Is ADHD/ADD Overdiagnosed in America?

Suzette - posted on 04/02/2010

Lyndsay, it's only recently that psychologists have been given priveleges in some states (New Mexico being one) to prescribe psychiatric medication.
http://www.mentalhelp.net/poc/view_doc.p...

Before that it was psychiatrists or doctors that had to prescribe medications, however, a psychologists could easily diagnose ADD and ADHD.
So can a neurologist, a master level counselor, or a social worker. But there's problems with all of the above.
http://www.additudemag.com/web/article/5...

Suzette - posted on 04/02/2010

Kati, there are doctors who write scripts after they hear that a teacher or school counselor thinks that a child is possibly exhibiting signs of ADHD or ADD. They believe that person is enough of a professional (as do some parents) to see the symptoms and diagnose it. We've been talking about kids who act like zombies, they're kids who don't belong on the medication that have been misdiagnosed. There are a lot of doctors who do it, you can google the subject and come up with some of them yourself. Or find the statistics. I'm glad you have a great doctor who didn't do this, but not everyone does.

Lyndsay - posted on 04/02/2010

When I was a teenager I asked my doctor about ADHD (all of my friends "had it" and I kind of felt left out lol) and he told me physicians don't diagnose it, you have to get a psychological referral.

Rosie - posted on 04/02/2010

what i'm seeing alot on this thread is the opinion that parents and teachers are jumping to the conclusion of a child haveing ADHD, but i havn't heard of an actual doctor diagnosing it. my kids dr. wouldn't diagnose it, i had to go to a psychologist. maybe the problem is more parents attempting to use it as an excuse because they hear of it more often, but it's not being diagnosed. i think the doctors (psychologists) are understanding it more hence more diagnoses than before, and more parents taking their kids to the doctor than before that wouldn't of been taken since it is better known than before,so hence more diagnosises. once again it wasn't easy at all to get my child diagnosed.

Mari - posted on 04/02/2010

No offence to anybody here and it is just my opinion but I do think it has been getting out of hands. I don't belive that so many kids have ADD/ADHD, yes there could be some but not so many. I think it is just to make teachers life easier, so the ones who are bit mre active then others would sit still, so they woul not have to work so hard and also may beto support healthcare since these medications are costly. Also, when you were little did this ever come up ADD/ADHD? Not so often or not at all. I hear about it now so often. I also was very active kid and didn't have allot of patience or didn't pay allot of attention and got bored with things very quick, so was I considered ADD/ADHD, since ths is how I understand kids are evaluated by now. This is what I heard from my friend. Correct me if I am wrong, okay. But show me a kid who wil sit still for hours and won't run around and act like they are chased by a hive of bees. We have all been there and done those silly things and we are not ADD/ADHD. I cinsider and active kids being healthy kid. So, to be honest I think our kids are put on medication too quickly, also there is alternative way to this, just give them Efalex if you think they really have this condition, it helps too, not in five minutes though but it does help.

Rosie - posted on 04/02/2010

i would like to know the statistics on how many people don't have adhd that are diagnosed with it. for me it wasn't easy to get my child diagnosed, and i know 2 other children with adhd and it wasn't easy for them to get diagnosed either. it's not like the doctor asked if he was hyper and didn't focus and that was it. it was hours of questions and tests. so, no, i don't think it is overdiagnosed. show me some proof that it is instead of just more kids having it. that's like having an outbreak of polio or something and people saying those people don't have it cause more kids are being diagnosed with it. makes no sense to me.

Suzette - posted on 04/02/2010

Amy, very good and valid points. I think a lot of people tend to use the tv as a babysitter as well, which only does more harm than good and it takes their interests in books away. If more parents were to gear their childrens interests into books rather than allow them to sit in front of the television for long periods of time, perhaps this problem wouldn't be so extreme.

