Is Adhd Misdiagnosed

Attention Deficit Hyperactivity Disorder: Misdiagnosed
In recent years, Attention Deficit Hyperactivity Disorder has become a very common disorder. As a result, people and doctors have raised the question, is this disorder being over diagnosed? If you were to ask people this question many would think the answer is yes. People think this is true because of the drug companies “aggressive marketing epidemic”. This epidemic involves drug companies trying to educate people, specifically doctors, parents, and teachers on how to spot symptoms of ADHD in children. Therefore, making people assume that doctors are over diagnosing to gain more profit off the drug companies stimulants. (Frances) Although this idea seems to be a pretty logical explanation, there is not enough evidence to pin point a direct correlation between the “aggressive marketing epidemic” and doctors’ profits contributing to over diagnoses. (Frances)
Although now that we understand Attention Deficit Hyperactivity Disorder is not over diagnosed, we can see there actually is a problem with diagnosing. This problem is misdiagnosing. Misdiagnosing pertaining to ADHD means that there are several cases where people have all the symptoms of this disorder but are not actually diagnosed and the opposite; people are diagnosed with ADHD who actually do not have it. Misdiagnosing accrues for mainly three reasons; the definition of ADHD is too broad, the growing emphasis on educational achievements, and errors in diagnosing methods.
Understanding why Attention Deficit Hyperactivity Disorder is misdiagnosed we start by looking at the definition of this disorder, which is “a disorder characterized by a persistent pattern of inattention and or hyperactivity” (Gale Encyclopedia of Medicine). The definition can contribute to misdiagnosing because the symptoms that go with this disease are too broad. They are too broad in the sense that several other disorders can be linked to the same symptoms. Statistics show that “75% of children with ADHD have the same symptoms for several other disorders such as conduct disorder, oppositional defiant disorder, depression, dipolar disorder, anxiety, learning disorders, and language-based disorders” (Connor). Therefore, several children are being misdiagnosed with ADHD when they could very well have another type of disorder.
Not only do the symptoms effect the definition being too broad but also the misconceptions that ADD, Attention Deficit Disorder is a disorder of its own. ADD is not a separate disorder from ADHD; it is actually part of it. ADD is part of ADHD because it goes along with one of the three types of ADHD. The three types are Predominantly Inattentive, Predominantly Hyperactive-Impulsive, and a combination of the two:
Predominantly Inattentive Type, which is ADD, is defined as an individual who has difficulty in organizing or finishing a task, paying attention to detail, or following instructions. Predominantly Hyperactive-Impulsive Type is geared more toward your traditional ADHD patient who fidgets, excessively talks, cannot sit still for long periods of time, and interrupts people. Lastly, the combined type is someone who has equal depiction of symptoms for both types (“Facts About ADHD”).
Inevitably, since ADD is a disorder within a disorder statistics of people having ADHD seem to be significantly increasing. ADD being apart of ADHD clearly lead to people thinking that the disorder is being over diagnosed.
There are other factors that contribute to ADHD being misdiagnosed; one of these being the new way our society determines the success of people. This new way of evaluating success is by looking at how great a person’s educational achievements are. How does this new standard for success have any part of the ADHD diagnosing problem? Marcia Clemmitt explained it this way, “over the past half-century, success in American culture has been increasingly defined in terms of educational achievement. It may not be surprising, then, that over the same period traits that make it difficult for children to sit still at a desk or focus on lessons that bore them have increasingly been viewed as a significant disorder” (Clemmitt). Now that AHD is being view as a significant disorder, it is only natural that people look more carefully for traits of ADHD. When people become hypersensitive look for these traits there will be a greater misinterpretation of traits which will lead to misdiagnoses. Therefore, this leads to more people becoming diagnosed with ADHD.
Now that we understand more about the broadness of ADHD and the way America now determines success, we will look at examples of each. We can see clear examples of each based on different ages groups. Let’s start by looking at children roughly from ages 4 to 12. “Statistics show that there is an estimated 1.46 to 2.46 million children with ADHD in the United States” (Teaching Children With Attention Deficient Hyperactivity Disorder). It is obvious that evaluating children as early as age four is somewhat drastic but this is a result of American determining success by means of educational achievement.
