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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