ADHD Diagnosis: Too Much or Just Right?

*Updated 2024

One in nine children in the US between the ages of 3 and 17 have been diagnosed with ADHD, a mental disorder that inhibits impulse control and attention span. Already back in 2011, demand for ADHD drugs was so off the charts that there were nationwide shortages – and the same holds true again (or still?) today.  This has repeatedly garnered national attention, prompting the question – is ADHD over-diagnosed? In 2017, researchers concluded that the answer was yes, especially in children born close to school cut-off dates. Ever since then, research has remained consistent with the conclusion that ADHD is being over-diagnosed and over-treated in children.

Let’s take a look at some of the arguments that suggest that ADHD is over-diagnosed, and some which suggest that diagnosis is right on.

 

ADHD diagnosis is on point

 

Increased diagnosis is a sign of increased understanding

Today more than ever, the medical community is aware of the salience of mental health in overall health, and doctors of all specialties bring this knowledge to their practice. Indeed, diagnoses of mental disorders writ large have increased across the board: autism, depression, and anxiety diagnoses have all been on the rise since 2007. But that could also be because their definitions have widened.  Spectrum diseases are sometimes difficult to spot, but awareness of the symptoms of spectrum diseases like ADHD and others have enabled millions across the globe – including three-quarters of newly diagnosed adults, who became aware of their symptoms because of fallout from the pandemic – to treat their disorders, a fine achievement for the field of mental health.

 

The media promotes ADHD over-diagnosis as a foregone conclusion, while scientists remain unconvinced

The media has made much of the rise in ADHD diagnoses, attributing it mainly to money-hungry pharmaceutical giants and lazy parents. However, journalists sometimes report and interpret ADHD data inaccurately. For example, The New York Times once reported 11 percent of students in the US had received an ADHD diagnosis; in reality, according to the CDC, 11 percent of all high school students had received an ADHD diagnosis at some point in their lives. Such details are crucial in shaping the public’s perception of diagnosis rates. While some researchers suggest that there is no conclusive evidence of systematic over-diagnoses, certain cases in which the media mishandles data elevate normal diagnosis of ADHD to the level of scandal.

 

Worry about over-diagnosis is merely a sign of society’s discomfort with mental disorders

Stigmas against mental disorders have been well documented for centuries. While people tend to accept physical illness as an unfortunate inconvenience of life, mental disorders were first avoided altogether, and later, approached with suspicion. Even today, the stigma of mental illness remains. Studies have confirmed that people are particularly quick to stigmatize children with ADHD, even if the child is receiving treatment. These attitudes not only feed into public doubt about the “realness” and “treatability” of ADHD, but may also drive self-stigmatization that discourages ADHD patients or their families from seeking treatment.

 

ADHD is over-diagnosed

 

Misbehavior is mistakenly perceived as a disorder.

Parents, teachers, and physicians do not always link hyperactive behavior to the right cause. Family doctors produce more than half of all first ADHD diagnoses, but they do so in 7-minute consultations which are unlikely to probe deeply enough into the patient’s lifestyle to identify causes for ADHD symptoms other than ADHD. For example, diet (namely intake of caffeine, artificial sweeteners, and preservatives), sleep deprivation, and stress contribute to hyperactivity and irritability that can masquerade as ADHD. A study which found that children in foster care are three times as likely to be diagnosed with ADHD also supports the notion that ADHD diagnosis may have more to do with environmental factors than the actual presence of the disorder.

 

The rate of ADHD diagnosis rises with the broadening of diagnostic criteria

In the US, the diagnosis of ADHD is generally determined by recommendations found in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The latest version of this manual has a significantly expanded list of diagnostic criteria, which includes behaviors most of us engage in on a daily basis (i.e., losing your keys – come on!). Unsurprisingly, a study that compared ADHD diagnoses between doctors who used an older DSM version and those who used the new edition (with broader criteria) showed that doctors using the new criteria diagnosed ADHD more frequently. A comparison of the DSM to the World Health Organization’s IDC, a manual whose criteria for ADHD is narrower, showed that the IDC manual led to fewer ADHD diagnoses.

 

Educational assessment standards drive ADHD diagnoses

Education policies that require schools to meet achievement benchmarks in order to receive federal funding have impacted the frequency of ADHD diagnoses in lower-performing regions. Schools are motivated to have children diagnosed with ADHD because federal standards may allow them to be excluded from testing data or may guarantee funding for those students regardless of performance. The 20 percent rise in ADHD cases since the No Child Left Behind Act signals an important correlation between pressure for student achievement and increased diagnosis of the condition. The popular (but incorrect) perception that medicines used to treat ADHD enhance academic performance might also lead to parents to seek these treatments and educators to recommend them.

 

The Bottom Line: There is some evidence to support the notion that ADHD diagnosis may be driven by factors other than the presence of the actual disease. However, growth in the number of diagnoses for any given condition does not necessarily point to undue inflation. Scepticism on the part of scientists and the public alike can only push us closer to better understanding of the statistics surrounding ADHD and what they mean for your child. Do you think ADHD is over-diagnosed?

 

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