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Higher numbers of diagnosis exist in some affluent populations, while in poor white populations and ethnic minorities there is under-diagnosis, says Professor Ilina Singh

Imbalance of adhd diagnosis in the us
Edward, aged 16, holds his daily dose of pills. Photograph: Baptiste Lignel/Otra Vista/The Guardian

'In America, medication is becoming almost as much a staple of childhood as Disney and McDonald’s. Kids pack their pills for school or college along with their lunch money. Some are taking drugs for depression and anxiety, others for attention deficit hyperactivity disorder (ADHD). The right drugs at the right time can save young people from profound distress and enable them to concentrate in class. But some adolescents, critics say, are given medication to mask the ordinary emotional turmoil of growing up; there is a risk that they will never learn to live without it.

According to America’s Centers for Disease Control, 11% of four- to 17-year-olds in the US have been diagnosed with ADHD, a label for those who are disruptive in class and unable to concentrate; just over 6% are taking medication. But the official figure hides huge variation across regions and class. Numbers are very high in the white, middle-class east coast population, says Ilina Singh, professor of neuroscience and society at Oxford University, while there is under-diagnosis in poor white populations and among ethnic minorities.

“In the middle-class, educated group in New York, you probably are seeing kids who are just under more academic pressure,” she says. “Parents will begin to look at psychiatric diagnosis and treatment with drugs as one option for making children perform better. You have parents saying, ‘My child must be on Ritalin because all the other children in the class are.’”

In the UK, meanwhile, about 3% of children are diagnosed with ADHD; just 1% are on medication. American children can go through six or seven different drugs quite early in their lives; in the UK, children are usually sent for cognitive behaviour therapy first, in line with guidance from the National Institute for Health and Care Excellence.

Medication for ADHD has long provoked controversy. But in recent years, the big upturn in the US has been in prescribing for depression and anxiety. It is now generally accepted, says David Healy, professor of psychiatry at Bangor University, that 20%-25% of students at most universities in the US are on medication, often on multiple prescriptions. There, he says, taking your meds is often seen as proof that a young person is dealing with their problems. “But you are not going to learn coping skills if you are taking pills,” he adds.

He believes the UK may follow where the US leads. Once, it was unusual for British children to be put on medication; mental health teams would expect to work with a family over issues such as divorce. But increasingly, Healy says, young people turning 18, who transition into the adult mental health services where he works, arrive with a diagnosis of ADHD, autistic spectrum disorder or even bipolar – and will argue that they should carry on taking the pills they have been given by the children’s services. “We used to have a world in which it was accepted that kids in their teens were confused,” he says. “It’s an extraordinary change compared with even five years ago. This is the new norm.”'

This is an extract from an article published in The Guardian newspaper, 21 November 2015.

Read the full article, with portraits and interviews by photographer Baptiste Lignel here.