Amy - posted on 04/02/2010

i think some of it is learned behavior patterns. Not necessarily a chemical problem. I know some kids who go crazy if they eat the dyes that are in foods. that's valid. I think before medicating, you need to look at the whole picture. I had people tell my my 3 year old was ADHD because she was so active. i blew it off because she is a CHILD. She will play and act silly. She listens - mostly - when you ask her to do something or stop doing something. She will play alone for quite some time. Does well sticking with an activity for a long period of time....who knows what they'd try and put her on if we took her to a doc. She will sit and we'll read for half an hour - and she's not a zombie so i know she's retaining information. I do think some of it is lack of discipline and it's easier for some to just drug than deal. Granted, there are truly some cases out there where the kids NEED it. But in general i think parents beg for something to 'control' them or the teacher can't handle it and just wants an easier job, and doctors get money for the drugs so why not write out a script?



I know a teacher who handled a class of 35 just fine and another who was nearly tearing her hair out with only 15. I do think some teachers can handle things better than others. As adults we are so busy in our schedules that we pack our kids here, there, give them toys with all kinds of gadgets, lights, overstimulation "stuff" that I think kids don't get the chance to learn and sit and truly concentrate on task at hand. How many kids can sit still to watch tv? a lot. so, why don't we think they can sit that long to listen to a book? if you do it with them, they learn.

Good Day! - posted on 04/02/2010

No offense taken. And I agree that the blame should be spread around. The system as a whole seems to be screwed up.

I did my student teaching in a very poor district. I don't think parents (in general) would have done anything if the teacher noticed a problem. It was a miracle to get them to show up for scheduled conferences. And they were too poor to keep up with doc visits and meds anyway. I guess that is the complete opposite end of the spectrum. Perhaps the problem with overdiagnosis of ADHD falls somewhere in between the two extremes I've experienced.

LaCi - posted on 04/02/2010

It's part of teachers jobs to address concerns about behavior, but absolutely, under no circumstances should a teacher offer up a diagnosis. "your son seems to have difficulty (insert concern here), you may want to speak to a (insert professional of your choice)" is acceptable, "I think your son has ADD" is what we're against.

Suzette - posted on 04/02/2010

If you take into consideration that most parents are like the ones you described with the first child, where they're either trusting teachers to make a call based on their education, doctors based on their education, etc. Not to mention most parents are too busy with work, their own education, other children, a spouse, a divorce, etc. Can you really point at just one when it comes to teachers, doctors, psychologists, or parents and place the blame?

First of all, parents should be prioritizing better. I realize that most households need two incomes to survive. That doesn't mean that the child should have to suffer for it, it means that the parents have to prioritize their attention to the child better. Unfortunately, they use excuses like, "I need to relax" and the attention gets taken from the child. Sad, but true.

Second, there needs to be a more thorough exam done than the half hearted ones that are being done now, by all professionals. (Not just some teachers, but the doctors and psychologists too.) Writing a script for medication isn't something that should be taken so lightly, neither is referring a parent to take their child to a doctor for that script.

Letting a parent know that there is a problem that is disrupting a child's learning is not what I was talking about. What I was talking about was telling a parent that their child is exhibiting signs of a "specified" disorder when you're not a psychologist. That's not something anyone has any right to diagnose unless they are a certified psychologist.

I believe your view is more than slightly skewed, no offense. There are school districts that have teachers with the lowest degree/certifications needed, they pay horribly, and they don't provide trainings/workshops for them. Well, unless you count trainings, workshops, retreats that the teachers have to pay for if they want to attend. Those school districts have books that are between 5-10 years old, if not older from what I'm told, the parents are told their children are exhibiting signs of disorders simply because the teachers are tired of dealing with them and their classrooms are extremely full and they're over run with students. That's more the norm than you'd think, and it's due to the boards not allocating the money properly. Parents complain and it gets them nowhere. I don't believe it all should fall on the professionals shoulders, in these cases it needs to fall on the teachers and the boards shoulders as well.

Good Day! - posted on 04/02/2010

I do agree that medication makes kids zombies and it is sad. I had a student who was a zombie every other week, depending on if she was with mom or dad that week. One made sure she had her meds and the other didn't. I preferred it when she was spazzy and hyper because I could actually get feedback from her while I was teaching and see if she really understood what she was doing. But unfortunately talking to her parents about it would do not good, as they were more caught up on their divorce.

