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Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition that affects children and adults. Doctors often diagnose ADHD in childhood.

Among parents and in the medical community, there’s some concern about overdiagnosis in children and adolescents. The concern grows from the steadily increasing number of children diagnosed with ADHD. One 2017 study found that ADHD diagnoses roughly doubled between 2005 and 2014.

Read on to learn more about the possible overdiagnosis of ADHD and other factors that might be behind the increase in ADHD prevalence.

Overdiagnosis vs. misdiagnosis

Overdiagnosis is the diagnosis of a condition that would not have caused symptoms or issues. It can be harmful if it leads to unneeded treatments or psychological stress. Misdiagnosis is when a wrong diagnosis is made; for example, if a person is diagnosed with cancer when they have a benign cyst.

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Given the sharp increase of ADHD diagnoses in recent years, studies have looked at the potential overdiagnosis of ADHD in children. The term “overdiagnosis” can be described as the frequent diagnosis of a condition, even if it doesn’t meet diagnostic criteria.

Another review of studies on overdiagnosis among children and adolescents found that factors such as the sex of the child influenced the diagnosis.

When diagnosing neurodevelopmental disorders in children, doctors use a multi-person interview approach. The child’s parents, caregivers, and teachers give descriptions of the child’s behavior. The healthcare professional then assesses whether the information gathered from these interviews points to a diagnosis.

Researchers found that those close to the child may have unconscious beliefs or biases about how ADHD “looks.” This can lead to imbalanced diagnosis rates in males compared with females. This may explain why more male children receive an ADHD diagnosis than female children.

The researchers also reported that clinicians tended to assess children or teens based strictly on numerical age, instead of how old they are when compared with their peers.

This means that a child on the younger side of their grade in school, for example, might be diagnosed with ADHD, while their peers who behave similarly might not because they’re slightly older.

Issues associated with overdiagnosis

Overdiagnosis of ADHD can lead to a host of issues, including:

  • overprescription of unnecessary medication
  • anxiety or depression related to diagnosis
  • unnecessary labeling or assistance
  • needless financial costs

The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), is used for diagnosing many conditions, including ADHD. Diagnostic criteria get revised and updated with each new edition, and disorders get changed, removed, or added.

The DSM-5 is the most recent edition of the manual. It featured changes to the diagnostic criteria of ADHD from DSM-4 that include:

  • a change in classification, from “disorders usually diagnosed in infancy, childhood, and adolescence” to “neurodevelopmental disorders”
  • more examples of how ADHD can present in adolescents and adults
  • a change to age of onset, from before age 7 to before age 12, and changed wording from “evidence of impairment” to “evidence of symptoms”
  • an update to “clinically significant” functional impairments, which means they now need to just interfere with social, academic, or occupational functioning
  • removal of autism spectrum disorder as an exclusionary diagnosis

The increased age of onset accounts for the reality that ADHD symptoms may appear in response to expectations and demands from the elementary school environment.

Most studies have found that while, at the very least, the misdiagnosis of ADHD and other neurodevelopmental disorders is common, the vast majority have not concluded that overdiagnosis, specifically, is happening.

There may be several reasons leading to the increase in ADHD diagnoses, including:

  • more awareness of neurodevelopmental disorders and less stigma, leading to healthcare use
  • improved diagnostic procedures, which means better identification of ADHD
  • changes in diagnostic criteria between DSM-4 and DSM-5, leading to lower thresholds for a diagnosis
  • doctors may not stick to diagnostic criteria and may be affected by their own bias and judgment

It can be hard to say whether a diagnosis is “true” or not when studying diagnoses. Standardized diagnostic procedures are necessary to reduce any bias in clinical judgment and lower the chance of misdiagnosis.

There’s no clear consensus on whether ADHD is overdiagnosed or not. But there does seem to be agreement that, in general, there is a fair amount of misdiagnosis when it comes to ADHD — especially among children and teens.

This could be caused, in part, by a lack of standardized diagnostic tests. It could also be the personal bias of clinicians or unclear and open-ended criteria.

Being an active part of the diagnostic process can help you reduce your or your child’s risk of being diagnosed with ADHD when they don’t have ADHD. If you have questions, ask your doctor about their reasoning for the diagnosis. Don’t hesitate to get a second opinion if you feel the need.