German Study Suggests ADHD Overdiagnosis

April 02, 2012

German Study Suggests ADHD Overdiagnosis

[caption id="attachment_1311" align="alignleft" width="300"] Image courtesy of David Castillo Dominici[/caption] New German Study Suggests ADHD Overdiagnosis - Especially Among Boys Over the course of the last twenty years the diagnosis of ADHD or Attention-Deficit Hyperactivity Disorder (previously known only as ADD) has increased exponentially worldwide. In the U.S. alone diagnosis of ADHD steadily increased at a rate between 3%-5.5% each year between 1997 and 2007, according to the CDC. In Germany, the prevalence of ADHD diagnosis rose 381% between 1989 and 2001. These startling statistics have led to an increased call for research into both the causes of this disorder itself and the diagnostic methods and criteria used to determine whether a child has ADHD or not. Heeding the latter call, researchers from Germany’s Ruhr-Universität Bochum (RUB) and University of Basel recently published a study in the Journal of Consulting and Clinical Psychology. The results of this study prove that, though we know far more about ADHD than we did in 1989, at least part of the reason for the numbers of ADHD patients climbing so substantially can be attributed to misdiagnosis. Heuristics vs. Diagnostic Criteria Like any psychiatric illness, ADHD diagnosis should be determined based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). This manual is published by the American Psychiatric Association, but used worldwide. It seeks to provide common language and set of criteria for the classification of mental disorders which include intellectual disabilities and ADHD, the most common psychiatric condition diagnosed in children. Theoretically, all ADHD diagnosis should follow the criteria set out in the DSM as a means to streamline the treatment and study of this disorder. However, because of the immense increase in diagnosis, many parents, educators and medical professionals have long suspected that the methods used to diagnose ADHD were less-than-perfect. What has caused the number of children with the disorder to increase so sharply over the past twenty years? The answer: misdiagnosis as a result of the use of heuristics and so-called rules of thumb over agreed upon diagnostic criteria. The researchers from this study, Dr. Silvia Schneider and Dr. Jürgen Margraf (of RUB) and Dr. Katrin Bruchmüller (University of Basel) found that this overdiagnosis was especially present in male subjects, causing the numbers of boys with ADHD to skew even further. The Methods To test their theory on the effects of heuristics on the diagnosis of ADHD, the researchers asked 473 child and adolescent psychologists and psychotherapists from Germany to look at one of four different case vignettes. Of these four, only one actually fulfilled the proper qualifications for an ADHD diagnosis. In addition, the researchers made gender a factor, allowing for eight total case files four male, four female. The results were almost universal. When looking at these case files and given the gendered element, Steven had ADHD, Sally did not. Why the Male Prototype Is Significant The results of this study, though only representing a small population of researchers and patients prove startling for the diagnosis of ADHD among male patients. Many of the clinicians used gender as a factor in their diagnosis, relying on previous patients and experienced-based problem solving to dictate their “medical/scientific” findings, rather than the medical and scientific criteria themselves. In other words, boys were more likely to receive an ADHD diagnosis without actually meeting all the qualifications whereas the girls were not. What’s more, the gender of the clinician also seemed to play a role in ADHD diagnosis. The researchers found that male therapist was far more likely to diagnose ADHD than a female therapist. Implications in Education As we continue to deal with the increase of ADHD diagnosis and the associated medication and therapy that comes along with it, more studies like these are needed and on a larger scale. With the increased pressure to perform on national level tests and an already-recognized gender gap in that achievement, trying to get to the root of why boys are getting misdiagnosed with ADHD is important. As educators, we need to be diligent in working with our student’s team of resources including parents and medical personnel and be willing to speak up if we feel a misdiagnosis is present. What are your thoughts? Do you see a lot of misdiagnosed ADHD patients, especially among boys?



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