I had another child who was a bright cheerful child (on meds) but for some reason the doc decided to change his medication mid-year. He became so withdrawn and would burst into tears over the smallest thing. I immediately alerted his mom, who took him off that medication and brought him back to the doc. The next week he was himself again.

So here is the thing...should I not have alerted this child's mom to his dramatic behavior change because I am not a certified psychologist? It is part of my job to keep parents informed as to how their children are doing in my classroom. It is the docs decision to change the meds or not.

Children spend the majority of the day in school so it is likely teachers who notice things. And like I said before, parents should not take the teachers word for it when regarding any learning disorder. It takes evaluation from trained professionals. So maybe the blame for over diagnosis needs to fall on the professionals, not the teachers who are simply making observations.

And maybe my view is slightly skewed, because I taught in an amazing public school district that could afford teachers with higher degrees and qualifications. The district also paid for numerous trainings and workshops.

Suzette - posted on 04/02/2010

Sara, with a lot of teachers it is equating to getting a checklist off the internet because they dont' have enough classes to equate to psych minor, they don't have any classes towards a psych degree, they have a checklist. A lot of them are older teachers or they've received their education years ago and are just taking the 'refresher' courses. (If that, because let's face it, a teacher doesn't get paid like they ought to.) Most teachers I've met are as educated as they have to be, and it's because they don't make enough money to be otherwise. Those student loans are going to come crawling to bite them or they were only given so much in grants to go to school so they weren't able to afford to get much else in education than what they needed.



I agree that a good teacher will plan so there's no downtime. They will keep the kids engaged and have the kids moving around. However, there aren't a lot of good teachers either. Because they get so discouraged with the system, the kids (for SO many reasons), and/or because teaching sometimes isn't what they thought it would be they give up. There aren't a lot of good teachers left. We have more and more teachers that aren't willing to fight for the kids' education due to the system and they just give up. Kids aren't being taught, at many ages, and they're getting discouraged too. Though there are the lucky few who get a few good teachers here and there. Just enough really that it gives them enough encouragement to realize how bad the rest of them are lacking. (No offense, it's not directed at you!)



Unfortunately, it's not practical. Again with the school system and how discouraging it can be. You're right, they need to be educated. If it could be a proper refresher course, it would be great. If they could be tested on it yearly, also great. I don't see the school system doing that though. They'd say something about funds and money so they could allocate it elsewhere.

You're right, it will be the opposite problem. It's the lesser of two evils. Personally, I'd rather have it underdiagnosed than a bunch of drugged up zombie kids running around. I know it would make it more difficult on the teachers, and the parents, but at least they'd be children again.

Good Day! - posted on 04/02/2010

A pshyc minor doesn't equate getting a checklist off the Internet. But I do see what you are saying. A teacher is not qualified to make a diagnosis and I completely agree. But most teachers I know are educated enough to at least make an intelligent judgment about if a child needs extra help. They NEED to be. Because the classroom may be the first place a disorder like ADHD will start to show itself, because of the nature of a classroom.

Okay, so I agree that many teachers will flippantly tell parents that their children need medications. And many parents probably listen and doctors cave to the parents. Let's face it, 30 still quiet children make for a lovely teaching job. But to me, if a student is getting restless, I'm not doing my job. Every good teacher knows that you must plan so that there is no potential for downtime or for kids to get bored. Yes, there are times when kids must sit still for a few minutes so the teacher can explain a new concept etc. But keeping the kids engaged during this time is part of being a good teacher. And I feel that the mark of a good teacher is a classroom in which the students are moving around the room, out of their seats and engaged in hands-on learning. I think that would eliminate a lot of, "your kid won't sit still so she has ADHD."

Because it is probably not practical for all districts to have a clinical physcologist, we must rely on teachers to first notice the potential signs of ADHD. They need to be educated. If teachers were not allowed to alert parents to potential problems, we would have the opposite situation on had...ADHD being under diagnosed and capable kids failing out because they can't focus and never received help.

