Over-Diagnosis and Prevalence of ADHD

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Educators, medical professionals and parents alike are questioning if the diagnosis of attention-deficit/hyperactivity disorder (ADHD) is being handed out to our youth at an alarming rate. Many people in the academic and professional community feel that ADHD is being over-diagnosed and that many children are being treated with medications who are not truly ADHD. Has ADHD become the “flavor of the day?” Or could there be other circumstances that explain the symptoms rather than a general diagnosis of ADHD?

The defining feature of ADHD “is a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development” and the symptoms must have been present after the age of 7.1 Additional criteria that must be met are impairment in at least two settings, such as home and school, and there must be clear evidence that the impairment is interfering with daily functioning. Lastly, the symptoms may not occur as a result of other mental disorders. The criteria are very specific and specify that the presenting symptoms must be severe and more frequent than peers of the same age.

Research by way of neuro-imaging has found that children diagnosed with ADHD do not possess the typical asymmetry in the frontal lobe area of the brain.2 The frontal lobe is responsible for controlling motor behavior and preventing focus on stimuli that is irrelevant or distracting. This information can be diagnosed through EEGs, however it is rarely done, and is contra-indicated in guidelines for diagnosing ADHD. As a result, the diagnosis may be based solely upon subjective reports.

According to the CDC, in 2003, almost four million children in America ages 3 through 17 had been diagnosed with ADHD. Of those four million, children with fair to poor health were three times as likely to be diagnosed with ADHD. One has to question if stereotypes of children play into the diagnostic process.

diagnosis of adhd

An issue of PEDIATRICS found that a diagnosis of A/HD was more likely to be influenced by a student’s home and school environment.3 For example, a child living with their biological father was less likely to receive a diagnosis of A/HD. If the child’s family was in the lowest income quintile they were more likely to receive a diagnosis of ADHD. Higher diagnosis rates were found among students who had older teachers. Perhaps a child with an older teacher is unable to grasp concepts due to outdated teaching methods or a teacher’s unwillingness to adopt new strategies. Are teachers stereotyping students based upon environment and developing a misguided perception of the student’s behavior as a result? Unfortunately, there is no definitive answer—but it does invite speculation.

Half of all marriages today end in divorce. While it is a sad statistic, it is the truth. As a result, approximately one million children are suffering from the stressors of divorce. Children of divorced parents are often the recipients of inconsistent affection and discipline; exposed to arguments, possible threats and monetary pressures; and, in some cases, violence. They may begin to display behaviors such as an inability to focus, being easily distracted, engaging in risky or impulsive behavior, or expressing opposition to authority figures. These behaviors resemble the characteristics of a child with ADHD. However; the above behaviors are acute and directly related to the divorce of the parents. In addition, when a doctor is evaluating a child of divorced parents for a diagnosis of ADHD, one parent is usually absent. Thus, it may be unclear if the behaviors presented are a result of ADHD or an acute stress reaction.4

Peg Dawson, a psychologist on staff at Seacoast Mental Health Center in New Hampshire, wrote an article describing the poor sleep patterns of adolescents and the effect of poor sleep. Most teenagers require 8.5 to 9.25 hours of sleep each night. However, 25 percent report that they sleep less than 6.5 hours a night.5 Lack of sleep is associated with irritability, reduced alertness, tardiness, impulsivity, hyperactivity and behavior and academic problems.

Researchers have suggested that 15 to 30 percent of children will experience sleep disturbances at some point during their childhood and up to 75 percent of all adolescents have sleep problems. These are astounding numbers. The symptoms mentioned above are synonymous with the general criteria of ADHD. Is it possible that children and adolescents are being diagnosed with A/HD when in fact there is an undiagnosed sleep disorder?

youth adhd

The American Academy of Pediatrics (AAP) established evidence-based guidelines to aid in proper diagnosis and treatment of patients with ADHD. The guidelines are utilization of DSM-IV criteria, evidence directly obtained from parents and classroom teachers and an evaluation for coexisting conditions.6 Research was conducted by Jerry Rushton, Kathryn Fant and Sarah Clark to determine if physicians are utilizing the guidelines set forth by the AAP. The data gathered was extremely concerning. Of family physicians and pediatricians surveyed to determine routine adherence to the four components of the guidelines, only 34.9 percent of pediatricians and 14.3 percent of family physicians reported consistent adherence to the AAP guidelines.

ADHD is being diagnosed to an alarming degree. Today’s youth are under great pressure to excel at all costs and are experiencing other disorders such as anxiety and depression, which imitate the well-known symptoms of ADHD. While it may be more “acceptable” to be diagnosed with ADHD in mainstream society, it is still a diagnosis that is often treated with medication. Often that medication is stimulant-based. As a nation, we are placing children on medication without knowing the potential long-term effects and expecting that the pill will cure whatever ails the child. Perhaps we should allow children to be children and allow them to grow and develop coping skills to interact with the world around them rather than rush to judgment and medication to “fix” them.

Regan D. Sarmento, M. Ed.

References

  1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (4th ed.)(1994).

  2. Barabasz, A., & Barabasz, M. (1999). Treating ADHD with hypnosis and neurotherapy. (ERIC Document Reproduction Service No. ED435076).

  3. https://www.ncbi.nlm.nih.gov/pubmed/11230624

  4. https://www.ncbi.nlm.nih.gov/pubmed/16585277

  5. http://pediatrics.aappublications.org/content/107/Supplement_1/867

    https://www.cdc.gov/nchs/data/series/sr_10/sr10_231.pdf

    Visser, S., & Lesesne, C. (2003). Mental health in the United States: prevalence of diagnosis and medication treatment for Attention-deficit/hyperactivity disorder-United States. Journal of the American Medical Association, 294, 2293-2296.

  6. Dawson, P. (2005, January). Sleep and adolescents. Counseling 101, 21-26.

    Guevara, J., Lozano, P., Wickizer, T., Mell, L., & Gephart, H. (2001). Utilization and cost of health care services for children with attention-deficit/hyperactivity disorder [Electronic version]. Pediatrics, 108, 71-78.

    https://www.ncbi.nlm.nih.gov/pubmed/15687419

  7. https://www.ncbi.nlm.nih.gov/pubmed/15231969