Why might ADHD not be Over-Diagnosed?

Although the number of those diagnosed with ADHD in the US seems to be very high, it actually is on the lower spectrum throughout the world. "A review of the literature shows that the United States is actually on the lower end of the prevalence range across the world," says Myron Genel, M.D., a professor of pediatrics at Yale University School of Medicine. Germany shows prevalence rates of 9.6 percent, Puerto Rico shows rates as high as 16.1 percent. These numbers compared to the 6.1 percent in the US shows that ADHD may in fact not be over-diagnosed.
Another issue regarding the diagnosis of ADHD is the use of stimulants to treat patients. Although the use of these drugs seems to be a bit scary to some, the abuse of these drugs is very low. For instance a study on the use of Ritalin by The Journal of the American Medical Association has shown "Reports of methylphenidate abuse by patients with ADHD or their families have been rare, with only four total cases reported in the studies." With over 60 percent of children being prescribed Ritalin or other medications to treat ADHD that is a very low number. This shows that the argument against the use of these drugs to treat the disorder seem to hold little ground, especially considering the help these medications give those that take them. I myself take Ritalin and find it to be a great help, not only in my work ethic, but also with my relationships and general well-being.
Although there seems to be a lot of evidence pointing to the fact that ADHD is over-diagnosed, not much of the data is conclusive. The most likely reason people believe ADHD is over-diagnosed is because of how sensationalized this idea has been spread throughout the media. The portrayals given by the media of these false positive diagnoses give people a biased look at the actual percentage of those given false positive diagnoses. The other side of the argument simply isn't portrayed in the media.
The issue of the criteria used to diagnose the disorder being too lenient has also been addressed. "It is widely stressed that changes in DSM-5 are intended to and will reduce clinician subjectivity in the diagnostic process and increase diagnostic reliability by providing additional behavioral descriptions that include developmentally appropriate examples. It is also emphasized that just because many of the behaviors viewed as ADHD symptoms are commonplace is not a sound reason to question the validity of ADHD diagnoses." (Cheng)

So is ADHD over-diagnosed? After doing the research it seems to me to be. What do you think? Share in the comments what you think.

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Why might ADHD be Over-diagnosed?

Diagnosing a child with ADHD seems to be pretty common today. According to the DSM-IV TR, approximately 3 to 7% of school-age children meet the criteria for ADHD-this is a pretty large number. Yet, why might it be a disorder that is over-diagnosed? One reason is that it may just be an easy scapegoat for parents with hyperactive children. Dealing with a hyperactive child is difficult. Dealing with all of that energy can be understandably frustrating, so parents trying to find any solution to such a thing is also very understandable. If a parent can simply take their child to a doctor and get a magic pill to fix their child, that may seem like a convenient solution to their problem. Yet, hyperactivity could just be a common attribute of children in adolescence. This was even said by Hillary Clinton. In a press conference in March of 2000, she voiced concern about over diagnosis by suggesting that physicians might be too quick to diagnose children whose problems may be simply normal characteristics of childhood and adolescence. She's not alone in her concern. In a CNN online poll conducted in 2002 they found that 76% of respondents believed that ADHD is over-diagnosed. (Mark Sciutto) But why do so many people believe this? It may be because many children are being diagnosed with ADHD when in reality they are suffering from something else. Other disorders share similar criteria for diagnosis. For example, Kissinger (1998) introduces the topic of over-diagnosis by describing a child who was initially believed to have ADHD because he was persistently inattentive even during “a popular study unit on cowboys”. Only after additional information was gathered did the origins of his problems become apparent-he was experiencing traumatic stress as a result of being sexually abused by a man who had worn cowboy boots. Clearly, this child should not have been diagnosed with ADHD. How often does this happen? As many as 75% of children with ADHD meet the criteria for another psychiatric diagnosis (Barkley, 2005) For instance the inability to sustain attention is another characteristic of those suffering from depression or anxiety. The number of those suffering from depression and anxiety disorders in the US is huge- competing for the highest rates in the world, so to think that many of these children are simply suffering from one of these disorders and not ADHD is not a huge leap. One of the major arguments for ADHD being over-diagnosed is the problem of diagnostic inaccuracy. For instance, Cotugno (1993) evaluated 92 children previously referred to a specialized ADHD clinic. He found that, after a comprehensive evaluation, only 22% of the children were given a primary diagnosis of ADHD and only 37% were given a secondary diagnosis of ADHD. Similarly, Desgranges, Desgranges, and Karsky (1995) found that 62% of clinic referrals for suspected ADHD were not confirmed as ADHD cases after further evaluation. One of the issues behind this is the variability in assessment procedures.  Handler and DuPaul (2005) found that a large majority of practicing psychologists did not regularly follow assessment procedures that are consistent with the best practice guidelines. Similarly, Wasserman and colleagues (1999) found that primary care physicians varied considerably in their assessment and diagnosis of childhood disorders. They found that physicians relied very heavily on interviews and most did not adhere to the DSM criteria or use standardized assessment tools. I myself found this to be true when I was given my diagnosis. My psychiatrist simply issued interview questions and didn't require any other tests or guidelines in order to give me my diagnosis. After doing this research it makes me question whether or not I really have the disorder myself.
Another reason ADHD may be over-diagnosed is the high demand American schools are putting on young children. Expecting kids in kindergarten to sit and read at such an early age could be a result in the increased diagnosis of Attention Deficit Hyperactive Disorder. For instance after the implementation of the No Child Left Behind act, the diagnosis of ADHD increased. This shows the direct correlation between the expectations being put on these children resulting in the diagnosis of the disorder. In order to increase test scores teachers pressured more students towards their diagnosis. What better way to increase test scores than a magic psycho-stimulant that increases the attention of your students?