To begin, evaluating children this young was only possible after the change in age guidelines for testing. “This change went from kids’ ages 6-12 to 4-18, because of additional research on this age range,” says a member of the American Academy of Pediatrics, Mark Wolraich (Hallmich). This new research discovered that preschoolers are now showing symptoms of attention disorder. A study done by the Journal of Development & Behavioral Pediatrics stated that, “symptoms of ADHD appeared at or before age 4 in two-thirds of the children.” Dr. Mark Riddle, a pediatrics professor at John Hopkins University School of Medicine explained this discovery by stating, “a great deal of children at ages 3, 4, and 5 in daycare and nursery school settings are being introduced to rules and educational goals that at one time were goals of kindergarteners” (Mascarelli). This evidence shows that because we now view success as educational achievements, preschoolers are now being held to a higher standard than is appropriate for their age group. Therefore, children are being diagnosed younger and younger which increases attention disorder statistics while also making room for more misdiagnoses. Since we see the examples for definition broadness and success determination in the youngest age group, we will now look at the middle school and high school aged factors. To start, looking at statistics of teenagers; “21 percent of teens with ADHD skip school repeatedly, 35 percent eventually drop out of school, 45 percent have been suspended, and 30 percent have failed or had to repeat a year of school” (Barkley). Linking these to our two main factors for misdiagnoses, we first see that researchers now understand that there are some cases of ADHD that only start to reveal themselves in middle and high school ages. This is because these age groups show more symptoms of inattentive ADHD which stated before is more like Attention Deficit Disorder, which goes a long with the ADD misconception and issue of the definition being too broad.
The other factor of misdiagnoses, the determination of success based on educational achievement can also be linked to this age group in the same way it is linked to preschoolers. Dr. Benedetto Vitiello, “the chief of child and adolescent treatment at the National Institute of Mental Health” says “they show signs of attention disorder because students at this age start to live more complicated lives and classes get more demanding, they are expected to deal with multiple teachers while also being more independent and organized” (Marscarelli). They ultimately do not have the attention skills they are being asked to have, which makes sense when looking at the statistics stated in the previous paragraph. But also it shows the pressures that are put on kids to keep their performance at the high standard they are given can lead to symptoms of ADHD which may or may not mean the kid or kids actually have the disorder.
Middle and high school age children have clear examples for misdiagnosing based on the issues of definition and success but looking at college students, their examples lead only to one issue; determining success by educational achievements. A study done by the Journal of American College Health showed that “29.9 percent of college students surveyed agreed to taking drugs illicitly during finals week and 15 percent did before test” (Jewett). In Minnesota, a survey in 2010 showed that “one-quarter of all Minnesota College students that report ADHD symptoms were diagnosed within one year of being in college” (Bankston). These studies go along with the assumption that students do not get tested for ADHD until college because they abuse one of the treatment methods for ADHD. This treatment being the taking of schedule II controlled substances, for example Adderall.
Christopher Meyer, a college student at the University of Minnesota was interviewed by Amanda Bankston a student as well, writing for the Star Tribune. In his interview he talked about his experience with Adderall. Bankston wrote that Meyer said, “He got his first taste of it during spring final exams, and that it [Adderall] was going for twenty dollars per pill.” Since he “struggled to get a consistent and affordable supply from his local drug dealer” he went to a doctor and got prescribed Adderall. He reported that “he takes Adderall up to three times a day and his more productive than ever” (Bankston). This interview shows the assumption is true, that college students are being misdiagnosed because of their want for the stimulants to perform better in school. This also is an example that since we determine success by educational achievement these students feel the need to be prescribed to these stimulants to achieve success.
Successful achievement seems to be the main reason for misdiagnoses in college students but looking at our last age group; adults they lead more towards the issue of definition broadness. Research estimates show that “nine million to ten million adults in the United States could have ADHD but less than two million have actually been diagnosed” (Clemmitt). This is because like the 75 percent of children with ADHD who have the same symptoms as other disorders, adults fall under a similar category. Allen Frances, a professor a Duke University explained this by saying, “that identifying ADHD in adults is particularly different because the nonspecific ADHD like symptoms can be pinpointed to almost every one of the psychiatric disorders” (Frances). Therefore, in the case of misdiagnosing adults, the definition being too broad is the main issue.
