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ADHD Diagnosis: Too Much or Just Right?

By Chaya Benyamin
 
In 2003, diagnoses for children with ADHD, a mental disorder which inhibits impulse control and attention span, in the US was 7.5 percent. By 2010, that number shot to 18 percent, nearly 10.5 million children. Then, in late 2011, demand for ADHD drugs was so off the charts that there were nation-wide shortages, garnering national attention and prompting the question – is ADHD over diagnosed?
Let’s take a look at some of the arguments that suggest that ADHD is over-diagnosed, and some which suggest that diagnosis is right on.

 

ADHD diagnosis is on point.

Increased diagnosis is a sign of increased understanding.

Today more than ever, the medical community is aware of the salience of mental health in overall health, and doctors of all specialties bring this knowledge to their practice. Indeed, diagnosis of mental disorders writ large have increased across the board: autism, depression, and anxiety diagnoses have all been on the rise since 2007. Spectrum diseased like the aforementioned are sometimes difficult to spot (it’s even been suggested that girls are underdiagnosed for ADHD), but awareness of the symptoms of spectrum diseases like ADHD and others have enabled millions across the globe to treat their disorders – a fine achievement for the field of mental health.

 

Media promotes ADHD overdiagnosis as a foregone conclusion, while scientists remain unconvinced.

The media has made much of the rise in ADHD diagnoses, attributing it mainly to money hungry pharmaceutical giants and lazy parents. Journalists sometimes report and interpret ADHD data inaccurately. For example, the New York Times reported 11 percent of students in the US had received an ADHD diagnosis; in reality, 11 percent of all high school students had received an ADHD diagnosis at some point in their lives. Such details are crucial in shaping the public’s perception of diagnosis rates. While researchers have found no conclusive evidence of systematic overdiagnosis, media’s mishandling of data elevates normal diagnosis of ADHD to the level of scandal.

 

Worry about over diagnosis of ADHD is merely a sign of society’s discomfort with mental disorders.

Stigmas against mental disorder have been well documented for centuries. While people tend to accept physical illness as an unfortunate inconvenience of life, mental disorders were first avoided altogether, and later, approached with suspicion. Studies have confirmed that people are particularly quick to stigmatize children with ADHD, even if the child is receiving treatment. These attitudes not only feed into public doubt about the “realness” and “treatability” of ADHD, but may also drive self-stigmatization that discourages ADHD patients or their families from seeking treatment.

 

ADHD is overdiagnosed.

 

Misbehavior is mistakenly perceived as a disorder.

Parents, teachers, and physicians do not always link hyperactive behavior to the right cause. Family doctors produce more than half of all first ADHD diagnoses, but they do so in 7 minute consultations which are unlikely to probe deeply enough into the patient’s lifestyle to identify causes for ADHD symptoms other than ADHD. For example, diet (namely intake of caffeine, artificial sweeteners, and preservatives), sleep deprivation, and stress contribute to hyperactivity and irritability that can masquerade as ADHD. A study which found that children in foster care are three times as likely to be diagnosed with ADHD also supports the notion that ADHD diagnosis may have more to do with environmental factors than the actual presence of the disorder.

 

The rate of ADHD diagnosis rises with the broadening of diagnostic criteria.

In the US, diagnosis of ADHD is generally determined by recommendations found in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The latest version of this manual has a significantly expanded list of diagnostic criteria, which includes behaviors most of us engage in on a daily basis (i.e., losing your keys – come on!). Unsurprisingly, a study which compared ADHD diagnoses between doctors who used an older DSM version and those who used the new edition (with broader criteria) showed that doctors using the new criteria diagnosed ADHD more frequently. A comparison of the DSM to the World Health Organization’s IDC, a manual whose criteria for ADHD is narrower, showed that the IDC manual led to fewer ADHD diagnoses.

 

Educational assessment standards drive ADHD diagnoses.

Education policies that require schools to meet achievement benchmarks in order to receive federal funding has impacted the frequency of ADHD diagnoses in lower performing regions. Schools are motivated to have children diagnosed with ADHD because federal standards may allow them to be excluded from testing data, or may guarantee funding for those students regardless of performance. The 20 percent rise in ADHD cases since the No Child Left Behind Act signals and important correlation between pressure for student achievement and increased diagnosis of the condition. The popular (but incorrect) perception that medicines used to treat ADHD enhance academic performance might also lead to parents to seek these treatments, and educators to recommend them.

 

Bottom Lines: There is some evidence to support the notion that ADHD diagnosis may be driven by factors other than the presence of the actual disease. However, growth in the number of diagnoses for any given condition does not necessarily point to undue inflation. Skepticism on the part of scientists and the public alike can only push us closer to better understanding of the statistics surrounding ADHD and what they mean for your child, medicine, and society at large.

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