ADHD mostly receives negative press coverage relative to other neurodivergent conditions. A common belief among the general public is that doctors tend to over-diagnose ADHD, especially following the global pandemic. While we tend to disagree with this widely held opinion, a 2021 meta-analysis reported evidence of overdiagnosis of ADHD in both children and adolescents. This study stated that what looks like an overdiagnosis is more so a misdiagnosis of ADHD, where people with other conditions may be diagnosed with ADHD.
ADHD is a neurodevelopmental condition in which your brain works differently from most of society. It is estimated that about 8.7% of adolescents in the United States were diagnosed with ADHD in 2011. Of this percentage, ADHD severely impacts approximately half of the adolescents, who then find it difficult to function normally. The concerns regarding overdiagnosis arise from the fact that ADHD cases roughly doubled between 2005 and 2014, as shown by a 2017 study.
The term overdiagnosis in the medical dictionary is described as a frequent diagnosis of a certain condition, regardless of whether it meets the diagnostic criteria. The common way to reach a diagnosis for ADHD commonly adopted by doctors includes a multi-person interview approach. The child’s parents, guardians, caregivers, and teachers are required to give an account of the child’s behavior. The information gathered by the healthcare practitioner is then analyzed, followed by a diagnosis.
Many factors, apart from misdiagnosis on the doctor’s end, contribute to the overdiagnosis of ADHD in children and adults. A few of them could be:
As much as someone tries to avoid it, it is almost impossible to be free of bias. Since the multi-person interview approach to diagnosing ADHD involves speaking to the parents and other adults surrounding the individual, the results tend to be biased. In some cases, the parents may subconsciously have a certain belief or perception of how ADHD looks. In this case, the parents’ bias may lead to ADHD being over diagnosed in individuals.
It is reported that clinicians often tend to assess children for an ADHD diagnosis strictly based on their numerical age. In this way, they end up giving positive diagnoses to younger children acting the same way as their fellow adult peers without considering other factors. Similarly, children who are younger than their grade-level peers may be provided a misdiagnosis owing to their reduced emotional and intellectual development. This also results in ADHD being over diagnosed in children of young age.
Ineffective or inadequate parenting commonly leads to behavioral changes in children, regardless of whether they have ADHD. When a child victim of neglectful parenting presents improper behavior, their symptoms might be misdiagnosed as ADHD. However, this is not always the case. Children with ADHD are equally affected by bad parenting and tend to show erratic behavior. Their condition later gets diagnosed when they seek professional help.
Another reason for ADHD overdiagnoses could be the rate at which social media is helping spread awareness regarding this neurodivergent condition. With years of effort put into destigmatizing neurodivergence, more people have come to terms with it and are being open about their symptoms. With multiple search engines at your service, more people are aware of what ADHD is supposed to look like and rush to their doctor when they suspect they have this condition.
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is used to diagnose ADHD, among other conditions. The revision and improvement of the diagnostic criteria of DSM-5 reduce the chances of errors during diagnostic procedures. The revision of diagnostic criteria from DSM-4 to DSM-5 has undoubtedly, led to low diagnostic thresholds. Improved editions of diagnostic tests warrant better results and may be responsible for the claim that ADHD is over diagnosed.
Individuals with borderline personality disorder (BPD – a mental illness) tend to present with impulsive behavior that may look very similar to ADHD at first glance. As an experienced clinician, one should know better and run thorough diagnostic tests to assess and provide the individual with a correct diagnosis. In some cases, confusion, impatience, or exhaustion owing to the inefficient healthcare system may cause your doctor to provide you with a misdiagnosis. This could also add to the belief that ADHD is over diagnosed.
People with attention-deficit hyperactive disorder (ADHD) must have noticed that they show optimal functioning rates when they stick to a routine. Since the global pandemic of COVID-19 vastly disrupted everyone’s routine, people finally started presenting with symptoms of ADHD.
While this does not mean that people ‘developed’ ADHD during the lockdown, they just started noticing their symptoms during that period of idleness. If you are diagnosed with ADHD at some point later in life, chances are you have always had it, but the symptoms were never so prominent. The disruption or lack of routine threw off the ADHD-wired brains, and people started presenting with symptoms similar to those of ADHD, hence the increase in diagnoses.
While Attention Deficit Hyperactive Disorder treatment is sufficient in greatly improving symptoms, its overtreatment, like any other, has its side effects. Some possible side effects of over diagnosed ADHD and its overtreatment include:
It is common for patients to feel anxious and uneasy when they get diagnosed with a certain condition. The same anxiety is seen in patients diagnosed with ADHD. Misdiagnosing ADHD in children or adolescents causes panic and unnecessary behavior changes. Since the individual in question would not have ADHD and was misdiagnosed, an otherwise successful treatment plan devised solely to deal with people with ADHD seems futile for healthy people.
Sometimes, the patient or their loved ones fret over the potential long-term side effects of over diagnosed ADHD; it may adversely affect their mental health. Such a person(s) is likely to develop anxiety or hypertensive disorders, to name a few.
Researchers worldwide continue working to find qualitative and statistical proof for overdiagnosis and overtreatment of ADHD. They work alongside experienced healthcare professionals to get to the roots of ADHD overdiagnoses or misdiagnoses and figure out ways to prevent that from happening. Furthermore, research now extends further toward analyzing the disparities in ADHD diagnosis among different genders, ethnicities, and races.
ADHD is gaining recognition as more individuals learn about this neurodevelopmental issue. Due to this understanding, many people who could benefit from treatment may be able to receive it. However, an increasing number of individuals are also being over diagnosed. Both misdiagnosis and overdiagnosis of ADHD are possible. It is also likely that some groups of children are diagnosed with ADHD more frequently than average, while others are never diagnosed.