Is ADHD Real? - What about ADHD overdiagnosis?

ADHD is real!

Attention Deficit Hyperactivity Disorder (ADHD) is a very real condition. Over one million South African adults have the condition. As many as 1 in 20 South African school children have ADHD. This is the same as the figure seen in school children in the European Union.

The worldwide consensus: ADHD is a recognised and valid diagnosis

All the major North American medical institutions recognise Attention Deficit Hyperactivity Disorder as a legitimate condition. The Royal College of Australia and New Zealand agrees. There are legal guidelines in addressing it in Australia.

Awareness has increased significantly in Europe over the last two decades. Many global organisations are led by doctors and scientists from Europe. Stigma around it has also reduced. This can be seen in The European Union’s approval of Intuniv, an alternative to stimulant medication.

Medication is also available for children with Attention Deficit Hyperactivity Disorder in Japan. Taiwan’s Ministry of Health and Welfare estimate that between 5 and 7 children in Taiwan have the condition.

The South African Society of Psychiatrists notes that ADHD is a known and very real condition.

There are many reasons all these organisations and countries agree that ADHD is real and serious.

How do we know that ADHD is real?

One of the ways that it has been objectively confirmed is with the use of brain scans. They have revealed that people living with the condition have brain activity that is slightly different from the general population.

These physical differences include having different brain activity in the prefrontal cortex. Emotions, problem solving, and behaviour are all significantly influenced by this area of the brain. The physical differences between the brains are quite slight, but very real.

Another proof of the disorder is the effectiveness of treatment. Embarking on treatment has shown objective improvement. This is from thousands of patients in research programmes from around the world. Both talk-therapy approaches, and medication continue to show definite results.

Studies have also shown the hereditary nature of the condition. About 25% of those with ADHD also have a parent who has it. Most of the other 75% also have a blood-relative that has the same condition. Adoption is one of the ways these facts have been realised. Genetics plays a greater role in the condition than environmental factors. This is suggested by the evidence.

Most professionals are concerned about under-diagnosis

There are many places in the world where children remain undiagnosed. This means that there are possibly millions of children who never receive the help they need. These children can face unfair labels of being lazy or unintelligent.

Girls seem to be particularly under-diagnosed. This is in part because the condition is still seen as a “boy’s problem”.

So, what are some of the concerns about possible over-diagnosis?

In more affluent places in the world, there is a concern on the other end of the spectrum. Middle and upper-middle class segments of the population might, in fact, be over-diagnosing. Why would anyone suggest this might be the case?

Studies have shown that between 2005 and 2014 children diagnosed with ADHD increased dramatically. In the United States, the increase was by over 40%.

Going further back, the increase is even more shocking. Prior to the early 1990s, fewer than 5% of the children in the USA were diagnosed with it. By 2013 11% of children between the age of 4 and 17 had received the diagnosis. This is an increase of over 100%. (This figure also doesn’t consider the many adults who were diagnosed for the first time during this period.)

The question is: where did all these cases of Attention Deficit Hyperactivity Disorder come from? Were millions of children suffering a pathological inability to focus? Is it only in the last two decades that they have received the medication that they require?

This seems very unlikely.

Children behaving like children has become a liability

Until very recently in human history, childhood’s typical behaviour was tolerated. It might have irritated adults, but it was not demonised.

Children were expected to have low impulse control and chatter incessantly. A four-year-old was not expected to sit still and listen for extended periods of time. No one expected a Grade 1 to have highly developed organisational skills. High energy was a characteristic expected to be found in younger kids.

Young children’s natural curiosity meant that questions would be blurted out. Kids would also interrupt others in their excitement. Part of going to school was to learn manners.

None of this behaviour required medication to rectify. It was understood that maturity would come in time with the input from parents and teachers guiding the process.

Expecting children to sit still for hours and retain their curiosity and interest is simply not viable.

These factors need to be taken into account at the point of assessment in true ADHD cases.

What has happened to make these normal attributes of childhood symptoms of a problem?

Some research is pointing to increased schooling expectations as a possible leading cause of the increase in Attention Deficit Hyperactivity Disorder diagnosis.

Kids are spending more time doing school activities and less time playing than ever before. For many decades, pre-school had very few academic expectations. Nowadays this has changed. It is no longer as informal as it was. Despite the voluminous research showing the importance of play, even pre-schoolers are often expected to be able to do basic maths. There are even expectations of pre-schoolers learning to read in some sectors.

A Harvard study published in 2018 showed a significant link between early school enrolment and higher rates of Attention Deficit Hyperactivity Disorder diagnosis. This seems to indicate that the youngest children are falling victim of the heightened academic expectations that have been placed on them.

Some parents see average grades (“C” and “B” symbols) as underperforming. Medication can be given in the hopes it will result in better academic results.

Our team of experts at Japari has considered all these factors in designing our learning environment to assist all young learners, including those with various challenges to learning.

Broadening of definitions, greater awareness and less involvement from parents are also factors

Over the years, the medical definition of what ADHD is has broadened. It now encompasses not only symptoms that are loud and hyperactive. It also includes indications that manifest in being reserved and quiet. The widening of the spectrum it is no surprise that more children have been diagnosed with ADHD.

Children with mild symptoms might find themselves with an Attention Deficit Hyperactivity Disorder diagnosis nowadays. This is due to more people being more informed about the condition. Because of this awareness, healthcare professionals, caregivers and parents are more “on the lookout” for symptoms. As outlined above, in years past these symptoms would have in all probability been considered normal aspects of childhood.

A study in 2015 found that poor parenting could also play a part in the upsurge in children getting diagnosed with ADHD. Parents being too busy to be involved in their children’s lives leads to behaviour that at least mimics its symptoms.

To be clear…

There is no clear consensus that ADHD is definitely being over-diagnosed. The concerns outlined above, however, have been raised by certain healthcare professionals. But the general agreement is that there is quite a bit of misdiagnosis when it comes to Attention Deficit Hyperactivity Disorder.

We would like to see more caution in diagnosing Attention Deficit Hyperactivity Disorder. It is a real and rightly recognised ailment. But the solution for treating it might not lie in rushing to medicate.

Playing an active role in the diagnostic process of your child will help to make the results accurate. Ask questions and look for second opinions. Try to understand the reasoning behind the diagnosis. And then get your child the help they need.

An assessment from a reputable institution with a longstanding track record of helping children to cope with varied learning disabilities, such as Japari School, is recommended. Call us today for information on an in-depth assessment.