Wednesday, December 18th, 2013
Is ADHD underdiagnosed? Overdiagnosed? Overtreated? Undertreated?
These questions continue to get debated in 2013 with no resolution. On the one hand, we see statistics indicating how the rate of ADHD is going up – although many times these studies do not perform gold standard diagnoses of kids but rather report how many kids have been given a diagnosis. Yet talk to many practitioners and they will have stories of kids who clearly show evidence of ADHD yet do not receive a diagnosis.
How do we make sense of all this? One lens to apply is a simple one: we need to know how kids are getting diagnosed. I have contented that we have an ADHD paradox in this country – many kids get the label (and a pill) when they probably wouldn’t be diagnosed if they went through a comprehensive evaluation, yet many kids with ADHD are not properly diagnosed and treated (including behavioral and psychosocial interventions) because they don’t get a comprehensive evaluation. The common denominator here is a lack of a comprehensive evaluation. Ideally this is done by an experienced team that can apply a multidisciplinary perspective to fully examine cognitive, neuropsychological, behavioral, educational, and emotional functioning – and then offer an evidence-based plan of action.
That’s what is lacking. But it takes funding, insurance coverage, and a national commitment to mental health research and treatment.
ADHD Diagnosis via Shutterstock.com
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Monday, April 1st, 2013
The latest numbers on the rate of ADHD are extraordinary. The New York Times has reported data collected from the Centers for Disease Control and Prevention which suggest that 11% of youth (between 4 and 17 years of age) have been diagnosed with ADHD at some point in their lifetime.
This is troubling – primarily because the data come from phone surveys of parents. This means that parents are receiving this diagnosis at unprecedented rates – not that kids are being properly diagnosed with ADHD at higher rates than before. It is too easy for kids to get labeled ADHD and not go through the comprehensive screening that should take place as administered by a multidisciplinary team of professionals.
It’s becoming clear that ADHD is being used as a label to try to provide a quick handle on behavior that may – or even may not – be somewhat troublesome. ADHD involves much more than not sitting still and not paying attention. All kids exhibit “ADHD” like behaviors now and then. It’s a difficult condition to diagnose because it is based on increased frequencies of a number of behaviors across a number of contexts (home and school) for a sustained period of time which cause impairment for the child. Without a detailed diagnostic process, it can be too easy to misread normative behaviors as symptoms of ADHD.
Part of the increase comes from diagnoses of older kids including those in high school. Diagnostic criteria are beginning to reflect the thinking that symptoms can develop later in childhood and even in the teen years (and not just the early years). That said, it can also become another convenient label for a kid who is not doing well in school. At the other end of the spectrum, diagnosing preschoolers can raise related issues in terms of figuring out which kids are really showing early signs and which kids are just being kids.
There are a number of problems with overdiagnosis. Kids typically get treated with drugs that are not appropriate for them. They get labeled rather than receive the kind of attention that they deserve (for example, to improve their engagement in the classroom). And some kids get diagnosed simply because they are in very large classrooms which promote inattention and not sitting still.
The less obvious issue is that the cursory diagnosing that may be going on is also a disservice to kids who do suffer from ADHD. They should be getting full assessments and comprehensive treatment plans that find optimal combinations of psychosocial intervention and, when necessary, well monitored use of drug therapy. Tossing around labels and drugs as a diagnostic and treatment strategy is not going to give them the help they need, especially since we know that ADHD can persist into adulthood and cause much in the way of academic and social impairment.
The bottom line? If you are a parent, and you (or someone else) suspects that your child might have ADHD, try to seek out an assessment from a multidisciplinary team that has the requisite experience to know how to sort out normative behaviors and issues from clinically meaningful ADHD. You might need to network with other parents, your pediatrician, and educators to locate a provider. But it will be worth your time and effort to make sure your child isn’t misdiagnosed as having ADHD – or not given the proper assessment and treatment plan if they do show the clinically meaningful symptoms of ADHD.
ADHD image via Shutterstock.com
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