Is ADHD Overdiagnosed?

Over the last few decades, there has been a steady increase in the number of people who are diagnosed with attention-deficit/hyperactivity disorder (ADHD). The Centers for Disease Control and Prevention (CDC) suggests that it is not possible to tell if this increase is caused by more people actually having ADHD or a change in the number of people who are diagnosed.

Some experts have suggested, however, that this increase might partly stem from the overdiagnosis of ADHD.

ADHD is a common neurotype characterized by patterns of hyperactivity, inattention, and impulsivity. It is most often identified in childhood, but increased awareness about the characteristics of ADHD has also led to a surge in the number of people diagnosed with adult ADHD. 

This awareness can help many who need support access it. Yet, its growing prevalence leads many to wonder if ADHD is overdiagnosed.

How Many People Have ADHD?

ADHD is one of the most common neurobehavioral disorders diagnosed in children.

The CDC reports that six million children in the U.S. between the ages of 3 and 17 have been diagnosed with ADHD at some point during their lives. This number represents 9.8% of kids between those ages.

Diagnosis rates vary by age group:

• 2% of kids between the ages of 3 and 5
• 10% of kids between the ages of 6 and 11
• 12% of kids between 12 and 17

Boys are also more likely to be diagnosed with ADHD than girls. Approximately 13% of boys receive an ADHD diagnosis compared to 6% of girls. This disparity, however, is influenced by the fact that ADHD is often underdiagnosed in girls and women.

Is ADHD Common Because It's Overdiagnosed?

Between 1997 and 2016, the prevalence of ADHD increased from 6.1% to 10.2%. While experts agree that more people are diagnosed with ADHD today than in the past, there is no consensus on precisely what is responsible for this trend.

One meta-analysis suggests that ADHD is overdiagnosed both in children and adolescents. The concern with the overdiagnosis of ADHD is the resulting overtreatment, especially since ADHD often requires stimulant medication.

Reasons ADHD Might Be Overdiagnosed

The overdiagnosis of ADHD might occur due to several factors:

• Diagnostic inflation: The diagnostic criteria have changed over the years, and some suggest that the widening of definitions and the inclusion of mild or ambiguous symptoms means that some people may be misdiagnosed as having ADHD when they do not.
• Lack of experience with ADHD: ADHD is often diagnosed by primary care doctors and pediatricians who may not have as much experience working with children and adults with ADHD.
• Medicalizing normal behavior patterns: Some experts suggest that normal childhood behaviors are often medicalized and pathologized. Behaviors that are typical of a young child might then be seen as characteristics of hyperactivity and inattention.

ADHD May Have Been Underdiagnosed in the Past

It's important to recognize that recent increases in ADHD diagnoses might not represent an overdiagnosis of this neurotype. Instead, it may reflect a historical underdiagnosis. Increased awareness means parents, teachers, and medical professionals are more aware of ADHD characteristics.

Certain groups are still prone to being underdiagnosed. Girls and women, for example, are less likely to be diagnosed because they are more likely to experience inattention and other internalizing characteristics. Because their traits are less disruptive to others, they are less likely to receive an accurate diagnosis.

Characteristics of ADHD

Getting the right diagnosis, and avoiding the overdiagnosis of ADHD, starts with understanding the traits and characteristics of this neurotype.

ADHD involves persistent patterns of inattention and hyperactivity. It is categorized into three types: primarily inattentive, primarily hyperactive, and a combined type involving both inattention and hyperactivity.

Inattentive Traits

Examples of inattention include:

• Lack of attention to detail
• A limited attention span
• Issues finishing tasks
• Inability to meet deadlines
• Struggles with timeliness
• Consistently losing important items like keys or cell phones
• Avoiding tasks that require intense and sustained attention, like schoolwork or creating reports

Hyperactive Traits

Hyperactivity can present with the following symptoms:

• Restlessness or jitteriness
• Struggles in maintaining conversations due to interrupting others
• Consistently challenged when tasked with sitting still, either in the classroom, workplace, or social settings
• Unable to enjoy activities quietly
  

ADHD Traits Come With Strengths and Challenges

It is also important to note that while ADHD is diagnosed as a neurobehavioral condition, it is considered a disability because people with this neurotype are expected to fit into a neurotypical society with neurotypical expectations.

People with ADHD have brains that work differently than those of people without ADHD. While this can create challenges, people with ADHD brains also have many strengths.

ADHD is also lifelong. These traits and characteristics are usually first noticed during childhood, which is when most people are diagnosed. ADHD characteristics can also change over time, which means that a person's support and accommodation needs may also shift.

How to Ensure You Get the Right Diagnosis

Getting the right diagnosis involves being aware of your traits and how they affect you. It also involves seeing a doctor or mental health professional who is trained and experienced in recognizing ADHD characteristics.

Be Aware of Conditions That Mimic ADHD

When seeking out mental health support for ADHD symptoms, be aware that there are other disorders that may have symptoms that resemble ADHD characteristics. Several psychiatric disorders have inattention or impulsivity as part of their symptoms.

For example:

• Borderline personality disorder is a mental illness that presents with impulsive behavior that can look similar to ADHD.
• Manic episodes that occur in bipolar disorder may sometimes be mistaken for impulsivity, restlessness, and hyperactivity, which can be features of ADHD.
• Inattention and lack of focus that some people with ADHD exhibit might sometimes be mistaken for symptoms of depression.

Be Aware of Co-Occurring Conditions

It is also possible that ADHD can co-occur with other diagnoses. Other conditions that sometimes co-occur with ADHD include:

• Anxiety
• Depression
• Oppositional defiant disorder
• Conduct disorder
• Learning disorders
• Tourette's syndrome
• Autism spectrum disorder
  

What Happens After an ADHD Diagnosis?

After a person has been diagnosed with ADHD, the next step is determining the support or accommodations they need. The right approach for you or your child depends on your needs and how your ADHD characteristics affect your daily life.

Treatment for ADHD includes medication, psychotherapy, and lifestyle support:

ADHD Medications

Stimulant medications are used most frequently due to their high efficacy, but that doesn't mean that they are right for everyone. Stimulants that are used to treat ADHD can boost levels of essential chemicals like dopamine and norepinephrine in certain areas of the brain. Dopamine is involved in motivation, pleasure, attention, and movement.

ADHD Therapies

There are also different types of therapy that may be useful for managing ADHD.

Cognitive-behavioral therapy (CBT) is a form of talk therapy that may help some people with ADHD. It bridges the connections between our thoughts, feelings, and actions and can potentially help with organization, time management, and distractibility.

Other helpful therapy types include mindfulness-based cognitive therapy, dialectical behavior therapy (DBT), supportive psychotherapy, narrative therapy, interpersonal therapy, and group therapy.

ADHD coaching can also be helpful. It is not a type of psychotherapy, but it can help people identify strengths, recognize challenges, and develop strategies for achieving goals.  

Support and Accommodations

Supporting people with ADHD also often involves accommodations at school or the workplace. Interventions may also involve teachers and parents learning more about ADHD and how to reinforce positive behaviors in the classroom and at home.

Other forms of support include learning more about ADHD and attending support groups.