Original Post Read the section of your DSM-5 that talks about ADHD. In recent years, there has been much
talk about the possible over diagnosis and over medication of children diagnosed with ADHD.
See what you can find concerning this discussion and then discuss, with each other, what you’ve
found and what conclusions you draw from your research.
Classmate Response 1 ADHD
The diagnosis and medication of children being diagnosed with ADHD has increased in Western
Medicine in recent years. According to a National Health Interview Survey, an annual federal
survey of about 35,000 households, “It found a steady increase in diagnoses, from about 6
percent of children between 1997 and 1998 to more than 10 percent between 2015 and 2016.”
This may be due to healthcare being more accessible to the public, and mental health becoming
less taboo and taken more seriously.
Further, the current modern society we live in demands focus and concentration more than ever
and ADHD has been much easier to pinpoint. The controversy stems from the difficulty to
identify ADHD biologically and can come across to people that do not understand or have
ADHD as “just a kid being a kid.” It is difficult for me to assume that it is over diagnosed
considering I had ADHD my whole life, and was not diagnosed until I was 24 years old because
of my relational skills and gracious teachers that worked with me that I was able to get through
college. Not every kid is so fortunate to have a small school and teachers that help you succeed.
Many times, kids who go undiagnosed go their life simply thinking something is wrong with
them or wonder if they don’t care because that is what people tell them, and they end up being
frustrated and not continuing their education because of having ADHD.
I do believe that even though biological factors may be difficult to identify ADHD and some
people have the potential to abuse this, it should not take away from those kids who truly have
ADHD and need medication to treat it.
Classmate Response 2 Diagnosis of ADHD in Children
COLLAPSE
Upon reading about ADHD in the DSM-5 and the possibility of over-diagnosis of the disorder,
my first thoughts were based on seeing that 15 (FIFTEEN!!) other disorders and disorder groups
in the Differential Diagnosis section were listed. Does this mean, I wonder, that symptoms
shared among ADHD and at least 15 other disorder groups could be part of the possibility of
overdiagnosis? This alone could account for an enormous percentage of children and adults
being misdiagnosed with ADD and ADHD. Distractedness, inattention, forgetfulness—many
people suffering from short-term and long-term depression experience this. Why are children
tossed into a basket and labeled “ADD” or “ADHD” when many of the diagnostic features are
behaviors of normal children? Take Criterion A-2c, “Often runs about or climbs in situations
where it is inappropriate.” Really? Ask almost any parents of school-aged children at church if
they have had to correct their children multiple times for running, shouting, and climbing on and
under pews! What about inquisitive children who ask a lot of questions (talkativeness—Criteria
A-2f, g)? I have 3 children, and they all went through phases where they wanted to know the
answers to everything, and to tell us everything they thought was exciting and interesting.
Teachers are overloaded, and often don’t have the emotional bandwidth to handle 30 normally
active children. It’s true that some children do need some extra attention and may be extra
energetic, but that doesn’t mean they all have ADD or ADHD, does it? It seems that some
doctors, clinicians and educators may not be performing due diligence in diagnosing patients.
One of my great-nephews has ADHD, and it is quite obvious in his behavior and speech. He is
adopted, and his birth mother was battling drug addiction while she was pregnant, which, I read,
is one of the possible contributing factors to a child having ADHD. Out of my inlaws, one has
ADD and the other has ADHD. They are adults, a mother and son. I know the disorder is real,
but I question the numbers of children diagnosed with it nationally, especially after my research
this week.
I found some curiosities on several websites. A 2017 Harvard Health Blog cites a study
performed in 1990 that stated that in some school districts, 28% of boys were diagnosed with
ADHD. The clinical psychologist who led the study was castigated and her data stolen. Another
article in Psychology Today by Christopher Lane, PhD, referenced several studies on the
overdiagnosis of ADHD. Among data referring to ADHD diagnoses in children, he also cited
that twice as many boys were diagnosed as girls. According to researchers, the fault in
overdiagnosis lies with lack of interrater reliability, vague wording of diagnostic criteria,
stereotyping, and symptoms shared by ADHD and other disorders. In addition, Lane suggests,
overdiagnosis of boys stems from overrating the “externalizing behavior of boys.” That means
typical boy behavior, like moving a lot, vocalizing noises and loud play. A large number of
children—1.1 million in the U.S, pre-2017 numbers—receive medication such as Ritalin and
Adderall, and out of this number, an estimated 800,000 receive medication because of “relative
immaturity.” This means that some children don’t mature as fast as others, but eventually, most
do catch up with their same-age peers, as parents and seasoned teachers will attest.
I wanted to see some data for myself on statistics of ADHD. I pulled up the CDC website, which
had three data sets from 2003, 2007 and 2011, estimating “Parents [who] reported whether a
doctor or health professional ever told them that their child had ADHD.” I selected my state,
New Mexico. In 2011, it states, 6.8% of children had been reported. According to
Macrotrends.net, the 2010 population in New Mexico was estimated at 2,064,552. That means
that approximately 140,390 had ADHD at that time in the state. The population of the largest
city, Albuquerque, was 745,000 in 2010. According to the US Census Bureau, in 2010 about
22.8% of the population of children ages 5-18 lived in Albuquerque, which is about 169,860
children. So if I calculate 6.8% of the children ages 5-18 in Albuquerque who were reported to
have ADHD at that time, that’s 11,550 children in Albuquerque alone. What?? Okay, I admit
that I don’t fully understand statistical analysis, and maybe I’m doing it wrong. But that seems
like a high number for one relatively sparsely-populated state.