Suzette - posted on 04/01/2010

Personally I think it's overdiagnosed. My friend's daughter, who can be hyper at times, had her mother called to a parent/teacher conference when she entered the 2nd grade. She'd only been in the class for a week. Apparently the teacher thought that she was ADHD because she 'talked a lot and didn't like to sit still.' At times she can get very bored and other times if you give her a book that she hasn't read, she'll sit there for hours and read it, sometimes twice, before asking for another one. But if you ask her to do something that she can be done with quickly, she's going to get bored and turn to a friend and chat. Like most children.



My friend became worried and took her to a doctor and a counselor, they stated she's just a normal, hyper, child who doesn't like to sit still when she's bored. (Go figure.) The teacher, from what I heard, wasn't too pleased.



Because my friend was worried, they cut out a lot of sugars in her daughters diet. From the way I perceived her acting afterwards, she still acted the same. It's the way she is, give her a simple task and she's going to get bored while she sits and waits after finishing. I know a lot of adults that are the same way, I'm one of them, and I know I'm not ADHD or ADD.



I completely agree with LaCi on this one. I'm going to college for a Psychology degree. When you take enough classes for a psych degree as a minor, you're not getting all the information you need. Anyone can get a fact sheet off the internet and run it down while watching another person, or child in this case, for a couple of months. The result would still be the same, it will be hit or miss. Sometimes the person referred to take their child to the doc will wind up with meds just because that doc happens to be script happy, other times they'll wind up going to a counselor because, like my friend's doc, they didn't want to jump to conclusions.



A clinical psych on staff would be a great idea, the only problem is that most school board's spend the money they're allocated now so irresponsibly that they wouldn't be able to afford one.

Lyndsay - posted on 04/01/2010

Personally, I think yes. I could go on for hours about this. Although I do agree with you that its more often than not used as an excuse, I still think it's overdiagnosed. I also think that bipolar and other types of depression in adolescents is horrifically overdiagnosed. I work in a group home... I have 8 kids aged 10-18, and of them only two are not medicated for one thing or another. One of my girls who is 16 just got put on meds for being "depressed", which is ridiculous because I have known a lot of truly depressed people in my life and she was nothing like any of them.



I feel like medications are used as a way to control behaviour, even if many times the behaviour can be managed in other ways. I am not saying that they are not useful, because I definitely think that some kids need them. However... I think that teachers, parents, and doctors should be looking at other alternatives and not just jumping to medication as a quick-fix.



I also think every parent who is being told to medicate their kids should watch this video:



http://www.pbs.org/wgbh/pages/frontline/...



It's kind of long and broken up into segments, but its good. There is one part where the crew follows a mom and her 4 year old to the doctors office (it shows several visits), the doctor tells the mom to try a new medication or up the dose. After the family leaves the producer asks the doctor what effect the new dose will have, why he chose it, etc. And do you know what he says? "I don't really know". I DON'T KNOW. Like seriously? Just think about that.

Jessica - posted on 04/01/2010

I was a hyper, spastic child....went to the Doc and guess what he said?! She's ADD, here are pills to deal with her! My parents didn't think I was quite that bad, but doc said so,so I was started on pills. I became the most drone child ever. No smiles, didn't act out, wasn't hyper....pills worked right? Hell no, my parents took me off of them and decided they would rather deal with me being a hyper spazz then drug to me shut up! lol. Now I do agree that for some people, it is very real and they need the pills, but then the pills wouldnt affect them the same as they did me. Drone child. What the Doc should have told my parents is that i'm a happy, spazzing child with alot of personailty but that drugs weren't a needed thing!

Tania - posted on 04/01/2010

I think it is. I see it this way. Adults have trouble concentrating and sitting for long periods of time. Now imagine what its like for a young child sitting in class and trying to focus and listen for an hour. It must seem like forever.
On the other hand I do believe that some children do suffer from ADD/ADHD and other disorders and those kids can not be left behind.
My son has NVLD which can often mask as ADD. It can be very serious if untreated as it gets worse with age.
If you or even teachers think there could be an issue with the child you must get them tested. Never assume that because they are hyper or don't listen that the have this disorder.
It is not something I would ever lable my child as just because.

