2022 Oct 27;23(21):13054. doi: 10.3390/ijms232113054. While there is concern from rising ADHD diagnoses, a U.S. national survey reported in 2006 that only 11% of adults with ADHD were being treated for it. So you might conclude from the prior passage that I think that ADHD is over-diagnosed and too many American adults are on ADHD medication. Attention deficit hyperactivity disorder: an update. Neurodevelopmental disorders: conceptual approaches. Community groups, some of which receive funding from pharmaceutical companies that make stimulants, also promote increased diagnosis and pharmacological treatment. Accessibility These drugs can temper hallmark symptoms like severe inattention and hyperactivity but also carry risks like sleep deprivation, appetite suppression and, more rarely, addiction and hallucinations. [my emphases added]. and other adults. While attention deficit hyperactivity disorder (ADHD) is considered one of the most common neurodevelopmental disorders among children, 1 the number of adults diagnosed with ADHD has doubled in the past decade. Beheshti A, Chavanon ML, Schneider S, Christiansen H. BMC Psychiatry. So what is going on here, is adult ADHD over-diagnosed or under-recognized? The DSM-5 criteria for adult ADHD are so broad that they fail to distinguish between illness and normal variation. Greely H, Campbell P, Sahakian B, et al. Investigating ADHD treatment trajectories: listening to families stories about medication use. Agatha has been struggling with school work since starting college in the fall. Careers, Unable to load your collection due to an error. In actuality a combination of symptom endorsements, a detailed personal history, and objective cognitive tests sensitive to the kinds of impairments and weaknesses common in ADHD would all be ideal for establishing the diagnosis. Nearly every client I have worked with in an assessment or therapeutic context who received a valid diagnosis of ADHD has expressed this view at some point. Palladino VS, McNeill R, Reif A, Kittel-Schneider S. Genetic risk factors and gene-environment interactions in adult and childhood attention-deficit/hyperactivity disorder. We suggest even more caution when these data are absent or unavailable. This study examined the current state of public perceptions towards . This conclusion is supported by high comorbidity, a variable course, and a variable response to treatment.25 These variations might best be viewed as identifying subgroups rather than additional diagnoses. Larry Maucieri, Ph.D., is a clinical psychologist and an assistant professor at Governors State University. Sensory processing issues are common in neurodevelopmental disorders such as ADHD and autism. The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Is ADHD Overdiagnosed? - Verywell Mind - Know More. Live Brighter. A few years ago, while I was studying and treating children with ADHD, I suddenly began . The failure to do so could easily lead clinicians to misdiagnose other problems as ADHD or to diagnose ADHD when there is no mental disorder. Yeung A, Ng E, Abi-Jaoude E. TikTok and Attention-Deficit/Hyperactivity Disorder: A Cross-Sectional Study of Social Media Content Quality [published online ahead of print, 2022 Feb 23]. Receiving a diagnosis of ADHD may make it possible for some adults to be considered disabled, and to receive benefits. Talks excessively. An official website of the United States government. Dextroamphetamine: cognitive and behavioral effects in normal prepubertal boys. Screening questionnaires and rating scales are often used to validate a clinical diagnosis of adult ADHD. Is ADHD Overdiagnosed? Learn What the Research Says 2022 Oct 13;13:1015102. doi: 10.3389/fpsyg.2022.1015102. On the other hand, diagnostic disparities and underdiagnosis exist in various communities, including women and underrepresented minorities, as seen with Agatha. Zimmerman M, Galione J. Psychiatrists and nonpsychiatrist physicians reported use of the DSM-IV criteria for major depressive disorder. One way to improve validity for assessing childhood onset is to obtain collateral information, for example, from parents. As a sometimes non-linear thinker (perhaps due to my left handedness), I actually think it is possible for ADHD to be over-diagnosed in some people (who dont have the disorder) AND under-diagnosed in others who actually do have the disorder. The release of the DSM-V in 2013 saw the definition of ADHD broaden significantly. Following changes that placed increased focus on inattention, rather than hyperactivity, there was a correspondingly significant increase in ADHD diagnosis among females.34 Specifically, between 1991 and 2008, diagnosis rates increased by a factor of 5.6 in girls compared to only 3.7 in boys.35 In other words, knowing girls and underrepresented groups are more likely to have missed diagnoses, and even present with different symptoms, patients and clinicians might be asking