Now that we understand two of the three issues of misdiagnosing and see ample amounts of different age group examples of each, we need to look at the third issue; how doctors’ evaluations of these patients are making misdiagnoses. To begin, most doctors use a “cross-sectional symptom evaluation” because of time restrictions, but even though this method is fast it can result misdiagnosing ADHD (Connor). Stephen Hinshaw, a psychology professor at the University of California explained the issue of cross-sectional symptom evaluation:
Most diagnosis occur in a 10-minute pediatric visit after a teacher or parent identifies hyperactivity symptoms, in a visit like that, you get tons of false positives and tons of false negatives. Under diagnosis can occur because symptoms are context-dependent. For example, a child who sits quietly during an evaluation could still very well have ADHD. A false positive can occur because doctors do not take the time to evaluate and rule out other possible disorders or conditions (Connor). Therefore, even though cross-sectional symptom evaluation leads to error in diagnosing, due to time restrictions this wrong method is continued to be used to evaluate children. This ultimately contributes in misdiagnoses.
Not only are the doctors to blame for misdiagnosing but also when it comes to preschoolers and children, the parents and teachers are to blame. This is because they are usually the first to detect symptoms. This way is through the parents and or teachers and behavior therapy. “During behavior therapy parents should learn to be consistent in giving positive reinforcement for appropriate behaviors and ignoring or punishing inappropriate ones”, says Mark Wolriach. He goes on saying that “if there is no improvement after behavior therapy, they [preschoolers] have moderate to sever ADHD symptoms” (Hellmich). The problem with this is preschoolers show almost all hyperactive symptoms at this age. Since the parents are usually going to see these characteristics the most and the first line of treatment lies in their hands, it could lead to less thorough evaluations.
Since we understand the three main issues of misdiagnoses of Attention Deficit Hyperactivity Disorder, we know need to evaluate possible ways to fix these misdiagnosis. Before we look at ways that will potentially help this problem, we need to look at one way which several people think will help but in reality will only make the problem worse. This is the DSM5 Field Trials. “The DSM5 is the fifth edition of the American Psychiatric Association 's Diagnostic and Statistical Manual of Mental Disorders” (DSM5: The Future of Psychiatric Diagnosis). The reason the DSM5 will not work is because, as Allen Frances put it, “rather than attempting to contain a runaway ADHD epidemic, DSM5 would further fan its flames” (Frances). Frances is not the only one against the fifth addition, Dutch psychologist Laura Batstra worries that, "DSM5 will further inflate the already too broadly defined category of ADHD, especially for adults. This will lead to even more misdiagnosis” (Frances). Since there is evidence that the DSM5 will not work we now have to look at solutions that could potentially fix this problem.
Foremost, the way doctors diagnose patients with Attention Disorders needs to be changed. Dr. Batstra developed an “effective, common sense approach identified as the stepped diagnosis of ADHD with by stepped treatment or next-step approach” (Frances). Dr. Batstra explains, “that the next-step approach consist of watchful waiting, normalizing, parent and teacher training on managing difficult kids, and simple behavior modifications and environmental manipulation of milder cases...Then once all of these steps have been executed make the final diagnosis” (Frances). By using this method of evaluating patients you are looking at ADHD as a last resort not a “quick fix.” It helps doctors, parents, and teachers look at these types of behaviors in children as minority behaviors. Besides changing the way patients are diagnosed ultimately more research needs to be conducted for Attention Deficit Hyperactivity Disorder.
The main issues involving ADHD starts with the broadness of the disease. If researchers could narrow down the symptoms and create a clearer definition, less misdiagnosing would occur. This could help solve the problem because there would be less confusion and room for error when a doctor is detecting ADHD. For example, there are two extremes with diagnosing and a huge middle of grayness. On one end, the patient has unmistakable symptoms of ADHD. On the other end, the patient has absolutely no signs of ADHD symptoms. But in the middle is a flexible and unclear region which is heavily populated (Clemmit). In this area are the patients who can not be determined as clinically having ADHD or a normal person with extensive energy. But if there was clearer definition of ADHD the middle “gray” would significantly drop.
In conclusion, Attention Deficit Hyperactivity Disorder is not technically over diagnosed but it is however misdiagnosed. ADHD is misdiagnosed significantly for three reasons; too broad of a definition, America determining success by academic achievements, and diagnosing methods. If changes in the methods of diagnosing or a clearer cut definition of Attention Hyperactivity Disorder does not happen the amount of people being misdiagnosed will continue to escalate. As people we can better equip ourselves to help put an end to misdiagnosing Attention Deficit Hyperactivity Disorder by being more educated about the different factors, symptoms, and treatments of ADHD and understanding that it is a growing concept.

Works Cited

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