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Is ADHD really being overdiagnosed?

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A new study from the U.S. Centers for Disease Control and Prevention finds that one third of children being diagnosed with attention deficit hyperactivity disorder are under the age of 6. Susanna Visser, a researcher at the U.S. National Center on Birth Defects and Developmental Disabilities, studied the diagnosis of more than 3,000 children. She found that about half of the children were diagnosed before the age of 7, and 31 percent were diagnosed before the age of 6. Researchers found that the first person to become concerned about the child’s behavior was the parent or a family member in three out of every four cases.

But is the disorder being over-diagnosed as suggested by numerous, recent headlines pointing at this study?

“Often, the most important questions are the hardest to answer. If we knew the physiological processes that result in the symptoms which we use to diagnose ADHD, then we could determine whether it is being over-diagnosed,” says psychiatrist Dr. Francis Castellanos, of The Child Study Center at NYU Langone Medical Center. “On the other hand, it’s always the case that both over- and under-diagnosis exist, and I strongly suspect that is also occurring in ADHD.

“We know the rate of diagnosis varies substantially by community — probably more than could be accounted by ‘real’ variation. We also know that minority families and families with low levels of economic resources have much lower rates of diagnosed ADHD — it’s likely that many children in those communities are being under-diagnosed.”

Another prominent find was that a little more than half of the children diagnosed received their diagnosis from the pediatrician or family doctor, instead of a psychiatrist.

“Many types of doctors are trained and qualified to diagnose ADHD in children. This includes medical doctors, such as pediatricians, child and adolescent psychiatrists, pediatric neurologists, and family physicians,” says Castellanos. “Non-medical doctors include clinical child psychologists and neuropsychologists, who are also exceedingly well trained. However, just because someone has one of those credentials does not mean they are necessarily the best person to evaluate complex cases.

“The Visser study showed that when children present with ADHD before age 6, child psychiatrists are more frequently involved, which is appropriate, since they are the specialty, which is the most focused on ADHD and similar conditions.”

In addition, since there is no specific test to formally diagnose the disorder, a doctor must rely heavily on the parents’ observations and opinions. This can be a positive or negative thing since the symptoms are also the very same typical behaviors that most preschoolers demonstrate: inattention, hyperactivity, and impulsive behavior.

Children with attention deficit hyperactivity disorder are in constant motion, squirm and fidget, make careless mistakes, often lose things, are easily distracted and don’t listen well, and do not complete tasks. Symptoms need to occur in multiple settings (at home, in school, at social functions, etc.) and last for at least six months.

Some parents who aren’t quite used to the unrelenting demands and energy of very young children might object to their bursts of energy. Not all, or even most high-energy children actually have attention deficit hyperactivity disorder. However, it does have a very strong genetic component, so if the parents have had problems with hyperactivity, it is even more likely that their child could have it. Researchers suggest that the number may be as high as 75 percent for a child born of both parents with the disorder.

Danielle Sullivan, a mom of three, has worked as a writer and editor in the parenting world for more than 10 years. Sullivan also writes about pets and parenting for Disney’s Babble.com. Find Sullivan on her blogs, Just Write Mom and Some Puppy To Love.

Updated 4:57 pm, July 9, 2018
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