD may encounter difficulty finding treatment as doctors become increasingly suspicious, Arnold said.
Another important issue is the possibility of addiction, said Dr. Karen Miotto, director of the University of California, Los Angeles, Alcoholism and Addiction Medicine Service.
“I see the most tragic cases,” Miotto said. “For example, there was a woman I saw who had been in medical school. She started misusing Adderall, and then she started needing more and more. Then she started doctor-shopping to get more medication.”
Eventually the woman became dependent on the drugs and flunked out of med school.
“She said she was just trying to do better in school,” Miotto said. “Just trying to keep up. There’s a point in time where you need to come to terms with things. I said, ‘Honey, this isn’t about medical school anymore. Now you have a serious illness — it’s called addiction.'''