Are we SELLING ADHD?

In 2013, the Centers for Disease Control and Prevention (CDC) reported that one in nine children received a diagnosis of Attention-Deficit Hyperactivity Disorder (ADHD). In another report from the CDC (2007), the diagnosis of ADHD had increased from 6.9% to 9.5%. Are the numbers surprising? But why are children being diagnosed at high rates with ADHD? While there are a few reasons that will be discussed, I will start with one common reason; the practitioner’s error. In the world of managed health care, practitioners are forced to make a diagnosis in the first session. The first session? YES, the first session! So between gathering pertinent client history and gaining a clear understanding of the presenting problem, a diagnosis has to be made. Many times this first session does not provide an accurate picture of the client; and with limited collateral information from the child’s school or doctor, simple diagnosing errors can occur. There have been many studies that support that practitioners over diagnose with limited assessment information. In one study, 1000 clinicians who assessed ADHD in children, 15% reported REGULARLY using information from multiple sources. A second reason ADHD is over diagnosed is due to ethnic and gender bias. African-American males have been diagnosed with ADHD more often than any other ethnic culture. But what is even more alarming is the fact that these children do not meet the full criteria to be diagnosed with ADHD. Are we basing the diagnosis on poor assessments from practitioners? Are the behaviors children exhibit normal, age appropriate behaviors that is over-exaggerated by the school system? Are parents seeking a “quick fix” (medication) to manage “unmanageable” behavior? I believe that all of these questions are relevant factors when we look at how ADHD is often over diagnosed. While this issue is something that we need to continue to address to decrease the number of children that are inaccurately diagnosed, there are some things that can be done to help us understand what this issue is. First, mental health professionals have to be very careful in how they diagnose ADHD. Thorough assessments should be completed which include interviews with teachers, parents, day care providers and others who observe the child in various environments and settings (e.g. home, school, day care) and attest to their behaviors. Parent training in managing difficult behaviors and education of ADHD is vital in teaching parents the skills such as communication and proper discipline to manage behaviors. Last, as mental health professionals, we have to teach children appropriate self-control skills to be able to self-regulate their behaviors instead of placing them on medication. ADHD is real - it’s not made up, the problem is that it is being diagnosed to regularly. We have to be cautious in diagnosing children with ADHD by considering all of the factors and implications involved. As one pediatrician indicated:

“…our society in many ways has created an epidemic. Where were these boys 50 or 100 or 1000 years ago? They were outside, they were busy doing things; they lived in societies and cultures that had a place where they could develop their talents; and their behavior, for the most part, was tolerated. In our modern society, a premium is paced on being mostly sedentary and quiet.”