Another study stated that because criteria due to medical conditions that can resemble ADHD,
such as sleep apnea, are not excluded. Also, only one out of four pediatricians who diagnosed
ADHD did so based on the DSM (which, in my opinion, may not be a bad thing, given the DSM-
5’s vagaries in this disorder). Why doctors place children who may have other underlying
conditions on stimulants is a mystery. Physicians may often feel pressured by parents, who have
themselves been pressured by educators, to treat what is actually normal, childish behavior.
Clearly, further research must be performed that is free of influence by the pharmaceutical
industry.
So that’s some of the sobering and confusing news I discovered. The good news is that there are
ways of managing symptoms of ADHD in children. Most require direct intervention of parents in
the home, such as ensuring children get enough sleep, following a routine, and having assistance
in managing time and activities. All children need structure and training, and most parents want
the best for their children and do a great job. Parents ought to be commended and encouraged as
they raise the next generation of adults. Really, we’re all just doing the best we can as parents,
and frankly, it’s sometimes as worrisome and difficult when our children are adults as it was
when they were little, only with different worries and difficulties! (I think I’ve been a little on a
soapbox this week.)
Here are some ADHD symptom management ideas I found:
Counseling to help children learn to manage feelings of being overwhelmed. Children with
ADHD often feel beset by the many details of their lives and social ostracizing that sometimes
results from their behavior. Counseling can help them and their families work through events and
feelings of depression and anxiety to help them preserve their self-esteem.
Family therapy. Parents need support and education to help them learn skills and develop
strategies to help their children with ADHD. Such skills include teaching children at home about
time management, organization skills, supporting children emotionally, helping children to
recognize what they are feeling, and so forth. Family therapy can also help the children learn to
understand how their behavior affects those around them.
Behavioral therapy and social skills training to teach children to manage themselves and learn
appropriate interactions with others.
Classroom/school programs to help children learn material with different techniques. Some
children are kinetic learners, meaning they learn while doing (to give an example, my own son
learned to tell time with an analog clock one afternoon when he was 5, and I turned our living
room into a giant “clock.” He also learned his times tables while jumping on a mini trampoline.).
I’d like to add here extended training for educators to learn about true ADHD symptoms, and to
provide them with further strategies to keep all children engaged in learning.
Addressing sleep issues. Inadequate or poor quality sleep caused by sleep apnea can create
difficulties for anyone. Children with and without ADHD are more susceptible than adults to
behavioral problems when they don’t get enough good quality sleep. A sleep specialist should be
consulted, and other underlying physical and/or mental concerns addressed.
Diet. While studies have shown that an excess of sugar does not cause ADHD, some children
don’t have a nutritious diet. Good nutrition is important for good overall health, so nutrition
guidelines and education should be offered to parents (here, I could launch into another rant
about lack of accessibility to grocery stores in inner cities, and families who have to purchase
food at mini-marts because a trip to a larger store is a long busride away, especially when having
to carry bags home and manage children as well, but I’ll save that tirade for another time).
Exercise has been proven to increase cognitive function in children and adults. Along with the
release of dopamine, a natural stimulant, moderate to vigorous physical exertion helps children
with ADHD release pent-up energy and improve mood .
It is my very strongly held opinion that treatment without medications should be performed first.
Many children are given medication when they may be helped greatly through positive,
supportive interactions with caring adults and by supporting and teaching their parents,
caregivers and educators. If, after other interventions are followed, medication may help, then
I’m all for trying them.
References:
Cohen, P., MD, Hochman, M., MD, MPH, & Bedard, R., MD. (2017, March 18). Is ADHD
overdiagnosed and overtreated? Retrieved July 09, 2020, from
https://www.health.harvard.edu/blog/is-adhd-overdiagnosed-and-overtreated-2017031611304
Lane, C., PhD. (2017, October 20). ADHD Is Now Widely Overdiagnosed and for Multiple
Reasons. Retrieved July 09, 2020, from https://www.psychologytoday.com/us/blog/side-
effects/201710/adhd-is-now-widely-overdiagnosed-and-multiple-reasons
Bruchmüller, K., Margraf, J., & Schneider, S. (2012). Is ADHD diagnosed in accord with
diagnostic criteria? Overdiagnosis and influence of client gender on diagnosis. Retrieved July 09,
2020, from https://psycnet.apa.org/doiLanding?doi=10.1037%2Fa0026582
TG. Grobe, E., C. Moreno, G., RL. Morrow, J., CJ. Newshaffer, M., F. Bokhari, R., GB.
LeFever, K., . . . Hofmann, S. (1970, January 01). Overdiagnosis of mental disorders in children
and adolescents (in developed countries). Retrieved July 09, 2020, from
https://capmh.biomedcentral.com/articles/10.1186/s13034-016-0140-5
E. (2019, September 4). Benefits of Exercise for Children with ADHD. Retrieved July 09, 2020,
from https://www.ellipticalreviews.com/benefits-of-exercise-for-children-with-adhd/
U.S. Census Bureau QuickFacts: Albuquerque city, New Mexico. (n.d.). Retrieved July 11,
2020, from https://www.census.gov/quickfacts/albuquerquecitynewmexico
New Mexico Population 1900-2019. (n.d.). Retrieved July 11, 2020, from
https://www.macrotrends.net/states/new-mexico/population
State-based Prevalence of ADHD Diagnosis and Treatment. (2020, March 12). Retrieved July
11, 2020, from https://www.cdc.gov/ncbddd/adhd/data/diagnosis-treatment-data.html
