Nearly four decades after it was added to the DSM, attention deficit hyperactivity disorder (ADHD) remains a controversial diagnosis. While many clinicians feel that ADHD is under-recognized in some groups, widely varying rates of diagnosis around the world and an increasing reliance on medication have created concerns that ADHD is becoming an overused “catch-all” diagnosis. This, in combination with the complexity of assessing the condition, has led to significant confusion surrounding ADHD. To further complicate matters, ADHD presentation differs from individual to individual with marked differences between males and females.
ADHD: Overdiagnosed or Underdiagnosed?
Over the past 15 years, the number of child ADHD diagnoses in the United States skyrocketed and, currently, 11% of all school children have an ADHD diagnosis. One possible explanation here is that many mental health conditions are diagnosed with greater frequency today than they were 15 years ago owing to increased awareness and better diagnostic tools. However, critics point to the fact that ADHD is diagnosed far more often in the U.S. than in other developed nations, and a disproportionate number of white males are said to have the condition.
At the same time, the rate at which ADHD is diagnosed still lags in historically under-represented groups: Hispanic children and children without health insurance are diagnosed about half as often as the rest of the population. Women also remain chronically under-diagnosed, with some experts estimating that up to 4 million American girls and women with the condition are not being treated. At the same time, many parents, and especially fathers, complain that their sons who exhibit typical male traits, such as the high need for physical activity, disinterest in learning, and preference for rough play, are being mistakenly diagnosed with ADHD. While it may be true in some cases, fathers often have a hard time accepting the diagnosis even when it is based on a thorough evaluation, especially if they also had such traits as children and consider them normal.
The conflicting data surrounding ADHD clearly suggests that some children, particularly white males, are being overdiagnosed. Meanwhile, many children who require treatment are slipping through the cracks, leaving them at greater risk of experiencing social and academic problems.
I Wasn’t Diagnosed as a Child – Now What?
ADHD is not exclusively a childhood disorder. Though the symptoms of ADHD often change over time, they rarely resolve on their own and can include significant impairments to attention, working memory, impulse control, and emotional regulation, while restlessness and hyperactivity tend to diminish over time. Some adults with the disorder experience marital and financial problems along with difficulties coping at work. Of course, life gets even more challenging if you have a child with similar issues. Understanding your own problems will help you better understand your child.
If you suspect you have ADHD, getting a diagnosis can help you understand and accept yourself more fully, especially if you connect with local support groups. You may also be eligible for legal protection against discrimination in the workplace. Finally, it can ensure helpful accommodations in educational settings and licensing exams. I observed that adults who are diagnosed with ADHD for the first time experience a sense of relief. They often say they have been blaming themselves for their problems, saw themselves as lazy or stupid and felt that nothing they do can help. Realizing that this is a neurological condition and that many tools and strategies exist and have been successfully used by others brings about a sense of hope and optimism. In fact, it has been proved that people with ADHD possess traits that make them excel in certain professional fields.
To receive an accurate diagnosis of ADHD, you’ll need to ask your health care provider for a referral to a qualified mental health professional, such as a licensed psychologist or psychiatrist. Alternately, you can ask a local support group for advice on where to go for assessment and treatment. The assessment should include a comprehensive interview with detailed questions about your childhood history and current functioning, review of your educational records, testing, and completion of rating scales.
The ADHD Diagnosis: Too Many Options, Too Little Trust
The amount of media coverage given to ADHD has, paradoxically, made it more difficult for children and adults to receive an accurate diagnosis. Many educators, parents, and physicians think they know exactly what ADHD looks like: When a person displays signs of hyperactivity, inattention, or behavioral problems, ADHD is often the first (and sometimes only) condition considered. These symptoms are seen as being readily recognizable hallmarks of the disorder when in reality they can indicate a broad range of different mental, physical, or emotional issues. High-functioning Autism, intellectual giftedness, anxiety, depression, bipolar disorder, trauma, neurological conditions, and numerous physical ailments can mimic ADHD.
Complicating matters further, not all kids with ADHD display overt symptoms like physical hyperactivity or excessive talkativeness. In fact, most girls with ADHD are neither hyperactive nor disruptive. Our deeply entrenched, overly simplistic picture of ADHD puts these children at risk of being overlooked altogether.
When a child is identified as having ADHD-like symptoms, his or her path to treatment is often muddied by inadequate ADHD assessment practices. Rather than seeing a mental health professional who specializes in developmental disorders, many children receive a diagnosis of ADHD following just one or two visits with their family physician. The diagnosis is often based solely on observation, along with a short review of the child’s behavioral history and academic record, and medication is recommended as a front-line treatment. In some cases, parents have even been pressured by their child’s teachers to request ADHD medication for their child’s “disruptive” behavior.
This perfunctory approach to assessment is problematic for multiple reasons: Many children are unnecessarily exposed to the risks of taking stimulant medications, which include insomnia, appetite suppression, cardiovascular problems, and dependency. Conversely, some parents completely avoid seeking help for their child’s learning or behavior issues because they don’t want their child to be medicated. Children who are misdiagnosed (or never assessed at all) continue to experience social and academic challenges, which often drive more disruptive behavior.
To prevent these undesirable outcomes, parents, teachers, and physicians must realize that ADHD cannot be accurately diagnosed via subjective observation alone. To properly diagnose this condition, a licensed psychologist or psychiatrist must administer a comprehensive psychoeducational assessment. Not only can this testing effectively identify ADHD and rule out lookalike conditions, but it’s also the only method of formal diagnosis accepted by most schools and colleges. If a child is not properly assessed, he or she may not be granted the special academic accommodations required to excel at school (e.g., extra time to write exams; quiet room). Furthermore, in addition to performing full assessments, many psychologists use objective measures (like computerized tests of attention) to test a child’s ability to maintain alertness, resist distraction and interference, and avoid impulsive responses.
This multifaceted, in-depth approach to ADHD assessment allows parents and educators to personalize the accommodations their child needs to thrive at school and home. It’s also necessary to identify any concurrent conditions that may require attention. Unfortunately, the high cost of psychoeducational testing (costs can range from $2000-3000) and the amount of time these tests take can create barriers to adequate treatment.
If you suspect your child might have ADHD, using free online ADHD screening tests is a good way to evaluate whether or not a full assessment is needed. If the results of these tests indicate that your child has ADHD, you should review the details of your health insurance policy to verify whether or not psychological testing is covered by your plan. In some areas, outside funding may be available to parents who do not have health insurance.
Does ADHD Mean Medication?
Before you seek help for yourself or your child, it’s important to understand the role that medication plays in ADHD treatment. Medication is seen as a frightening prospect by some and a simple panacea by others when neither of these views is universally true. Not all cases of ADHD require medication, and even when medication is used, it works best in combination with other forms of treatment. Medication alone cannot “cure” ADHD.
Cognitive-behavioral therapy, social skills groups (for children), lifestyle modifications, meditation and adjusting the school or workplace environment can all effectively manage ADHD, often without the addition of medication. If medication is needed to manage your symptoms, know that stimulants aren’t your only option: Non-stimulant medications that carry no risk of dependency, like certain SSRIs, can also treat ADHD.
Ultimately, the best ADHD treatment is the one that works for you (or your child), and you should never feel pressured or rushed by the person administering treatment. Before you seek help for ADHD, educate yourself about the condition – and your rights – by accessing resources both online and offline.
This article is brought to you by Shenfield and Associates.