Truly in the many years I have been talking to parents, I can honestly say that there is no topic that brings such passion as this one. Passion in many ways. While I never ask someone to change their mind about their view or feeling, I have had spirited debate many times about the cause and source of ADHD symptoms.
Since I have always suspected that ADHD may be overdiagnosed, I went searching for articles and found some recent research about some of the ways in which it can be misdiagnosed.
Todd Elder, Ph.D., a health economist at Michigan State University, East Lansing indicates what is actually immaturity may be mislabeled as ADHD, according to his study. In his study, Elder looked at the differences in ADHD and medication rates between the oldest and youngest children in a grade. He used data from the Early Childhood Longitudinal Study Kindergarten Cohort, funded by the National Center for Education Statistics. He looked at whether and how the age of a child relevant to his classmates made a difference.
He found that the youngest children in kindergarten were 60% more likely to be diagnosed with ADHD than their oldest classmates, which could translate to 900,000 children potentially misdiagnosed. They were more likely to be on ADHD medications than the older kids. According to Elder, "Diagnoses are explicitly based on a comparison of a kid's behaviors with those of their peers. Kids in the same grade and kids of the same age are two very different scenarios" he says.
Many parents I have met have found symptoms to decrease when they allowed some extra time for maturity before jumping to a conclusion, as different kids mature at different rates and there is no "one size fits all" when it comes to that.
In a similar study, Melinda Morrill, Ph.D., a research assistant professor of economics at North Carolina State University in Raleigh, and her colleagues studied data from two national health surveys and a national private health insurance claims database to evaluate ADHD diagnosis and treatment in children. The time period studied was from 1996 to 2006. They compared children born just a few days apart. According to Morrill, "children born before the cutoff had a 25% higher rate of ADHD diagnosis than children born after the cutoff for kindergarten eligibility," she said. "That's huge."
In her national sample, she said, "the average diagnosis rate of ADHD is 8%. Children born before the cutoff had a rate of 9.7%, she says, and children born after (the older kids in a class) had a rate of 7.6%." Based on her results, she agrees with Elder: "Immaturity could be mistaken for ADHD."
James Perrin, MD, a spokesman for the American Academy of Pediatrics and head of the division of general Pediatrics at Massachusetts General Hospital for Children, Boston, doubts the levels of misdiagnoses are as big as quoted in the prior mentioned study, but does point out that "it's not an easy diagnosis to make," he says of ADHD. "There is subjectivity." Parents should always get two opinions, he says. "We do recommend there be an independent verification," says Perrin, who has consulted for pharmaceutical companies that make medications for ADHD. He recommends that environmental changes must be made in addition to other treatments.
George Kapalka, Ph.D., of Monmouth University in Long Branch, N.J., who has researched ADHD, doesn't dispute there are misdiagnoses and he adds that any evaluation of ADHD should "clearly indicate impairment must be present in at least two settings, so the diagnosis should never be made based on school problems alone."
Parents want the best for their kids. The parents I have met along the way are some of the most committed, loving people and worry that their kids are being labeled the wrong way. According to this research at least some of them might be right. I will say here what I say to every parent I have ever met. It is very worthwhile to evaluate all the potential causes of the symptoms. To keep an open mind and to ask lots of questions. I also highly recommend that even if medication is the treatment route of choice, that during that time, parents work toward the child improving daily habits of diet, exercise, and sleep while learning self control and better information processing. Those things are really good and healthy for anyone regardless of a diagnosis or not.
As this is a very controversial topic and has brought lots of conversation in the past, I would love to hear from you on this blog about your experiences with a correct or incorrect diagnosis and how it turned out for you and your child. You might help someone else who is going through it right now.
Dr. Sherri Singer, Psy.D. is a Child and Family Psychologist who can be reached at http://www.happyfamilysite.com
