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Is ADHD Overdiagnosed? Results From a Recent Study

Although it is well established that many children with ADHD are never identified or treated, the extent to which children are incorrectly diagnosed with ADHD is not known. There are several reasons to be concerned about over or incorrect diagnosis. First, it can lead to children being inappropriately treated with stimulant medication when they do not need it. Second, it may contribute to children not receiving treatment that would better address another condition they actually have. Third, it could contribute to increased health care costs and health challenges later in life. The possibility of stigma is also an important factor to consider.

Clear diagnostic criteria for ADHD is set out in the DSM-IV-TR. In addition to a minimum number of inattentive and/or hyperactive-impulsive symptoms, children must show impairment from these symptoms in at least two settings, the symptoms must cause clinically significant impairment in social or academic functioning, they must have been associated with some impairment before age 7, and they must not be better explained by another mental disorder such as a mood or anxiety disorder.

Unfortunately, some clinicians who diagnose ADHD in children may not carefully follow the diagnostic guidelines. Instead, clinicians’ may focus on the presence of particular symptoms that they believe are central to the disorder and when these are present, fail to consider whether all the necessary additional criteria are met.

It is possible that this partially explains why many more boys are treated for ADHD than girls. Specifically, boys with ADHD are more likely than girls with ADHD to display disruptive behavior. If clinicians regard disruptive, impulsive, and hyperactive behavior as primary to the disorder it could contribute to boys being overdiagnosed and girls being underdiagnosed. That is because when such behavior is present, clinicians may be less attentive to necessary diagnostic criteria that are not met. And, when it is not evident, clinicians may disregard or at least underemphasize the presence of other ADHD symptoms when making their diagnostic decision.

A very interesting recent study in the Journal of Consulting and Clinical Psychology presents a very interesting look at this issue [Bruchmuller et. al., (2011). Is ADHD overdiagnosed in accord with diagnostic criteria? Overdiagnosis and influence of client gender on diagnosis. Journal of Consulting and Clinical Psychology, 80, 128-138. The study demonstrates that not all clinicians follow DSM-IV criteria “…requirements to base their diagnosis on a thorough evaluation of relevant diagnostic criteria.” Preliminary evidence suggests this may especially be true for male clinicians evaluating male children. Diagnosing children incorrectly can potentially lead to a number of adverse consequences and this research will hopefully contribute to raising awareness of this important issue. Click here to read the entire article.

Why I Recommend Cogmed Working Memory Training

Extensive research has clearly indicated that poor working memory is a significant contributor to learning difficulties for many children especially ADHD children and adults. Cogmed’s program is designed to train and improve working memory and has accumulated substantial research support, with more than a dozen studies published in leading scientific journals.  These include studies that have looked specifically at the impact of working memory training on student achievement and attention. Cogmed Working Memory Training has been widely used in Swedish schools for a number of years and is now being introduced to schools in the US and Canada.