more questions as a result. Is Adult Attention-Deficit Hyperactivity Disorder Being Overdiagnosed The epidemiology of pharmacologically treated attention deficit disorder in children, adolescents and adults in UK primary care. Summary. Information available on the Internet may have made this problem even more widespread. National Library of Medicine government site. Bozinovic K, McLamb F, OConnell K, et al. The site is secure. Costs of ADHD ADHD is expensive to society. Considering underlying causes as well as consequences, we conclude that the diagnosis of adult ADHD should be made cautiously, making use of multiple sources of information, including self-report, clinical interviews, collateral information, childhood documentation, and neuropsychological testing. It is probably even more important to examine school records to determine what teachers observed, and to show that symptoms caused functional impairment in the school environment.11 Finally, one can attempt to determine whether patients were assessed and treated for ADHD as children, and whether they had a clear response to therapy. PMC Epub 2021 Feb 23. the contents by NLM or the National Institutes of Health. Over the past 20 years, available literature showcases the presence of pervasive disparities in ADHD diagnosis related to both race and gender. To date, recent findings indicate that ADHD continues to be less frequently diagnosed in youth who are Black Indigenous and Persons of Color (BIPOC) and female, compared to those who are White and male, even after controlling for potential confounders such as socioeconomic status and adverse childhood experiences.3637 Girls continue to be diagnosed at older ages than boys and tend to endorse higher levels of perceived stress.38 Reasons for these disparities stem from a multitude of systems level factors, however racial and gender bias is likely to play a major role. It also required that other conditions that can also account for these symptoms be adequately ruled out. sharing sensitive information, make sure youre on a federal 3Research Associate, Institute of Community and Family Psychiatry, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec; Associate Professor, Department of Psychiatry, McGill University, Montreal, Quebec. Zimmerman M, Galione JN, Ruggero CJ, et al. Do stimulants improve functioning in adults with ADHD? Google search trends for the term ADHD, from 2004 to present, ADHD has also become prominent in popular culture. Confirming the presence of a childhood diagnosis in adult patients based on long-term recall is not a valid procedure. A recent study has found that more than half of ADHD content on TikTok was misleading, most of them posted by non-health care providers.25 That same study however did show that content posted by health care providers was overwhelmingly more accurate and useful to consumers.25. A 2012 study in Germany by Bruchmueller and colleagues showed that a large group of mental health providers had a bias toward diagnosing ADHD in boys more than in girls, with a greater tendency to abandon the DSM-5 criteria when diagnosing boys with ADHD. government site. Social media has also propelled ADHD into popular awareness, as it has taken over platforms like TikTok and Twitter. Clipboard, Search History, and several other advanced features are temporarily unavailable. 6 or more in either domain if <17 years old. Learn more about some of the ways it might present. ADHD in adults is commonly associated with severe impairments in many major life activities, and an adequate diagnosis is a first step towards treatment and support. Lange KW, Reichl S, Lange KM, Tucha L, Tucha O. ADHD: From childhood to young adulthood : The Nurse Practitioner - LWW You see, the problem with a lot of the media coverage on ADHD is that it tends to suggest (even if inadvertently or indirectly) that ADHD is not legitimate, an excuse, a first-world justification. Adult attention-deficit/hyperactivity disorder (ADHD) - Diagnosis and Thus, although the Connors checklist31 is a convenient screener for nonprofessionals, it should not be used as a validator of diagnosis. Smith ME, Farah MJ. While some may argue that the increase is concerning and due to intentional feigning of symptoms in order to gain access to stimulant medication or test accommodations, the evidence suggests these groups have a negligible impact on diagnostic trends. ADHD is not overdiagnosed, but it may be often misdiagnosed. Increasing incidence of thyroid cancer in the United States, 19732002. However, while some studies reported non-prescribed use of stimulants in about 7% of college students, most of the misuse was in the setting of attentional difficulties impairing the students ability to succeed in class.29 This is a possible indication that said student has undiagnosed ADHD, and not a desire to use the medication to get ahead. government site. Because ADHD is a complex disorder and each person