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Adults With Attention Deficit Hyperactivity Disorder A Controversial Diagnosis
A popular opinion in the press coverage of Adhd is that doctors both overdiagnose and overtreat the condition, especially in children with behavioral difficulties. A large 2021 study reports evidence of ADHD overdiagnosis, with the authors noting that people with other conditions may sometimes receive an ADHD diagnosis instead. Other data suggest that children who are among the youngest in their class may be more likely to receive an ADHD diagnosis. Their relative immaturity and resulting behavioral problems may seem like symptoms of ADHD when they are, in fact, due to age.A person’s views about ADHD overdiagnosis may depend on personal experience and bias. There is a large movement among people who oppose psychiatry to discredit the notion of ADHD. Conversely, ADHD advocates may lobby for earlier and more frequent diagnoses. The potential overdiagnosis of ADHD remains controversial, and it is hard to measure. What is clear, however, is that ADHD is often untreated or incorrectly treated. About 3 in 4 children with ADHD receive some type of treatment, but only 32% receive the combination of medication and behavioral treatment that most experts, including the American Academy of Pediatrics, recommend. Seeking care from a qualified provider, using specific diagnostic criteria, and ruling out other potential diagnoses can reduce the risk of ADHD overdiagnosis and misdiagnosis. Keep reading to learn more.Emerging evidence suggests that ADHD may, in fact, be overdiagnosed. The number of children aged 3–17 years who receive an ADHD diagnosis has risen over the years from 5.5% in 1997 to 9.8% in 2018. This increase does not necessarily indicate an overdiagnosis crisis. Other data, however, point to excessive diagnoses playing a role in this trend. Age-typical behaviors for young children may be symptoms of ADHD in an older child. For example, a 3-year-old cannot concentrate on the schoolwork that is routine for a 6-year-old. Some research suggests that this comparative immaturity might play a role in overdiagnosis. A 2016 study of children attending school in Israel found that the youngest third of students in a classroom were more likely to take stimulant ADHD drugs than the oldest third.In very young children, a few months can make a difference in skills and maturity, so it is possible that some children take ADHD medication because of comparative immaturity rather than ADHD. A 2021 systematic review lends more credibility to the notion that doctors overdiagnose ADHD. The authors reviewed 334 studies and found the following: The number of ADHD diagnoses has increased. The treatment of ADHD with medication has increased. The increase in ADHD may be due in part to diagnosing people who have only mild ADHD. Additionally, the five reviewed studies that evaluated the risks and benefits of treatment found that for milder cases of ADHD, the harms of treatment may outweigh any benefits. Although some studies do indicate an overdiagnosis of ADHD, there is no conclusive research identifying the reasons for it. Some potential explanations include: Children who are younger than grade-level peers, and therefore less developmentally mature, may receive an ADHD diagnosis. A person may get a misdiagnosis when they have another condition. The symptoms of sensory processing disorders, for example, may mimic those of ADHD. Ineffective parenting practices may play a part. A 2015 study found that ineffective parenting could contribute to behavioral problems in children with ADHD. While this is not a factor in overdiagnosis, it could explain an apparent increase in ADHD-related behavioral problems. The researchers found a correlation between the use of punishment and symptoms of inattention. Neglectful parenting also correlated with ADHD symptoms. Increased awareness is also an important factor to note. Increased awareness of ADHD may cause parents, caregivers, and healthcare professionals to look for inattentive symptoms. As a result, more people with mild symptoms may receive an ADHD diagnosis. The proper treatment of ADHD can improve the lives of people who have the diagnosis, but overtreatment can be harmful. No treatment is free of side effects. Some possible side effects include: growth delaysanxietyrapid heart ratehigh blood pressureloss of appetitetrouble sleepingDiagnosing ADHD based on immaturity may stigmatize developmentally normal behaviors. It may also cause a person and their parents or caregivers to worry about the potential long-term effects of a diagnosis that is actually incorrect.While data support the notion of overdiagnosis, the research on overtreatment trends in the opposite direction.Although it is true that overdiagnosis means that some people without ADHD receive treatment, on the whole, people with ADHD are actually undertreated. Most treatment guidelines point to the benefit of both medication and behavioral and lifestyle interventions. For example, the American Academy of Pediatrics advises that children over the age of 6 years with ADHD should receive medication and behavioral interventions, such as classroom support and therapy. Children under the age of 6 years, conversely, should only take medication when other interventions prove ineffective. According to the Centers for Disease Control and Prevention (CDC), a 2016 parent survey found that most children with ADHD did not receive treatment that met these guidelines. The results showed that: About 23% of children with ADHD received no treatment. About 30% received only medication. About 15% received behavioral treatments. About 32% received both medication and behavioral interventions. Some of the options for preventing overdiagnosis include: Using scientifically validated rating scales to diagnose ADHD: These scales include the Conners’ Rating Scales, the Vanderbilt ADHD Parent Rating Scale, and the Child Behavior Checklist. Using these diagnostic tools may be more effective than relying on first impressions or subjective assessments. Considering other diagnoses: Not all people with hyperactivity and inattention have ADHD. A number of other conditions, including sensory processing disorder and autism, may also cause these symptoms. Assessing for symptom consistency: A period of inattention in a new environment or hyperactivity that only occurs in one or two settings may not indicate ADHD. Instead, these behaviors could signal a problem with the environment, such as ineffective parenting or a stressful school environment. Considering how maturity might affect diagnosis: A child who behaves differently than the other children in their classroom does not necessarily have ADHD, especially if they are several months younger than most of their peers. Assessing how well treatment works: Parents and healthcare professionals should monitor the effects of treatment to determine whether it improves behavior and supports the child. Adults with ADHD should consider whether they perform significantly better on medication. Most people concerned about ADHD overdiagnosis are worried about the overuse of medication. For people who have only minor ADHD symptoms, it might be advisable to try behavioral interventions first and only use medication if those strategies do not work. The behavioral strategies for managing ADHD are similar to the strategies that parents or caregivers might use to manage behavioral problems in children without ADHD. There is no evidence that these interventions are harmful. It is possible for ADHD to be both underdiagnosed and overdiagnosed, as well as being both undertreated and overtreated. The evidence suggests that some people who do not need treatment still get it and that many people who do need treatment get inadequate treatment. It is similarly possible that the diagnosis of ADHD is excessive among some groups of children, while others receive no diagnoses at all. The data are not conclusive, and individual definitions of overdiagnosis and overtreatment vary. People with ADHD need treatment, and ADHD is a real diagnosis. These facts undermine the claims of the most strident opponents of ADHD treatment. Nevertheless, it is clear that some people taking medication for ADHD may not need it and may even be less healthy as a result of taking it.
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ADHD: Controversy, Key Research Findings, Rising Prevalence, and Promise
Each month The Brain & Behavior Research Foundation hosts a Meet the Scientist Webinar featuring a researcher discussing the latest findings related to mental illness. In January, 2021, the Foundation featured Dr. Stephen P. Hinshaw of The University of California, San Francisco and The University of California, Berkeley.
Description: Dr. Stephen Hinshaw will discuss the many controversies surrounding attention-deficit hyperactivity disorder (ADHD), basing the presentation in scientific findings rather than the myths that so often surround the topic. Included will be processes underlying ADHD, prevalence in males vs. females, risk for long-term impairments, the role of school policies in predicting rising rates of diagnosis, and a brief summary of effective treatments.
Learn more at https://www.bbrfoundation.org/event/adhd-controversy-key-research-findings-rising-prevalence-and-promise
Visit us on the web: https://www.bbrfoundation.org If you like this presentation, please share it!
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