Is ADHD Overdiagnosed and Overmedicated?
Recently, I read a very informative article by Dr. Tynan (Director of Integrated Health Care, American Psychological Association Center for Psychology and Health) on the stunning number of young children who are diagnosed and medicated for attention-deficit-hyperactive disorder (ADHD) in the United States.
The article states that an estimate of almost two hundred thousand 2-5 year olds have been diagnosed with attention-deficit-hyperactivity disorder. This statistic is shocking in itself, as currently there are no valid criteria for ADHD in children this young.
How Are Children Getting Over Diagnosed With ADHD?
Attention-deficit-hyperactivity-disorder is one of the most overdiagnosed learning disabilities, owing to its wide envelope of generic symptoms, restlessness, hyperactivity, inattention, uncontrolled speech, etc.
Many children exhibit these behaviour characteristics for a number of reasons — it’s not necessarily an indicator of having ADHD. This is one of the reasons why it’s an overdiagnosed condition. The danger of overdiagnosis and misdiagnosis are that the child might be put on behavioral therapy and medication that’s meant for treating a condition that they might not even have.
This can bring about unintentional alterations in behavior, medicine-related side effects and temporary neurochemical changes.
Two to five year olds are very immature, are changing rapidly, and are always on the move based on developmental norms. So it is very concerning to learn about the high number of children being given such a serious diagnosis so early in their development.
ADHD Diagnosis and Medication in the United States
The Journal of Pediatrics and the Center for Disease Control and Prevention have also recently reported on a very important national study on treatment interventions for ADHD across all ages. The findings from the report show the following:
“9 out of 10 children with ADHD were treated with medication and/or behavioral therapy, both of which are recommended ADHD treatments. Of these children:
- about 4 in 10 (43%) were treated with medication — the most common single ADHD treatment,
- about 1 in 10 (13%) received behavioral therapy alone, and
- about 3 in 10 (31%) were treated with combination therapy (medication and behavioral therapy).
- About 1 in 10 children with ADHD were receiving neither medication treatment nor behavioral therapy.
- About 1 in 10 were taking dietary supplements for ADHD, which are not currently recommended for the treatment of ADHD.”
Dr. Tynan accurately points out the significant concerns related to the above findings:
“Since 2011, the treatment guidelines from the American Academy of Pediatrics have recommended that preschoolers diagnosed with ADHD receive behavioral therapy first before medication. But, almost 50% of diagnosed preschoolers received no behavioral therapy. Too many are being treated with stimulants and other psychoactive medications as the sole form of treatment.”
The Problem With Overdiagnosis
Overdiagnosis is a phenomenon that plagues psychiatry and various other domains of medicine. Even though the intentions are right, medical practice favors more tests and more treatments. Screening programs that detect early symptoms, sensitive diagnostic systems, and widened definitions of diseases, all contribute to the problem of overdiagnosis. It leads to unnecessary labeling; unnecessary tests and therapies; and higher healthcare costs.
Ensuring Appropriate Treatment for Your Child
Making an accurate diagnosis takes time. It can’t be done by filling out a standardized form. Other conditions such as PTSD, depression, learning disabilities, etc. have to be ruled out by physicians. Understanding the child’s daily experience is also important. This entails the child’s school, family, and social situation. Take the time to speak to your child and observe them carefully before rushing to a diagnosis.
If treatment does begin, be sure to monitor, log and report any observations, side-effects, and behavioral changes. Don’t hesitate to get a second opinion.
It’s worth mentioning that there are multiple medication options for ADHD. If your child experiences discomfort from a particular medication, you can consult your physician to consider alternatives.
There’s a Better Way
Given that there is currently very little research that demonstrates the safe effectiveness of medications in young children, and given the number of side effects medications can have on young children, it is imperative that we continue to turn to behavioral and family treatment, along with effective school and classroom interventions (including teacher trainings, and changing the classroom structure, demand, and flow) to better meet the developmental needs of younger children.
Perhaps changes in our approach and expectations for active and high-energy children may be more safe and effective in the long run for the child and the family.
In fact, based on a review of the research on ADHD and behavioral interventions, the CDC’s National Center for Injury Prevention and Control reports that positive parenting, effective communication and discipline, and social rewards and praise can be very powerful tools in managing young children’s behaviors and outcomes.
Hence, based on a meta-analyses of many studies, the CDC has recently published a set of videos and tools to teach effective parenting skills on a new website: Essentials for Parenting.
As clinicians, pediatricians, teachers, and parents it is important for us to pay attention to the outlined concerns and utilize these listed resources to the best of our abilities in helping our youngest generation thrive.