Recently I read a statistic that nearly 11% of children in this nation have been diagnosed with ADHD. That’s almost 6.5 million kids!! As a clinician, I have to think that this is huge! Like something’s-gone-awry huge because this is a dramatic increase in numbers. The Centers for Disease Control and Prevention reported that the percentage of children diagnosed with the disorder in 2003 was only 7.8%. That’s an increase of over 40% in just 10 years. Huge.
Why is This Happening?
This is a question I have asked myself pretty regularly for the last few years. In addition to having my own clinical practice, I have spent the last 12 years working in the field of public education. Some might say that public ed. is the battle ground for ADHD. I know that I am contacted regularly regarding concerns of students not paying attention and being very busy and impulsive. As each year goes by and more initiatives and guidelines are mandated for educators – with no additional funding or time built into the day, by the way, I get kind of twitchy when the conclusion of ADHD is reached with no real investigation. I’m inclined to wonder if this is a disorder that is being over diagnosed because of other factors. I’m also inclined to think that this is often the case.
Maturity and development of the child will also have an impact on the prevalence of diagnosis. I believe that maturity coupled with the additional mandates and initiatives educators are implementing could be an important factor at play. With more instruction packed into a day that is not getting any longer, students’ (and remember, they are still children) attention and focus must be at level that is very difficult to maintain. We also know differences in development between genders. Boys develop at a slower pace than girls. Boys can also be more action oriented and often want (and need) to run, jump, and rough house. If a specific environment doesn’t lend itself to giving the students time to develop and – well – be children, they will definitely appear to be very off task, impulsive, and hyper. This probably accounts for the reason boys are more likely to be diagnosed with ADHD than girls (Centers for Disease Control and Prevention, 2013).
A delay in development, for whatever reason, can also lead to learning difficulties. One of the biggest questions I find myself asking – especially in an older child (8 years and up) – are they having trouble in one or more academic areas? Who can (or wants to) concentrate and really stick with something that is difficult or that they simply can’t do? I know how I’d answer this question for myself, so I don’t think we can rule out the level of focus a child demonstrates with reading or math if she/he can’t do one or the other…or both.
In addition to these factors, I believe the criteria as well as the procedure for diagnosing ADHD plays an important role in the prevalence of diagnoses. Diagnosing anyone with anything can be a tricky business. One in which I don’t feel can be done in one…or two…or maybe even three sessions. Many of the symptoms and behaviors are observable and reported by parents and teachers. Subjectivity often skews the frequency or severity of behaviors. Everyone tolerates behaviors at different levels. So, diagnosing disorders with integrity and fidelity is imperative. This means that gathering anecdotal information from multiple sources, across all environments should be a standard. Data collection through observations within the classroom or any other structured environment where expectations are clear will also be extremely helpful.
A comparative analysis of behavior will also show a more accurate view. When I conduct my observations, I will do an observation of a peer, of the same gender within the same environment, and at the same time. Behavior rating scales can be extremely helpful also. Rating scales help those reporting symptoms and behaviors quantify frequency and severity in a more organized fashion. Most scales are written from the diagnostic criteria as well, which means the symptom set(s) will be well defined.
If diagnosing an individual is conducted in this manner, the likelihood of an accurate diagnosis increases. With that said, I absolutely understand how difficult this can be to accomplish today.
What Can Be Done?
I like to encourage parents to be as educated as possible. Know the specific concerns educators and others who are spending time with your child have. Know all the data they’ve collected and interventions they have put in place and for how long. Maybe they are doing some things that are working great for your child – allowing them to maintain more attention and focus and be successful. I also think educators should be cautious regarding their reporting of symptoms and behaviors by making sure they are making unbiased statements. Remaining as objective as possible is key. The professionals (clinicians and physicians) doing the diagnosing should make sure that they are collecting the most accurate information possible – information that fits within the parameters of the research conducted to set the very specific diagnostic criteria.
In regards to some disorders, diagnosing is not an exact science. At least for now, there are no brain scans that can be done regularly and no blood tests conducted that can confirm for an individual and family that they without a doubt have X, Y, and Z. ADHD is a very real disorder that can adversely impact children and their families at a significant level. I think we need to just take a minute…breathe…and make sure the identification is accurate. Our youth is the future and we need them to be the most successful and confident they can be.
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, D.C. American Psychiatric Association.
Centers for Disease Control and Prevention. (2013).