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What Could Be Causing Indiana’s High Rate Of ADHD Diagnosis

Mark Evans

Photo: Gretchen Frazee

Mark Evans (right) was diagnosed with ADHD when he was in 2nd grade.

As more parents and doctors become aware of Attention Hyperactivity Disorder, the number of children diagnosed continues to rise, including in Indiana.

Just ten years ago, Indiana’s rate of ADHD diagnosis was about the same as the rest of the nation. But since then, it’s risen sharply and now Indiana has the fourth highest rate of children aged four to 17 diagnosed and medicated for ADHD in the U.S. at nearly one in ten.

If you include children aged two to 17, Indiana’s rank jumps to second in the nation.

Living With ADHD

ADHD is more than just a disorder for nine-year old Mark Evans. It’s something he has to live with.

On a recent afternoon, he bounds off the school bus along with three of his brothers and runs up to his house. As soon as he gets inside, his mom Gloria tells him to get out his school folder so she can check how he did that day.

It actually got to the point where he was so angry at times that I thought he might burst.”                -Gloria Evans

Mark isn’t having a good week so far. He lost behavior points at school both days this week. Today he lost points for talking to himself in class.

Doctors diagnosed Mark with ADHD about three years ago. His mother said it did not seem to be a problem until he reached second grade.

“He did preschool fine, he did kindergarten fine. I didn’t get any calls from teachers or anything and first grade was actually ok because he had a brother that was three months apart so they were together,” she says. “Then the next year I started getting the phone calls that he wasn’t focusing, getting kind of angry, not completing tasks.”

Gloria was reluctant to put Mark on medication because she was afraid of the side effects, but then he started getting in fights with his brothers.

“It actually got to the point where he was so angry at times that I thought he might burst. He balled up his little fists and get beet red,” she says. “He couldn’t handle his emotions.”

But after putting him on medication, Gloria’s fears were realized.

“He would just lick his lips all the way around until they were black all the way around,” she says. “His eyes would start to look funny. But I talked to the pediatrician. Instead of taking him off, we lowered the dose, that didn’t work, we tried time release capsules to see if a little bit in the evening, a little bit in the morning would work. That would wear off before he came home from school.”

She has now found a medication that works for him. He still gets some facial tics, but not as often.

Mark says the medication is better than getting in trouble at school.

“We have this chart called point play and when I don’t have my medication, I would get a lot of points off, but with my medication, I don’t get as many points off,” he explains.

Possible Factors For High ADHD Diagnoses

Nationally, the number of people with ADHD diagnoses has jumped more than 3 percent since 2003.

Indiana’s rate has increased even faster-more than 6 percent in the same time period to almost 16 percent of children aged four to 17.

It is hard to say exactly what’s causing Indiana’s high rate–few studies have looked specifically at Indiana and in an email, a spokesperson for the Family Social Services Administration, which oversees the division of mental health, said “we don’t have any specific information on the issue.”

But researchers at the Centers for Disease Control name three factors generally associated with states that have a higher percent of its population diagnosed with ADHD.

1. Physician prevalence and demographics.

CDC researchers say the more doctors you have the more likely children will be diagnosed, and the younger the doctors are.

“That could be tied to better education about ADHD, what it is, what it isn’t and more dedicated time in medical school, focusing on ADHD diagnosis because certainly the number of minutes spent on ADHD in medical school has been increasing,” says CDC epidemiologist Susanna Visser.

But according to the American Association of Medical Colleges, Indiana has fewer physicians than other states and has a higher percentage of doctors over forty years old.

2. Population on Medicaid.

Children in families that are on Medicaid often have the highest rate of ADHD diagnosis.

About 17 percent of Indiana’s population is on Medicaid. That is just above the national average of 16 percent, according to the Kaiser Family Foundation.

3. State policies.

CDC researchers say states that high-stakes testing and lower funding for special education tend to have higher rates of ADHD.

Indiana has raised the stakes for standardized testing several times since 1999 by linking school funding to performance. If students don’t pass the third grade reading exam, the IREAD-3, they’re held back until they pass the exam.

As far as special education is concerned, the state provides $24 million to schools. That’s a drop from $30 million in 2003. To compare, Illinois spends more than $300 million each year for special education.

There are also complicating medical factors.

“Children that are experiencing conflict or challenges in their home and have higher degrees of trauma also mimic symptoms of ADHD,” says Jim Bush, the Director of Clinical Decision Support at Eskenazi Health Midtown Community Mental Health in Indianapolis.

Bush works with teachers and school administrators in two dozen schools to try get them to help students with ADHD. He says while it’s important to find out what’s causing Indiana’s high rate of ADHD, it’s also important to make accommodations for the children who are having difficulties in school.

“When a young person is really doing their best to stay in a classroom what are their options? Are they able to stand up in the corner if they aren’t being distracting. Are they able to do certain things at their desk to help them stay busy?” he asks. “Can they have a squishy ball in their hands to keep them busy? Schools are really pushed to hit these targets and these goals and funding is related to performance so they really need to make sure that the whole class is learning, so if it’s disruptive it becomes challenging.”

Gloria Evans agrees. It is challenging.

“[Mark is] expected to learn the same, listen the same, have planning skills the same,” she says. “He’s expected to have every skill that every other child has, and he doesn’t. But unless he had his own classroom and special teachers, and then you come into the funds, and then it’s a whole big bureaucracy of the funds just are not there.”

Back at his house, Mark is concentrating on his math homework.

He tries to concentrate –  counting on his fingers when he can’t do the multiplication in his head. But every once in a while, he can’t help leaning over and asking his brother for help.

Gloria Evans says if his class had fewer students or was better able to respond to his individual needs, Mark would probably still need his medication but she thinks it would make a world of difference. For now, she says she’s just doing what she can to give him the best opportunity later in life.

“If you can’t do math, if you can’t multiply, if you can sit down long enough to learn to do fractions and read, especially reading and writing and as we used to say arithmetic, if you can’t do those three things and focus well enough to get the core of that, then you can’t expect that child to go to college because they have tests you have to take to go to college,” she says. “That was my biggest concern. That if I don’t get him the help he needs right now, I would be hindering him in the future”

While more than 70 percent of children grow out of ADHD, a recent study in the journal Pediatrics warns that children who have ADHD and aren’t treated properly have a higher mortality rate, are more likely to commit crimes and have more negative social interactions.

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