is unique, it's hard to make recommendations for all adults who have ADHD.But some of these suggestions may help: Make a list of tasks to accomplish each day. The Reality of ADHD Diagnosis in Adulthood - Verywell Mind - Know More Variable Patterns of Remission From ADHD in the Multimodal Treatment Study of ADHD. He described morbid alterations of attention that render [individuals] incapable of attending with constancy to any one object of education.16 Although not globally recognized and treated at the time, his observations bear striking similarities to modern descriptions of the inattention domains of ADHD. Sclar DA, Robison LM, Bowen KA, Schmidt JM, Castillo LV, Oganov AM. Psychologists have long debated whether ADHD is a deficit or a distinct cognitive style. Tell me how you did with being attentive in class in middle school compared to other students? PDF Overdiagnosis: what it is and what it isn t - BMJ Evidence-Based Medicine Later, in the 1930s, physicians Kramer and Pollnow wrote about children with hyperkinetic disease of infancy, a syndrome that more closely resembled modern ADHD descriptions including both hyperactivity, emotional excitability and impulsivity, and inattention.17. Thus one cannot use response to these drugs as a validator of the diagnosis. Posner MI. However, this leaves a lot up to the clinician, and may lead to under and over diagnosis. Does it ever get you in trouble with others? Most, including the popular Continuous Performance Test,32 lack specificity, meaning that, like screening tools, they cast the net too wide for the purpose of diagnosis. For stimulants there is also concern for diversion and misuse of the medication for performance enhancement rather than for treatment. It has been estimated that at least 40% to 50% of the population will meet criteria for at least 1 psychiatric diagnosis during their lifetime.8 The current system of nosology in psychiatry, based on phenomenology, that is, subjective reports and clinical observations, encourages overdiagnosis. Studies always give inflated rates because they all use flawed methodology- most commonly relying only on telephone surveys based on a checklist of ADHD symptoms. Unauthorized use of these marks is strictly prohibited. Castellas X, Ramos-Quiroga JA, Bosch R, et al. Thoughtful evaluation, accurate diagnosis, and adequate treatment can make a big difference. Zayats T, Neale BM. In fact, studies show that boys have historically been more likely to exhibit hyperactivity and disruptive behaviors, prompting earlier detection of the disorder, compared to those with inattentive symptoms, a group that most often includes girls.42 Interestingly, other studies have indicated there to be no true difference in level of hyperactivity across gender, rather a bias among teachers leading to under-recognition of hyperactive symptoms among girls.43 While some are concerned about the overdiagnosis of ADHD, there are still many groups who are underdiagnosed and unaccounted for in the data. Trends in diagnosis and the prescribing of stimulants. Kessler RC, Adler L, Barkley R, et al. DuPaul GJ, Weyandt LL, ODell SM, Varejao M. College students with ADHD: current status and future directions. National Library of Medicine She has seen a lot of ADHD content on TikTok recently, and wonders if she may have ADHD herself. adults diagnosis overdiagnosis It is our pleasure to introduce this special issue of the Journal of Clinical and Experimental Neuropsychology on the assessment of adult ADHD. The absence of gold standard measures for diagnosis is a general problem for psychiatry. Shame, low self-esteem, and even depression all frequently stem from a misunderstanding of their ADHD. The diagnosis should document the presence of at least 6 of 9 symptoms of inattention (or 5 symptoms for teens age 17 or older), or at least 6 of 9 symptoms of hyperactive/impulsive behavior (5 symptoms for teens age 17 and older). Studies have found that clinicians tend to be more responsive to White parents who solicit an ADHD diagnosis and treatment for their child compared to BIPOC parents.39 Further, BIPOC youth with ADHD are disproportionately more likely to be misdiagnosed with ODD or CD.4041. Les causes du sur-diagnostic peuvent inclure des changements des seuils diagnostiques, de mauvaises pratiques diagnostiques. This is also unlikely: mental disorders have a complex inheritance, and the best estimate of heritability for adult ADHD is 30% to 40%.29. An official website of the United States government. National population surveys reflect an increase in the prevalence from 6.1% to 10.2% in the 20-year period from 1997 to 2016 and experts continue to debate and disagree on the causes for this trend.1 On the one hand, while there are children whose diagnoses are irrefutable and undeniably require treatment, some experts worry about the risk of overdiagnosis and subsequent over prescription of stimulants and other psychotropics.
