Over-Diagnosis of Pediatric ADHD

Over-Diagnosis of Pediatric ADHD

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  Running head: OVER-DIAGNOSIS1 (3-3) Short Paper: Over-Diagnosis Alexandra Perkins Southern New Hampshire University
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  OVER-DIAGNOSIS 2 Behavioral andconduct disorders are diagnosed via DSM-V criteria. If an educator or parent expresses concern regarding the development of a child, concerned adults should bring these developmental delays to the attention of the child’s physician. Children will undergo preliminary assessments to determine if their maladaptive behaviors meet the criteria for behavioral and conduct disorders. Updated criteria for DSM-V still includes the same 18 primary symptoms for ADHD that were used in DSM-IV. Criteria continues to be “divided into two major symptom domains: inattention and hyperactivity/impulsivity. And, like in the DSM-IV, at least six symptoms in one domain are required for an ADHD diagnosis” (Grohol, 2013). Updates to the current DSM sought to revisit criteria for diagnosis previously found in the DSM-IV chapter that included diagnosis made in infancy, childhood, or adolescence. Instead, diagnostic criteria for behavioral and conduct disorders were relocated to chapters addressing disorders of a similar nature. ADHD diagnostic criteria can now be found in the neurodevelopmental disorders chapter of the current DSM, reflective of this disorder’s correlation with brain development (American Psychiatric Association, 2013). Children diagnosed with behavioral and conduct disorders must meet the criteria outlined in DSM-V. Specific to ADHD criteria, the onset criteria states “several inattentive or hyperactive-impulsive symptoms were present prior to age 12” (Grohol, 2013). Therefore, a child’s behavior that is not reflective of the criteria outlined in DSM-V will not be eligible for a diagnosis. The purpose of diagnostic criteria is to effectively recognize and treat specific maladaptive symptoms of the affected individual. Often this criterion also offers a classification of severity that is paramount when professionals are determining the course of treatment. As diagnostic criteria continue to be reviewed and updated DSM criteria is published, changes in methods of diagnosis will also be affected.
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  OVER-DIAGNOSIS 3 There area multitude of factors that contribute to the over-diagnosis of conduct and behavioral disorders. Currently, concerns raised by professionals, media outlets and the public about the overdiagnosis of ADHD in youth are salient. Media coverage emphasizes the “assumption that ADHD is over diagnosed and that stimulant drugs are overused and overprescribed in children and adolescents with and without ADHD” (Connor, 2011). This assumption was provoked by an increase of the prescription of stimulants for children. Following the expanded coverage of psychotropic medications in 1990, and the FDA Modernization Act passed in 1997, there were dramatic increases in the number of stimulants being prescribed to children (Connor, 2011); “As a result, the prescribing of stimulants for children with ADHD increased 4-fold between 1987 and 1996, with a further increase of 9.5% between 2000 and 2005. Currently, slightly more than 4% of children and adolescents in the United States use ADHD medications” (Connor, 2011). This rapid increase drove concerns of over-diagnosis in both professionals, educators, and parents. Media coverage further amplified these concerns, potentially contributing to both overdiagnosis and under-diagnosis of pediatric disorders. Parents began to express anxieties about their children not reaching milestones and concluded that there was an issue with their child, and other parents began to ignore these symptoms due to the belief that ADHD was being over diagnosed (Connor, 2011). However, this increase (while evidence does suggest significant overdiagnosis of children with ADHD) was also caused by increased awareness of the disorder and newly accessible treatment methods. There are both long- and short-term implications of over-diagnosis on children. Stimulant over prescription is an especially salient concern for parents and physicians. The short-term implications of over prescription can include increased vulnerability to side effects such as
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  OVER-DIAGNOSIS 4 decreased appetiteand sleep disturbances (National Institute on Mental Health, 2012). These short-term consequences can result in further developmental implications in the future, especially in younger children. Less frequently, children may also develop tics or flat affect, both symptoms of other psychiatric disorders. These side effects not only impar the executive function of these children, but incite further complications related to misdiagnosis. Long-term consequences of over-prescription of ADHD stimulants includes slower growth rates in preschool children, cardiovascular problems, and psychotic symptoms. Children who have been prescribed medication should be closely monitored to avoid overlooking these consequences. Perhaps the most severe side effect of taking unnecessary stimulants are psychotic symptoms. Children may begin to express hearing voices, hallucinating or experiencing manic impulses (NIMH, 2012). For some children, these psychotic symptoms manifest through suicidal ideation and ignoring either form of psychosis can result in severe bodily harm or death. Children taking stimulant medication without an ADHD diagnosis are especially susceptible to experiencing side effects. However, the overdiagnosis of behavioral disorder and over prescription of medication are complex and vary by geographic location, age, and gender. Research has found that some regions of the U.S. overprescribe while under prescribing in others (Connor, 2011). According to research conducted by the CDC, communities in North Carolina “found that 7.3% of children were receiving stimulants but only 3.4% of children met an unequivocal diagnosis of ADHD, which suggests that pockets of overprescribing do exist” (Connor, 2011). One major concern for long-term consequences of stimulant over prescription would be abuse. Concerns of substance abuse are valid; “abuse rates rise in persons with ADHD comorbid with substance use disorders and/or other disruptive behavior diagnoses, such as oppositional
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  OVER-DIAGNOSIS 5 defiant disorderand conduct disorder” (Connor, 2011). Addiction leads to use of other substances and maladaptive behavior, a serious concern for weary educators and parents. However, the clinical efficacy of stimulant medication outweighs risks of abuse liability. Without stimulant medication, children with ADHD and a need for psychotropics will continue to experience impairment. Controversy surrounding overdiagnosis continues to be a subject of interest due to physician over prescribing, severe side effects, stimulant abuse and diversion, and continuing unease regarding the legitimacy of the ADHD diagnosis. Comprehensive assessments are necessary to provide effective treatment and evidence-based stimulant prescription. This change will hopefully reassure parents and educators that treatment is consistent and with due expertise.
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  OVER-DIAGNOSIS 6 References American PsychiatricAssociation. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. Connor, D. F. (2011). Problems of overdiagnosis and overprescribing in ADHD. Psychiatric Times (28)8, 1-4. https://www.psychiatrictimes.com/adhd/problems-overdiagnosis-and- overprescribing-adhd Grohol, J. (2013). DSM-5 Changes: Attention Deficit Hyperactivity Disorder (ADHD). Psych Central. https://pro.psychcentral.com/dsm-5-changes-attention-deficit-hyperactivity- disorder-adhd/ National Institute on Mental Health. (2012). Attention Deficit Hyperactivity Disorder. U.S. Department of Health and Human Services. https://web.archive.org/web/20151014021850/http://www.nimh.nih.gov/health/publicatio ns/attention-deficit-hyperactivity-disorder/ADHD_Booklet_CL508_144426.pdf