ADHD Overdiagnosis? Most Done After Checklists, Neuropsychological Testing
A lot of people have gotten this idea — myself included — that a diagnosis for attention deficit hyperactivity disorder (ADHD) is pretty easily obtained. I’ve been led to believe this by media hype about the “overdiagnosis” of ADHD. Some journalists I’ve spoken to in the past believed this so insistently, they based their entire story around the premise.
But what if the common wisdom and journalists are wrong?
What if most ADHD diagnoses are made after careful consideration of a child or teenager’s actual behaviors, verified through a behavior rating scale or checklist? What if most children who receive an ADHD diagnosis actually go through neuropsychological testing too? What if, before giving an ADHD diagnosis, most parents were also questioned about their child’s behavior in different settings too?
Could so many diverse measures and datapoints all be wrong?
For years, many have been beating the drum of “over-diagnosis” of attention deficit disorder in children and teens. The media and some journalists have fanned the flames of this idea, suggesting that an ADHD diagnosis is easily gotten, and done for secondary gains (access to stimulant medications).
But the data suggest a far more nuanced picture.
Medscape has the story about a large national study that was published earlier this year from a national survey of parents with children, ages 2-15, who have attention deficit disorder:
Data on the epidemiology of the diagnosis, the presence of other disorders, and the types of medication or behavioral treatment the child received were collected, as well as information about the types of symptoms present at diagnosis.
Children were included if the respondent answered “yes” to a question of whether a provider had ever diagnosed the child with ADHD or attention-deficit disorder. There were 2976 children with a diagnosis of ADHD in the analysis.
This study, conducted in 2014 by the Centers for Disease Control and Prevention’s National Center for Health Statistics, is a pretty comprehensive picture of how ADHD is being diagnosed in America today. Here are some of the highlights from that study.
Most Received Some Sort of Psychological Testing
According to this large, nationally representative survey, nearly 90 percent of children were given a behavior rating scale or checklist to help in the diagnosis of their child. These checklists are scientifically-valid instruments used to help confirm or disconfirm a diagnosis.
In addition, an astounding 68 percent of children also underwent neuropsychological testing. This kind of testing is far more extensive and in-depth, performed by neuropsychologists who analyze the result and provide a comprehensive report about a child’s strengths and deficits. Neuropsychological testing is the gold standard for many conditions in childhood, including ADHD.
To put it simply, most children who receive an ADHD diagnosis in the U.S. today are undergoing psychological testing. This stands in contrast with the common but incorrect belief that a child can be taken to a doctor’s office and come out with a prescription for Ritalin.
Multiple Sources Checked
In addition, not only were children queried about their behavior, but 96 percent of parents were also included in the conversation about their child’s behavior to determine its severity and in what kind of settings it appeared in. Additionally, in nearly 82 percent of cases, another adult who wasn’t the child’s parent was also asked about the child’s behavior, to help confirm the attention and concentration concerns.
Pediatricians Doing Most of the Diagnosing
Pediatricians are doing most of the diagnosing of attention deficit disorder — 39 percent, according to the study. Psychiatrists come in second with 18 percent, while psychologists and primary care physicians are nearly tied with about 14 percent of the diagnosing each. Neurologists diagnosed children in approximately 5 percent of cases. The remainder of diagnoses were made by other types of health care providers.
The upshot? Most ADHD diagnosing done in the U.S. today is being done fairly carefully and thoughtfully by trained professionals who know their stuff when it comes to children and teens. This data shatters the common wisdom that ADHD diagnosing is just being done off of loose DSM-5 diagnostic criteria with little external validation.
Indeed, the scientific research shows that most ADHD diagnosing is done with a lot of attention being paid to objective data (behavioral checklists and neuropsychological testing) and validation from other sources (parents and other adults in the child’s life).
For Further Information
Visser SN, Zablotsky B, Holbrook JR, Danielson ML, Bitsko RH. (2015). Diagnostic Experiences of Children With Attention-Deficit/Hyperactivity Disorder (PDF). Natl Health Stat Report, 3, 1-7.
Grohol, J. (2018). ADHD Overdiagnosis? Most Done After Checklists, Neuropsychological Testing. Psych Central. Retrieved on April 8, 2020, from https://psychcentral.com/blog/adhd-overdiagnosis-most-done-after-checklists-neuropsychological-testing/