ADHD: Overdiagnosed & Unnecessarily Treated or Undetected?

Attention-deficit/hyperactive disorder is a neurobehavioural disorder whose symptoms begin in the preschool or early elementary school years. The most common childhood psychiatric condition, ADHD will affect just about one child in every school classroom. Although some people seem to outgrow the condition, a significant number will continue to have symptoms into their adult years.

The primary characteristic is chronic inattention, sometimes accompanied by hyperactivity or lack of impulse control. While this may sound like a lot of children you know, those with genuine ADHD struggle with significant symptoms that can't be eliminated simply by more effort on the part of the child or by "better" parenting skills. People with ADHD experience varying degrees of difficulty in a number of areas, including at school and in performing normal activities of daily life.

Diagnosis: Too Many or Too Few?

There is a common perception that many children are incorrectly diagnosed with ADHD, or that children are being given unnecessary medication. Unfortunately, there is also a certain reluctance to refer children for diagnosis. A study (Froehlich, 2007) conducted in the United States showed that 52.1% of children who fit the ADHD diagnostic guidelines (as laid out in the DSM-IV, the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders) have not received appropriate diagnosis.

Girls often miss out on diagnosis because they don't fit the pattern parents and teachers associate with the disorder. A girl with ADHD can be seen as a shy daydreamer, a tomboy or a "chatty Kathy," rather than as a student who is unable to concentrate in class. It may not be until a girl is in middle school or high school and has fallen far behind her peers, that her learning difficulties are taken seriously. Socioeconomic status seems to be a similar barrier to detecting ADHD: Dr. Froehlich's research showed that children from lower income homes were more likely to have ADHD, but less likely to be diagnosed or to receive consistent treatment.

What To Look For?

The DSM-IV defines three types of ADHD, according to whether an individual shows symptoms of attention-deficit, or hyperactivity/impulsivity, or of both. In all cases the symptoms must have been observed before a child reaches seven years of age, and must be observed in at least two different settings. Symptoms must also be present over a period of at least six months, and there must be clear evidence that there is impairment of functioning.

ADHD, like any other disorder, should be diagnosed by a health professional or a multidisciplinary team. If you suspect your child might have ADHD it is important to make note of specific concerns so you can describe these to a learning specialist or your child's physician. Use concrete, descriptive language, and remember to date your notes.

These are some symptoms as described by Health Canada:

Often fidgets with hands or feet or squirms in seat (in adolescents, may be limited to subjective feelings of restlessness)
Has difficulty remaining seated when required to do so
Is easily distracted by extraneous stimuli
Has difficulty awaiting turn in games or group situations
Often blurts out answers to questions before they have been completed
Has difficulty following instructions from others, but not because of oppositional behavior or failure of comprehension (e.g., fails to finish chores)
Has difficulty sustaining attention in tasks or play activities
Often shifts from one uncompleted activity to another
Has difficulty playing quietly
Often talks excessively
Often interrupts or intrudes on others (e.g., butts into other children's games)
Often does not seem to listen to what is being said to him or her
Often loses items necessary for tasks or activities at school or at home (e.g., pencils, toys, books, assignments)
Often engages in physically dangerous activities without considering possible consequences, but not for the purpose of thrill-seeking (e.g., runs into street without looking)

You can find similar checklists online or in books. If you think your child has displayed a significant number of the symptoms (for this list, Health Canada suggests a minimum of eight) and you have observed them for more than six months consider seeking professional advice. If you are put off by a teacher or health care professional, be prepared to advocate for your child. A missed diagnosis is just as serious as a misdiagnosis.

Sources:

"Attention Deficit Hyperactivity Disorder (ADHD)" Pediatric Clinical Practice Guidelines for Nurses in Primary Care (Health Canada)

"Majority of 2.4 million U.S. children with ADHD not diagnosed or consistently treated, according to new 'gold standard' Cincinnati Children's study" Jim Feuer (Cincinnati Children's Hospital Medical Center)

"Prevalence of ADHD established" Rick Naubert, PhD (PsychCentral)

"Struggles persist for adolescent girls with ADHD " Yasmin Anwar

"Whether kids with ADHD get treated may depend on parents' income" Eva Bender (Psychiatric News)