Yet another reason why you may question the diagnosis of ADHD is the disparity of the diagnosis of ADHD from state to state and county by county. As stated in the article A True ADHD Epidemic or an Epidemic of Overdiagnosis?: "If ADHD is a true neurodevelopmental disease—which it is—then the prevalence of diagnosis and treatment should be consistent. Yet there is dramatic difference in prevalence rates not only by state, but even by county. In 2011, the prevalence of ADHD in Kentucky was 14.8%, which was 250% higher than the 5.6% prevalence reported in Colorado. Although these statewide disparities exist across the United States, there is no reasonable biological explanation for these differences." Why is there such a difference between states in the diagnoses for ADHD across different states and counties? The reason is obviously not biological, so why is there such a difference? Maybe it's because of the way the symptoms of ADHD are addressed in these different cultures.

There seems to be a lot of evidence pointing towards ADHD being over-diagnosed. Next I'll be looking at the other argument, that ADHD is not over-diagnosed.

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How is ADHD Diagnosed?

In order to examine whether ADHD is over diagnosed we must first look at what criteria is used to diagnose the disorder. Typically psychiatrists, pediatricians, and child psychologists refer to the American Academy of Pediatrics or the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) to diagnose the disorder. These psychiatrists, pediatricians, or child psychologists should gather this information from several sources, including schools, caregivers, and parents. These health care providers should also compare this information to children of the same age, using standardized rating scales to determine the severity of the symptoms. To properly diagnose the disorder the child should also undergo several physical exams, including vision and hearing screenings. The FDA has also approved the use of Neuropsychiatric EEG-Based Assessment Aid (NEBA) System, a noninvasive scan that measures theta and beta brain waves. The theta/beta ratio is found to be higher in children with ADHD than those without it. (Hersher)These health care providers should also consider getting a complete medical history including any behaviors and life events such as, recent major life changes, undetected seizures, thyroid problems, sleep problems, anxiety, depression and lead toxicity. Yet, how often are all of these methods actually used to diagnose the disorder? It's hard to say. I know that I myself was simply asked if I had several of the symptoms associated with the disorder over a period of several years. I could have easily been lying, I wasn't, but that could have easily been the case. How often do psychiatrists skip several of these testing methods like my psychiatrist did? Are psychiatrists more strict when diagnosing a child rather than an adult? I certainly hope so.
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Do you have ADD?

It seems that these days everyone knows at least one individual that suffers from Attention Deficit Disorder, but what is it exactly? Inattention to detail and difficulty keeping attention are common problems in a lot of people, but when does it become a disorder? Common symptoms include the following: Chronic lateness and forgetfulness, anxiety, low self-esteem, problems at work or school, trouble controlling anger, impulsiveness, substance abuse or addiction, unorganization, procrastination, issues with frustration, chronic boredom, trouble concentrating while reading, mood swings, depression, and relationship problems. These again are common problems in a lot of people, so it is easy to self diagnose
yourself with ADHD. It's important to note that when diagnosing any disorder these symptoms :must be severe enough  to disrupt one's life. Correlation isn't necessarily causation. If you have a problem with substance abuse chances are it's not just because you have attention deficit disorder. Many people may suffer from several of these symptoms but in fact do not actually suffer from attention deficit disorder. The definition of a disorder is something that disrupts the systematic functioning or neat arrangement of something else. So do you have ADD? According to a parent report in 2012 approximately 11% of children from the ages 4-17 were diagnosed with ADHD. (Krucik) According to these numbers you very well may have the disorder. Yet, how do we know these children were properly diagnosed? That number seems to be absurdly high. So is this an overly diagnosed disorder? Let's take a further look into how this disorder is diagnosed.

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