These findings were based on a large-scale and rigorous epidemiologic study of 29,734 children and were published in a prestigious journal-the American Journal of Public Health (AJPH) (LeFever et al. In one district, 63 % of children who were young for their grade were medicated for ADHD-suggesting a widespread failure to distinguish between disorder and developmentally normal variation. They found that 8–10 % of children in southeastern Virginia, including 17 % of white boys, were being medicated in school for ADHD (LeFever et al. The long-standing ADHD debate had experienced a period of relative quiet until LeFever and colleagues documented high rates of ADHD drug treatment in the mid-1990s. Second, the attacks led to the total dismantling of a school health coalition and associated behavioral and public health interventions that showed promise for improving ADHD care. Nonetheless, the ad hominem attacks had a damaging impact.įirst, the attacks contributed to the suppression of a large and unique dataset of risk and protective factors associated with ADHD diagnosis and treatment. Besides the outright fallaciousness of the anonymous charge, there was then-and is now-ample evidence to support LeFever’s findings regarding high rates of ADHD diagnosis and drug treatment. The anonymous letter alleged that LeFever had falsely reported high rates of ADHD diagnosis to suit her own personal anti-medication agenda. One of the attacks came in the form of an anonymous allegation of scientific misconduct and resulted in the premature termination of LeFever’s work, including her part of a multi-site, multi-million dollar study funded by the Centers for Disease Control and Prevention (CDC) (Lenzer 2005a, b). In the course of this work, LeFever was repeatedly attacked for reporting high rates of ADHD diagnosis and treatment. Based on community input, she and her colleagues developed a systematic public health approach to improving the identification and care of children with behavioral problems in the region. With support from Children’s Hospital of The King’s Daughters and Eastern Virginia Medical School (EVMS), LeFever formed a regional school health coalition to improve ADHD treatment. This research documented exceptionally high rates of ADHD diagnosis and drug treatment in her community. In the mid-1990s, a practicing psychologist in southeastern Virginia, Gretchen LeFever, began a program of ADHD research that included epidemiologic surveys.
The authors offer a summary of the data on ADHD drug treatments, suggest judicious use of such treatments, and add their voices to others who are once again sounding a cautionary alarm. Tenure may be the only option for protecting innovative research from specious attacks. Notable key opinion leaders continue to claim that there is no cause for concern, but with a message shift from “the prevalence is not too high” to “high prevalence is not too concerning.” This paper provides an object lesson about how innovative research can be derailed to the detriment of sound medical and mental health care of children when industry interests are threatened. Today, the national rate of ADHD diagnosis exceeds all reasonable estimates of the disorder’s true prevalence, with 14 % of American children being diagnosed before reaching young adulthood. In the ensuing years, ADHD drug treatment continued to escalate.
These attacks contributed to the work being terminated in 2005. Other professionals with strong ties to the pharmaceutical industry launched ad hominem attacks on the coalition’s research and work. Psychologists in southeastern Virginia formed a regional school health coalition to implement and evaluate interventions to address the problem. Medicating ADHD is a controversial subject that was acutely inflamed in 1995 when high rates of ADHD diagnosis and treatment were documented in southeastern Virginia.
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