Overdiagnosis of ADHD in Children

Imagine a child sitting quietly for a long period of time, speaking only when spoken to and completely well behaved all around.  Imagine a child who actually likes vegetables and stays away from foods high in sugar; one that only plays and yells when outside and always uses his/her inside voice when in the house. Imagine a child who loves going to school and doesn’t argue about anything. Not a very excited childhood; not a very realistic one either. The truth is that as we all know, children are a handful. “Wait until your child is two, terrible twos are out of control.” We have all acknowledged that kids are loud and literally bouncing off the walls. It is no surprise that kids have so much energy and are always on the go. It is not uncommon for a child to want to play and yell instead of sitting quietly for a long period of time. It is not uncommon for a child to be easily distracted. They are kids, they want to play and yell and be able to do what they want. They should be allowed to express themselves in ways that make sense to them. It is not uncommon for children to get excited and speak out of turn. It is not uncommon for children to have trouble following or understanding directions.  It is however common that these characteristics of a growing healthy child are mistaken for a disorder named Attention deficit Hyperactive Disorder or ADHD.  The diagnosis of ADHD in children has increased dramatically over the last few decades. The overdiagnosis of ADHD in children is dangerous and needs to be addressed. It has become an easy way out in many cases. While I do believe that there are children that truly suffer from this disorder I also believe doctors are guilty of resorting to ADHD too quickly. 

    ADHD is the most commonly diagnosed behavioral disorder for kids in the United States, with at least 4.5 million diagnoses among children under age 18, according to the Centers for Disease Control and Prevention. This disorder can continue through childhood into adulthood. Symptoms of this disorder include difficulty paying attention or staying focused, controlling behavior and over-activity (hyperactivity).  ADHD can’t be physically diagnosed that is to say that is not diagnosed with a urine test, a brain scan, or a physical check-up. Therefore, a proper diagnosis can be challenging.  According to the CDC approximately 11% of children 4-17 have been diagnosed with ADHD as of 2011 and that number is still on the rise. 



The idea that ADHD has become an epidemic worries Dr. George Simon Ph.D. and expresses those thoughts in his article titled, ADHD: Epidemic of Incidence or Epidemic of Coincidence.  He claims that the ADHD is a profitable industry for the pharmaceutical business. He also points out that charges were made by the FDA against pharmaceutical companies for false advertising and marketing. While they do make a large profit from ADHD patients, they are not totally the blame for the idea that society has created. A pill fixes it all. With pills, children that have been diagnosed with ADHD, will be able to function properly and succeed. Dr. George Simon stated “It’s the rare occasion that any child experiencing difficulties receives the kind of comprehensive evaluation we once used to perform quite routinely before conferring an ADHD diagnosis upon a child. Pressure from third-party payers has had a lot to do with that.” He has confirmed that doctors have gotten lazy and do not utilize a thorough examination.

    We are so dependent on medications, but the question of their effectiveness on the diagnosed children is debatable. In 30 years there has been a twentyfold increase in the consumption of drugs for attention-deficit disorder. L. Alan Sroufe,  a professor emeritus of psychology at Minnesota’s Institute of Child Development, published an article about Ritalin, in the New York Times. The article titled Ritalin Gone Wrong, includes Dr. Sroufe’s concern about how heavily we rely on these types of medications and expresses a sense of doubt on the effect of them. According to Dr. Sroufe, attention Deficit drugs, when given to a child over a long period of time does not improve their school achievement nor their behaviors. Ritalin ironically has the side effect of stunting growth.According to an article titled, The Selling of Attention Deficit Disorder published in the New York Times, “Many doctors have portrayed the medications as benign — “safer than aspirin,” some say — even though they can have significant side effects and are regulated in the same class as morphine and oxycodone because of their potential for abuse and addiction.” As you can tell these are medications that are very intense for children, especially if they have been misdiagnosed.The picture below puts into perspective the children that are currently using ADHD medication prescribed to them. The medication these children are being exposed to have the potential to become addicting.

    The question that may arise at this point in time, is how and why is ADHD being overdiagnosed.  We are guilty of wanting the easy route and the simpler way of doing things. It is common in many cases ADHD was brought to attention through adults other than the parents; such as babysitters and teachers. There has been much controversy about teachers “diagnosing” ADHD in children using their “protocol.” However, not all angles are being looked at. Even though teachers observe their students for an average of 8 hours a day, they are not equipped to make that decision. Sadly in many cases, as soon as the disorder is brought up parents are convinced that that is the issue. “For a teacher to suggest that a child has ADHD is "inappropriate and dangerous," says Dr. Elizabeth Roberts, child psychiatrist in Murrieta, California.Dr. Roberts explains that outsiders should not be assuming that ADHD is the problem. There are many situations in which the child is distracted or acting out due to an internal problem. For example, a teacher may observe a child daydreaming during class and be quick to assume the child is suffering from ADHD, when the actual problem could be that he is being bullied and is trying to figure out where to hide at recess. Dr. Roberts shares her experiences and says that it is not unlikely for her to meet solely with the parents of the suspected diagnosed child and come to find out about tragedies in the family or other underlying issues that an outsider would be oblivious to. There are many reasons why a child could be showing signs of ADHD with ADHD, the actual disorder, not being one of them.

