How is ADHD diagnosed?
The number of children diagnosed as having ADHD has risen from 6.1% in 1997 to 10.2% in 2016 — leading some people to believe that the condition is overdiagnosed and children are being overmedicated.
ADHD is a clinical diagnosis based on symptoms, but that's true of other mental health disorders as well. To be diagnosed as having ADHD, children have to meet the following criteria.
For a diagnosis of ADHD, six or more of the following inattention-related symptoms must be present for children aged up to 16 years old and five or more for those aged 17 or older:
- Often failing to pay close attention to details or makes careless mistakes at school, at work, or in other activities
- Often having trouble paying attention to tasks or play activities
- Often not listening when spoken to directly
- Often losing focus and not following through on schoolwork, chores, or tasks at work
- Often having problems organizing tasks or activities
- Not liking to do tasks that require long periods of mental effort like schoolwork or homework
- Often losing things they need
- Being easily distracted
- Often being forgetful
As with inattention symptoms, six or more of the following hyperactivity and impulsivity symptoms must be present for children aged up to 16 years old and five or more for those aged 17 or older:
- Often fidgeting or squirming in the seat
- Often leaving the seat when staying in the seat is expected
- Often running or climbing in inappropriate situations
- Often not being able to play quietly
- Often acting like they're "driven by a motor"
- Often talking too much
- Often answering before the question is completed
- Often having problems waiting their turn
- Often interrupting or intruding on others’ conversations or activities
Along with the above symptoms, the following may be seen in a child with ADHD:
- Some of the symptoms show up there before the age of 12.
- Some of the symptoms happen in two or more places, like at home and at school.
- The symptoms interfere with or reduce the child's ability to function at school, at work, or in social situations.
- The symptoms can't be better explained by another mental disorder.
Types of ADHD
Children who meet the criteria listed above and have the symptoms for the past 6 months or more can have one of three types of ADHD:
- Combined presentation — both inattention and the hyperactivity/impulsivity symptoms present equally
- Predominantly inattentive presentation — more of inattention but less of hyperactivity/impulsivity symptoms
- Predominantly hyperactive/impulsive presentation — more of hyperactivity/impulsivity symptoms but less of inattention symptoms
Is ADHD overdiagnosed?
ADHD critics claim that more children are being diagnosed as having ADHD when in the past they would have simply been labeled lazy or bored in school.
One article claims that children who aren't doing well go to their pediatrician, who immediately diagnoses them with ADHD and writes a prescription, and that 90% of children diagnosed as having ADHD don't actually have a brain dysfunction.
A review of studies published in April 2021 agrees that ADHD may be overdiagnosed, especially in children who have milder symptoms. Children with milder symptoms are more likely to be harmed by overdiagnosis and overtreatment. Overdiagnosing happens when a child is diagnosed as having ADHD but is worse off because of the diagnosis.
Harms of ADHD overdiagnosis
Overdiagnosing ADHD is mainly harmful to children with milder symptoms. Children with milder ADHD symptoms don't benefit as much from medication.
The risks of taking the medicine may outweigh their benefits. The children may also be harmed emotionally because a diagnosis of ADHD may lead to feelings of disempowerment — they may feel like they can't control their actions and give up trying.
Another way overdiagnosis may harm children with mild symptoms is by stigmatizing them. These children may develop an identity that causes them to face more prejudice and judgment. This can make them feel even more isolated, left out, and ashamed.
Preventing overdiagnosis as well as undertreatment
Although ADHD may be overdiagnosed, it’s a real condition, and many children benefit from being treated for it.
One method for reducing overdiagnosis while also preventing undertreatment may be using a stepped diagnosis and treatment approach. In this approach, children who seem to have borderline symptoms would get help before they’re diagnosed as having ADHD.
Watching and waiting while providing education as well as psychological and social treatment options can ensure that fewer children are given an inappropriate psychiatric label. This approach also allows children who’ll benefit from medication and treatment to receive it.
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Centers for Disease Control and Prevention: "Symptoms and Diagnosis of ADHD."
Developmental Medicine and Child Neurology: "Childhood emotional and behavioral problems: reducing overdiagnosis without risking undertreatment."
JAMA Network Open: "Overdiagnosis of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: A Systematic Scoping Review," "Twenty-Year Trends in Diagnosed Attention-Deficit/Hyperactivity Disorder Among US Children and Adolescents, 1997-2016."
Science-Based Medicine: "The ADHD Controversy."
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