Is ADHD overdiagnosed in children?

Yes

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by Deborah Bauers

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Attention Deficit Hyperactivity Disorder is a mental health issue that continues to draw significant attention from the media, primarily due to two factors:

1. The ever-increasing numbers of children who are being diagnosed with ADHD

2. School nurses who are seeing and reporting a significant increase in the amounts of medications being dispensed during the school day to children who struggle with hyperactivity and inattentiveness

As a mental health professional with over twenty years of experience, I have seen a number of shoddy examples of ADHD assessment that have resulted in misdiagnosis and incorrect treatment. However, I have also witnessed the transformation that can occur when a child is correctly diagnosed and, with therapeutic intervention, receives the opportunity to reach his or her full potential.

There are some dynamics that can help us understand why ADHD may be being overly diagnosed in children. Diagnoses of mental illnesses are routinely performed by a variety of helping professionals. Although companies that have created and published standardized tools for assessment have attempted to responsibly control their use, there are few guidelines as to what the components of a comprehensive assessment for ADHD should include. Consequently, a wide range of practices exist that are routinely used to diagnosis this disorder. Some evaluations involve a brief and incomplete fifteen minute consultation followed by a diagnosis that is highly questionable due to the lack of information gathered and the brevity of observation. More comprehensive evaluations may include a variety of measurements, scales, and questionnaires designed to engage the participation of parents, teachers, and both medical and mental health professionals. Consequently, a diagnosed label of ADHD can result from a wide range of evaluative processes, some of them not comprehensive enough to make an accurate assessment.

The "Individuals with Disabilities Education Act Amendment" of 1997 placed a greater emphasis than ever before on narrowing the gap between expectation and level of accomplishment for disabled children in the public school system. It also stressed, for the first time, early childhood prevention as a key to helping disabled children succeed educationally. In 2001 President Bush signed a bill entitled "The No Child Left Behind Act." This piece of legislation held public schools to a higher level of accountability with respect to screening and providing services to children with learning disabilities. With the increasing pressure on state run schools to adequately provide services to children with potential learning disabilities or mental health issues, the requests for evaluations increased. For this reason, practitioners are performing more ADHD evaluations than ever before.

What Can You Do?

Unless you plan to become a lobbyist and advocate for mental health reforms in terms of regulating the diagnosis and treatment of various mental illness (which is not a bad idea), the only diagnosis you really need concern yourself with is the one that your own child receives. Before you settle in with the idea that your child has ADHD, here are some things to consider:

1. There are certain medical conditions that can mimic the hyperactive levels that are sometimes misdiagnosed as symptomatic for ADHD. They include, but are not limited to, thyroid dysfunction, hypoglycemia, allergies, and high lead levels.

2. Not every child who is hyperactive has a mental illness like ADHD. There is a normal continuum of behavior in children that includes both low and high levels of activity. There are children who are on the high end of the bell curve, but this doesn't mean that they meet the criteria for a hyperactivity that is consistent with ADHD.

3. Questionnaires that are frequently given out at your child's school or pediatrician's office are a poor substitute for a responsible assessment process. These questionnaires are intended to be used as guidelines in consideration of whether a child might display criteria to suggest ADHD.

4. There is an overlap in symptomology between several different mental health diagnoses. These may, at times, mimic each other. For instance: a child who only displays high levels of hyperactivity in the home probably doesn't have ADHD. He may be simply manifesting symptoms of boredom. Or, he may be at risk for oppositional defiance disorder, a type of conduct disorder that is often manifested within family dynamics but not necessarily in other social contexts.

5. Not every child who does have ADHD needs medication. Much can be accomplished with behavioral and cognitive therapy to educate both parents and children about how to cope with ADHD.

What Should a Thorough ADHD Assessment Look Like?

A thorough assessment for ADHD usually takes about 2 hours to administer and should include the following:

1. A comprehensive history and intake consisting of client's birth history and early childhood development, medical history, social history, and mental health history.

2. A Clinical Interview with Parents

3. Clinical Observation under supervised and unsupervised activities

4. A childhood symptoms scale

5. A Disruptive Behavioral Scale for both parents and teachers

6. A Current Symptoms Scale for both parents and teachers

7. An Issues Checklist for Parents

8. Tests to determine intelligence, memory retention abilities, and motor skills (If other learning disabilities may be involved).

9. Additional scales to routinely assess for and R/O Conduct Disorder, Anxiety Disorder, and Oppositional Defiance Disorder that may overlap in symptoms and mimic ADHD.

Once results of scales have been tabulated, these should be compared with observations and findings from clinical interviews, early childhood development, and the client's medical, social, and mental health history. A diagnosis of ADHD may be made if a client exhibits sufficient criteria as set forth by the American Psychiatric Association in keeping with the guidelines laid out in the Diagnostic and Statistical Manual of Mental Disorders. Even when a mental health professional has made a diagnosis, an appropriate referral should be made to a family physician or pediatrician to screen for and rule out other medical problems that might account for any of the manifested symptoms.

Let's put all of this information into perspective. ADHD impacts the lives of countless children every year. It's a real mental health issue, and it isn't going to go away. That being said, it is probably being overly diagnosed given the climate and objectives of a state run school system that is working to improve mandated services to students who struggle with disabilities.

As a parent or guardian, you may take on a proactive role for your child in the event that he or she manifests symptoms that could be ADHD. The best way to accomplish this is to educate yourself about the process of assessment and treatment and choose a mental health professional that is qualified and skilled in diagnosing this disorder. You are your child's best advocate. In a figurative sense, your responsible actions on behalf of your son or daughter more than meets the President's mandate of your child not being left behind.

http://www.gao.gov/n ew.items/d05618.pdf
http://www.ed.gov/of fices/OSERS/Policy/I DEA/regs.html

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