Sat. Aug 13th, 2022
ADHD and its overdiagnosis in children and adolescents

ADHD is a chronic neurodevelopmental disorder, whose symptoms must appear before the age of 12 in order to be diagnosed, according to the DSM-5 ( Diagnostic and Statistical Manual of Mental Disorders ).

It is a disorder that affects 2-5% of the child and adolescent population, according to the Spanish Federation of Associations for Helping Attention Deficit and Hyperactivity Disorder (Feaadah).

However, there is more and more talk about its overdiagnosis; overdiagnosing involves attributing a diagnosis to someone who really does not have it. This has consequences for the person, but also for their family and for the environment in which they live.

Could ADHD be an overdiagnosed disorder? We collect the conclusions of a review that has analyzed 334 studies on ADHD and mention the causes of this possible overdiagnosis. Finally, we talk about its consequences and how to make a proper diagnosis .

What is ADHD?

Before talking about the overdiagnosis of the disorder, let’s know what this consists of. ADHD stands for Attention Deficit Hyperactivity Disorder.

We are talking about a neurodevelopmental disorder characterized by attention difficulties ( attention deficit ) , symptoms of impulsiveness and/or hyperactivity. Symptoms can be mild, moderate, or severe.

Is ADHD Overdiagnosed?

Currently there is still an open debate on whether ADHD is a disorder that is overdiagnosed or not, that is, there is still controversy. Diarrhea in babies and children: why it occurs, what diet to follow. In the line that it is overdiagnosed, we found a recent exhaustive systematic review, from 2021.

The review is titled ” Overdiagnosis of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents ,” and has been published in the journal Jama Network.

The work, led by Luisa Kazda, was carried out by Australian researchers, based on a total of 334 published studies on children and adolescents with ADHD . The aim of the review was to  systematically identify, appraise and synthesize the evidence” around overdiagnosis of ADHD.

Overdiagnosis and overtreatment of ADHD

But what does this review say? According to her, there would be evidence of overdiagnosis, and also of overtreatment , of Attention Deficit Hyperactivity Disorders in children and adolescents.

In addition, an increasing percentage of minors receive pharmacological treatment for this reason.

ADHD Overdiagnosis: What Do the Experts Say?

The authors of this review of studies hypothesize that the rise in ADHD diagnoses is accompanied by a growing debate about what factors might be “causing” the disorder.

And they assure that, although there is often talk of an overdiagnosis, until now an exhaustive evaluation had not been carried out to demonstrate whether this was true or not.

Why is there an overdiagnosis of ADHD?

Experts suggest that this overdiagnosis of ADHD could be explained by various causes. Among the most important we find:

  • Diagnostic inflation (by changing the definition of the diagnosis or expanding it to include ambiguous or mild symptoms, “there are more” cases of ADHD).
  • The fact of medicalizing (opting for pharmacological treatment) patterns of behavior that were not previously considered pathological.
  • The difficulties in defining the limits between a “typical” development and an “atypical” or pathological development.
  • Clinical professionals with little training and/or experience.
  • Shallow investigation.

Further investigation is required

Even so, the authors of the review highlight the importance of continuing to investigate this supposed overdiagnosis, and affirm that there are still gaps in the evidence for this diagnosis or non-diagnosis.

In particular, they say, the long-term benefits and harms of diagnosing and treating ADHD in children and adolescents with mild symptoms should be investigated .

And they add that medical and mental health professionals should take all these data into account, especially so that they can properly identify this disorder and thus guarantee safe clinical practice.

The consequences of a misdiagnosis

The fact that our son receives an erroneous diagnosis of ADHD can imply negative consequences for him, at a social, emotional, academic level…

Above all, if you receive pharmacological treatment, with the adverse effects that this type of treatment can entail.

Also, let’s not forget that the fact of diagnosing a disorder that you do not have, implies not diagnosing what you do have or diagnosing something when in reality you only have difficulties, and not a real disorder.

For this reason, it is important to stop pathologizing behaviors that, in many cases, are “normal” or habitual during development .

The importance of a proper diagnosis

As a final reflection, we highlight the importance of receiving an adequate diagnosis (or not receiving a diagnosis, in case there is not one).

We remind you that, in case of doubts or suspicions that our child presents some type of difficulty or disorder, it is best to go to a specialized professional so that he can carry out an adequate evaluation of his case.

Ideally, we should go to centers with multidisciplinary teams, which have professionals from different branches and specialties, such as: a pediatric neurologist, a clinical psychologist, a developmental psychologist , etc.

The ADHD Assessment

The evaluation must include the tests that per protocol are administered in the case of ADHD, and that include: clinical interview (anamnesis), clinical observation, questionnaires to the parents and the minor (for example: the D2 attention test, the expensive…), and a good coordination with the school .

And let’s not forget that diagnosing ADHD requires:

  • Knowledge.
  • Time with the patient and their family .
  • Gather information about different contexts (ADHD symptoms must appear in at least two contexts, for example, at home and at school).
  • Define a general operating profile .
  • Explore the comorbidities of the disorder (if there is another disorder or additional symptoms).
  • Make a differential diagnosis (differentiate the disorder from other similar disorders with which it may be confused).