Is ADHD Overdiagnosed in Children?

Attention-deficit hyperactivity disorder (ADHD) is a disorder characterized by impulsiveness, hyperactivity and inattention. Approximately 4.5 million children, ages 5-17, were diagnosed with ADHD as of 2006, according to the Centers for Disease Control and Prevention.

History

• In 1902, Sir George F. Still published a series of lectures at the Royal College of Physicians in England. These lectures, described as the "Goustonian Lectures," consisted of Still explicating on a group of hyperactive and inattentive children. Still argued that the cause of the children's behavioral problems was genetic. Still did not use the actual phrase "attention-deficit hyperactivity disorder," however. This language was not adopted until 1980 when the American Psychiatric Association adopted it.

The Statistics

• The statistics associated with ADHD suggests that overdiagnosis is a possibility. Today, the CDC estimates that 4.5 million have been diagnosed with ADHD, and many organizations put the number much higher. The CDC notes that diagnoses of ADHD has increased an average of 3 percent every year from 1997 to 2006. Moreover, the Drug Enforcement Administration notes that since 1991 there has been a 500 percent increase in the prescriptions written for stimulant medication to treat ADHD. The increase in prescriptions for stimulant medication has also caught the attention of former U.S. Surgeon General David Satcher, who attributes the increase to better diagnoses and treatment of ADHD.

Expanded Diagnostic Criteria

• In 1994, the American Psychiatric Association expanded the criteria used to diagnose children with ADHD. The expanded criteria represents one explanation for the dramatic increase in the number of children being diagnosed with ADHD. According to Howard Abikoff, director of research at the New York University Child Study Center, the rise in diagnoses can be explained in part by the expanded criteria and the increased awareness of ADHD symptoms. Abikoff does, however, support the expanded criteria, noting that it was selected based on comprehensive research and data.

ADHD Medication and Performance

• According to the National Institute of Mental Health, children who take medication for ADHD perform better in elementary school than their counterparts.Several studies have shown that ADHD medication improves attention and memory skills, which has a positive effect on school performance. One study conducted by researchers at the University of California, Berkley, found that students with ADHD who took medication had reading scores 5.4 points higher than their peers who did not take medication. These studies offer hope for children who have ADHD. However, they also suggest one possible reason that ADHD diagnoses are so high. If ADHD medication can increase a child's performance in school, parents may be inspired to actively seek out a diagnosis. A study published by the Journal of Attention Disorders, however, seems to invalidate this argument. The study, conducted in 2007, found that the number of children inappropriately diagnosed with ADHD does not substantially exceed the number of false negatives (i.e. children with ADHD who are not diagnosed).

Warning

• More than 90 percent of children diagnosed with ADHD are prescribed Ritalin. Ritalin is a stimulant and potentially can be dangerous, particularly for individuals with heart problems. Consequently, it is imperative that children are not diagnosed with ADHD who do not actually have it. Even if your child does in fact have ADHD, the American Heart Association recommends that your child be evaluated for heart problems before starting medication.