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Is ADHD Overdiagnosed Or Underdiagnosed?

The prevalence of ADHD has skyrocketed over the last decade. As of 2016, there are 6.1 children in the US who received a diagnosis of ADHD. This means that 9.4 % of American children supposedly have this condition. Furthermore, three out of four of them receive treatment in the form of medication and/or behavioral treatment. This is a significant increase compared with three decades ago when 3-5% of children were diagnosed with this condition. About 60% of them will continue to have symptoms later on in life, with an estimated 8 million  American adults having ADHD. 

Interestingly, the US has currently the highest rate of ADHD diagnosis, compared to the rate found in countries all around the world. For example, about 5% of children are diagnosed with ADHD in  Brazil, China, and Europe. The question is- why is ADHD so common in the US nowadays?

The opinions are mixed. Some believe that the number of cases is going up because there is more awareness about this condition. Others believe that environmental toxins, medications are taken by the mother during pregnancy, and media/ technology overstimulate the brains and trigger symptoms of ADHD. Some believe that  ADHD is underdiagnosed, as the real number of cases should be higher. However, more and more medical professionals believe that ADHD may be overdiagnosed, rather than underdiagnosed. 

Reasons why ADHD may be overdiagnosed

Why and how did ADHD become the nr 2 most common childhood disease, second only to obesity? Dr. S. C. Newmark, MD, the head of the Pediatric Integrative Neurodevelopmental Program at the Osher Center for Integrative Medicine at the University of California has two main explanations. 

  1. Overdiagnosis may be caused by how ADHD is  evaluated/diagnosed and pressure for treatment from schools, parents to get a diagnosis for the child.
  2. There is a significant increase in the demands being made on children, schools, and families.

The diagnosis of ADHD should not be rushed, as a child with neurodevelopmental problems could be diagnosed with this condition, or not, based on the social and educational environment. The diagnosis of ADHD may be difficult to make at times, as it mimics learning disabilities, anxiety, and other conditions. The doctor needs to observe the children understand his environment including his home and school. There is no gold standard test with high accuracy to confirm the true cases of ADHD. 

Doctors feel pressure to make a diagnosis and start treatment as soon as possible, as the school asks the parents for answers. Many children take ADHD stimulant drugs due to academic pressure to get good grades and later be admitted to well-known universities. 

Furthermore, Dr. Newmark questions the reason why ADHD diagnosis varies so much from one state to another. Based on 2011 data, the prevalence of children diagnosed with ADHD in Kentucky was 250 % higher compared with children diagnosed with ADHD in Colorado (14.8% vs 5.6%). These inconsistencies don’t have a medical explanation, further suggesting that ADHD may not be a true epidemic, but rather an epidemic of overdiagnosis. 

The educational system in the US is becoming more demanding. Decades ago, children in kindergarten had fewer activities- they played, ate, and slept. Nowadays, children at the same age are expected to read and learn. Other educational policies also changed over the years, and schools started to receive incentives to promote test scores. Those US states where these test scores were incentivized experienced the most increase in ADHD cases. Getting the diagnosis and medication seem to be the magic bullet, a quick and effective solution. But is this the right decision? 

The overall stress is also on the rise, and both children and parents are affected. This stress can certainly cause symptoms that may suggest ADHD. What are these symptoms that are simply the child’s coping mechanism to deal with the stress? 

Recent studies support the fact that ADHD is overdiagnosed

A 2021 review of over three hundred relevant studies published in the JAMA (the Journal of the Medical Association)  further supports that ADHD is overdiagnosed, specifically in children and teenagers. Researchers found evidence that ADHD is both overdiagnosed and overtreated. 

Another study suggests that the changes in the diagnosis (DSM-5 being the latest version), problems with diagnostic practices, and advertising from pharmaceutical companies may play a role in ADHD overdiagnosis. 

The research is ongoing, and we will likely see more opinions to either support or deny the fact that ADHD is overdiagnosed. In the meantime, take some action if you believe that you or your child are treated for ADHD, but may not have this condition. 

  • Educate  yourself. Read, and learn as much as possible about ADHD. Do the symptoms really match your condition?
  • Talk to your doctor for an in depth evaluation. You can also choose to have a second opinion from another doctor, to get a fresh perspective on your condition.
  • If you are taking ADHD medication, answer this question: does it help you? Do you notice significant improvements of the symptoms? If the drugs do not help, it could be bipolar, PTSD, anxiety or other conditions, not ADHD. This is another reason to get the diagnosis re-considered. 
  • Are you using behavior therapy? If not, consider it. Therapists help not only manage the symptoms, but how to understand yourself, too. 

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