How Attention-Deficit Disorder Went Global

In March 2013 the federal Centers for Disease Control and Prevention released data showing that 11% of school-age children in the U.S.—an astonishing 6.4 million kids—had received a medical diagnosis of attention-deficit hyperactivity disorder, a 41% increase in the past decade. Over two-thirds of kids with an ADHD diagnosis receive prescriptions for stimulants like Adderall or Ritalin. The data sparked a much-needed debate about whether American children were being overdiagnosed and overmedicated for ADHD.

That debate should now go global. Consider what's been going on in Israel. In 2010 alone the use of two medications, Ritalin and Concerta, skyrocketed by 76%. The following year, a study by Israel's Maccabi Healthcare Services found that as many as one in five Israeli children were prescribed stimulants without a proper ADHD diagnosis.

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Israel and the U.S. are not alone. Growing awareness of ADHD combined with increasing pressure on children to achieve academically—in countries like China, India, South Korea and Saudi Arabia—has led to surging numbers of diagnoses and prescriptions world-wide. Between 2000 and 2010, global ADHD-medication sales soared 26% a year to more than $8 billion. The total is projected to reach as high as $14 billion in the next two years, and global sales outside the U.S. are rising at least twice as fast as in the U.S.

The marketing strategies and awareness efforts of multinational pharmaceutical companies have contributed to this trend. In Saudi Arabia, for instance, the Belgian company Janssen, which makes Concerta, is listed as the sole sponsor of a website for the Saudi ADHD Society, which increases awareness and treatment in that country.

As clinical and health-policy researchers who have watched this story unfold, we're concerned. ADHD is a seriously impairing neurodevelopmental condition, and in some cases medication is a godsend. Yet even in those cases we must bear in mind that the stimulants that treat ADHD can have serious side effects, including psychosis in rare cases, and may become addictive.

Yes, substantial evidence shows that ADHD medication—when truly warranted—not only boosts attention but also improves academic performance and a child's quality of life. But even as global sales surge, evidence accumulates that stimulants are no silver bullet.

Hundreds of controlled clinical trials around the world, as well as the National Institute of Mental Health's landmark Multimodal Treatment of Attention Deficit Hyperactivity Disorder (MTA) study, have found that while ADHD medications have clear benefits in the short-term (measured in months or a few years) the long-term effects are not as clear. Prolonged use may in some cases promote brain growth but in other cases may alter brain chemistry, eliminating some of the medications' initial effectiveness. Relying solely on meds may mean that children lose the chance to benefit from behavioral therapies that teach academic, social and vocational skills,

The pressure to treat ADHD is growing particularly fast in countries like China and South Korea that are making a strong push to improve academic performance. Many elementary and secondary schools in China force children to sit for hours at length, attending lectures and cramming for tests. It is only natural that children in these circumstances need help to remain focused. More and more, that help is coming in a pill.

There are signs of resistance to this trend, particularly in Europe. In the U.K., for example, health officials advise that physicians resort to medication only after trying behavioral therapy. And in 2011, shocked by the surge in prescriptions, Israel's Ministry of Health made it illegal for doctors to prescribe stimulants for children or adults without a proper diagnosis of ADHD.

We hope other nations will treat ADHD medication with justified caution. Doctors should diagnose ADHD as professional medical associations recommend—obtaining thorough medical histories to rule out alternative reasons for attention problems, which may include child maltreatment, depression or learning disorders. They should also gather behavioral checklists from schools in order to pinpoint whether the child's behavior is truly an "outlier."

International ADHD research and advocacy groups should monitor benefits and potential drawbacks of stimulant use in multiple countries around the world. And even with a valid diagnosis, medication shouldn't necessarily be the first or only line of defense. As we globalize communications and marketing, let's do our best to also globalize diagnostic accuracy and common sense.

Mr. Hinshaw is a professor of psychology and psychiatry and Mr. Scheffler is a professor of health economics and public policy at the University of California, Berkeley. They are the authors of "The ADHD Explosion: Myths, Medication, Money and Today's Push for Performance," just published by Oxford University Press.