Study: Children and teens overdiagnosed with ADHD in the US

While 11 percent of kids 4-17 are diagosed, only 5 percent actually have attention problems.

In the United States, there is concern that attention deficit hyperactivity disorder in children is overdiagnosed.

The American Psychiatric Association estimates that 5 percent of children have ADHD, yet the United States Center for Disease Control estimates that up to 11 percent are diagnosed with this condition. Just over 6 percent of children between the ages of 4-17 take medication for the condition.

In fact, there has been a dramatic increase in the rate of diagnosis and treatment over the last several years.

There is considerable speculation about this increase in diagnosis. Unfortunately, ADHD is a diagnosis of exclusion — other conditions that can contribute to attention problems have to be ruled out. It also requires parent and teacher observation of the child in a wide variety of situations to determine if there is an attention deficit. There are no tests that alone can be used to diagnosis this condition.

Is there a difference in diagnosis around the globe? While 11 percent of children are diagnosed with ADHD in the U.S., less than 1 percent are diagnosed with ADHD in France. Cultural differences could be at play — expectations of children in France are quite different, and French parenting emphasizes good behavior.

A new study published in the New England Journal of Medicine found that children whose birthdays are in August are more likely to be diagnosed with ADHD than children born in September. Why? The cutoff for kindergarten is often Sept.1, so children born in September start kindergarten a year later. It’s possible that by starting school at a later age, children are more mature when they are required to pay attention and sit still in class.

A large number of children with ADHD are diagnosed in second or third grade where the demands for sitting still and sustained attention significantly increases from earlier grades. Children who are unable to pay attention, keep their hands to themselves and are disruptive in class are more likely to be identified as having problems needing treatment.

The higher rate of diagnosis in the United States may also have to do with our culture’s comfort with using medication to solve psychological problems. If a pill can help a child fit in better in the classroom, be more attentive and less disruptive, parents and teachers may gravitate toward a diagnosis that supports taking medication. Needless to say, pharmaceutical industry advertising reinforces this trend.

ADHD — unless it is an extreme case — is most often identified by problems in school rather than at home. Family life is better able to accommodate to a wide range of behavior. Classroom size and teacher-student ratio, impacted by changes in the economy and birth rate, have been increasing in recent years. It makes it more difficult for teachers to accommodate children whose learning styles are different.

As a child psychologist with 40 years of clinical experience, I think that ADHD is both over- and underdiagnosed. Children with attention problems that don’t include disruptive behavior are often underdiagnosed. Kids with behavior problems and poor school performance may be overdiagnosed. Many teens are diagnosed with ADHD when their attention problems may be more closely related to lack of sleep.

So what should parents do if you or your teacher suspects that your child has ADHD?

Make sure your child receives a thorough evaluation by a qualified provider. An evaluation should include a full physical exam by a pediatric primary care provider, an evaluation by a child provider that has experience and training in the diagnosis and treatment of ADHD (this could include a pediatric or family primary care provider, child psychologist, child psychiatrist or child psychiatric nurse practitioner), an interview with the parents and child, use of rating scales completed by teachers and parents, and careful evaluation of other problems that may be contributing factors.

Behavior therapy should be the first line treatment for younger children. According to the CDC, behavior therapy should be used first for children who are diagnosed between the ages of 4 and 5. For kids 6-11, ideally both behavior therapy and medication can be used in combination.

Talk to us

More in Life

CloZee performs during the second day of Summer Meltdown on Saturday, Aug. 3, 2019 in Darrington, Wash. (Olivia Vanni / The Herald)
The psychedelic fest Summer Meltdown is back — and in Monroe

The music and camping event is on for July 28-31, with a new venue along the Skykomish River.

Gardening at spring. Planting tree in garden. Senior man watering planted fruit tree at his backyard
Bare root trees and roses have arrived for spring planting

They’re only available from January through March, so shop early for the tree or rose you want.

Veteran Keith F. Reyes, 64, gets his monthly pedicure at Nail Flare on Tuesday, Dec. 21, 2021 in Stanwood, Wa. (Olivia Vanni / The Herald)
No more gnarly feet: This ‘Wounded Warrior’ gets pedicures

Keith Reyes, 64, visits a Stanwood nail salon for “foot treatments” that help soothe blast injuries.

Photo Caption: A coal scuttle wasn't always used for coal; it could hold logs or collect ashes. This one from about 1900 sold for $125 at DuMouchelles in Detroit.
(c) 2022 by Cowles Syndicate Inc.
Coal scuttles of days long gone by now used for fire logs

This circa 1900 coal scuttle is made of oak with brass trim, and sold for $125 at auction.

Enumclaw, the band
Music, theater and more: What’s happening in Snohomish County

Most of these venues require proof of vaccination against COVID-19 or negative… Continue reading

Does this ring a “Belle”? Storied anime writer-director Mamoru Hosoda’s newest resets “Beauty and the Beast” in a musical, virtual environment — among other modern twists. (GKIDS/TNS)
‘Belle’ is striking virtual reality riff on ‘Beauty and the Beast’

In it, ‘Beauty’ is the charismatic online avatar of a moody teenager that attracts the attention of a bruised and brooding Beast

"Redeeming Love"
Movie review: ‘Redeeming Love’ doesn’t yield cinematic riches

The story, about a sex worker “redeemed” by a folksy farmer in Gold Rush-era California, is creepy “tradwife” fan fiction.

Eggs Florentine
Baked Eggs Florentine: A brunch favorite inspired by a queen

The kitchen manager at Quil Ceda Creek Casino shares a dish that pays homage to a spinach-crazy 16th century monarch.

This easy-to-make spinach and mushroom quiche is perfect for a light dinner or fancy brunch. (Gretchen McKay/Pittsburgh Post-Gazette/TNS)
Gretchen’s table: A spinach-mushroom quiche with cheesy goodness

The savory egg custard baked in a pie crust is easy to make — especially if you use a refrigerated crust.

Most Read