    An article published by Michigan State University, addresses the possibility that nearly one million children could potentially be misdiagnosed, because they are the younger kids in the class. Children in kindergarten are about 4-5 years old. 

The children that are 4 act like they are 4, believe it or not there is a big difference between a 4 and a 5 year old. Of course the 4 year old isn’t going to behave like the 5 year old, but that does not mean that ADHD is the reason. A teacher would find it harder to deal with a 4 year old and so it becomes a bit easier when they are being controlled under ADHD meds. The child could not be focusing because of problems at home or seems to be “daydreaming” but is actually thinking about where to hide from the bullies at recess. Another possibility is that these children that don't seem interested in school or in class could possibly be more intellectually advanced and therefore they are on the next level.Could this indicate an even larger problem? It is not surprise that the school systems in the United States are flawed in various ways. A teacher is given about 25-30 students. Of those students 2-3 "difficult" ones are problematic and is something that the teachers can not afford. It is easy for them to suggest that the children have ADHD, essentially drugging them up making them easier to deal with. However, it goes beyond that. A study published by the Child Mind Institute revealed that there may be another contributing factor to the rise of ADHD; federal funding. Schools, especially poorer schools rely heavily on federal funding. Something called, consequential accountability statutes would penalize schools if their student failed, with the exception of the students with ADHD because their scores were not thrown into the mix. Therefore, promising the passing test scores of the class as a whole. Now to put this into perspective and in a way that makes sense, "North Carolina, one of the first states to implement consequential accountability statutes, stands at a ADHD diagnosis rate of over 16 percent; California, one of the last states to implement these policies, ranks at only 6.2 percent. The difference is staggering.”

 Bob Hopper claims that ADHD is not over-diagnosed but actually under-diagnosed due to a “silent or inattentive” type of ADHD which commonly goes undetected. Bob Hopper, who has been a licensed clinical psychologist in boulder since 1981, argues that diagnosing ADHD is not a simple observational test. Both an intelligence test and a Continuous Performance Test, which is a standardized, normed, computerized assessment of attention specifically designed to help diagnose ADHD. A child that is sleep deprived reacts differently that an adult who is sleep deprived. When a child is sleep deprived, they show symptoms of ADHD such as hyperactivity and unfocused which can cause them to score the same as a patient with ADHD on the intelligence and continuous performance test. There are also many other conditions that often mimic ADHD however, they are constantly overlooked. A child may be suffering from hearing and vision problems and therefore does not stay still or pay attention to he teacher at the front of the class. The child could be suffering from high lead levels which has been proven to cause attention deficits and poor school performance. Another possible factor is as common as lack of B vitamin. Vitamin B6 is a necessary vitamin that is used in the making of neurotransmitters that affect behavior. The few of the many conditions that I listed above are not cured with Adderall or Ritalin, which are the two common medication given to children with ADHD. Sensory Integration dysfunction is the inefficient neurological processing of information received through the senses, causing problems with learning, development, and behavior. It is common for these children to crave fast movements such as twirling or running etc. Treating these children requires large open space or playground type gym and a determined occupational therapist that works with the children individually to help children appropriately respond and integrate to sensory input. 
   The question here is whether doctors have become more attentive and knowledgeable of ADHD or is it just because it explains situations easily. However, simply because children are showing signs of ADHD does not mean they have it. It is normal for children to have difficulties with learning and social interaction from time to time. According to Dr. David Salsberg is a Clinical Neuropsychologist in NYC, Clinical Instructor in The Department of Pediatrics at NYU Langone Medical Center, and Director of Pediatric Assessment, "If your child is actually struggling with anxiety or depression and has been misdiagnosed with ADHD, ADHD medication may intensify your child’s focus on anxiety or sadness."

  ADHD is over-diagnosed which is causing children to be given medication that have dangerous effects on them. There are cases in which there are underlying issues to the child acting out or simply the child needs more attention from his/her parents. In Today’s world, everyone is on the go, parents are constantly working, the children are left at daycare until the parents pick them up. There are different reasons for children to have problem focusing and extra energy. However, the significant increase in ADHD diagnostics causes worry in individuals as well as professionals.