Good Day! - posted on 04/01/2010

So then what should be the solution? Teachers will often be the first to notice a learning disability such as ADHD. I agree that parents should NOT take only a teacher's word for it that their child has ADHD. But if the teacher is noticing a consistent pattern of behavior that lines up with ADHD, then they should bring it to the parent's attention.

I know that I can identify a child with dyslexia, for example, but I don't have the skills necessary to help that child. That is left up to the school's reading specialist. But it is up to me to identify students whose problems with reading line up with dyslexia and refer them to the reading specialist for further testing to come up with a correct diagnosis, and then to receive specialized help.

Same with ADHD. I feel that teachers should be educated enough to at least recognize when a student could have ADHD. Perhaps each school or district should have a clinical psychologist on staff for this purpose.

LaCi - posted on 04/01/2010

Enough hours to comprise a minor in psych is really not enough. Although it is MUCH better than what my former university required, only a few basic psychology for education courses in their BS program for elementary education, I didn't see any listed for secondary except in the case of the social studies focused BS.

Another problem is the fact that people are seeking advice from medical doctors and not psychologists. Medical doctors also have limited knowledge of psychology. The sequence of experts should absolutely be clinical psychologist and then, last resort at the advice of the clinical psychologist, psychiatrist. Never a family doctor. The only psychology required for obtaining a medical license (at U of L at least) is whatever was listed in the general education curriculum for the first 4 year degree.

Jackie - posted on 04/01/2010

I absolutely believe there are kids out there who truly have the meds and need them, but I also fully believe there is a VAST majority of people out there who just want a Rx from their doc so they don't have to discipline their kids and the docs write them b/c they wont stand up to the parents....its ridiculous.....

Jocelyn - posted on 04/01/2010

I would say that generally people (doctors, teachers, parents themselves) are too quick to diagnose and blame all the problems on it. But I don't think that's the main problem; I think that these kids are way over-medicated. It seems that very few parents are willing to try things like changing the kid's diet etc.

Good Day! - posted on 04/01/2010

@LaCi

My teacher training required enough psychology classes to count as a minor. I'm not claiming to be an expert, I'm just saying that in (hopefully) most teacher programs, they are taught to look for the signs of ADHD and other learning disorders. Now because I'm not an expert, I would never tell a parent that their child has ADHD. But I would talk to the parent about what I've observed in my classroom and recommend a few things.

1. Behavior program - Meaning that at both home and school we would reward the student for good behavior. Most teachers do this for a class anyway, but this is for one individual student. Maybe put five sticky notes on his desk. For each time the student misbehaves during the day, take away a sticky note. At the end of the week reward him according to how many sticky notes are left. We did a similar thing with a boy in my class. The principal was even in on it and had a reward for this student. His parents would bring him to his favorite restaurant if he did well that week. This eliminates putting someone on medication if they really don't need it.

2. I would recommend that they see a doc. I wouldn't do this lightly. And if the doc says they child is not ADHD, then we go from there and work to find another solution. I've never recommended a parent take their kid to the doc. However, I have observed a student become so depressed on his new ADHD medication that I had to call his mom and tell her. She immediately took him off that medication and asked for a new one from the doc.

It's a tough situation. Yes, I believe it is over-diagnosed and there are kids out there on unnecessary medication. And I do believe it is an excuse for bad behavior. But some kids really are truly ADHD.

Jane - posted on 04/01/2010

I think it's over diagnosed but not necessarily by doctors but teachers as well. When my now 16 year old son was in elementary school, I had three years of constantly being told my son was suffering from ADHD. The pediatrician was awesome and continued to defend my belief that this was not the case (thank goodness) but the teachers persisted and even wanted me to take my son to another doctor. Finally, he wound up with a teacher who said "your son is just a mover" and she gave him the flexibility to be a little boy who just didn't like to sit still for too long. We muddled through and once he hit 5th grade, all the crap I was going through with some of the teachers was done. Never was ADHD...he was just a healthy, energetic little boy.

Shannon - posted on 04/01/2010

IDK.. But, my guess is YES. Doctors these days have to put a name to the problem & prescribe something. So why not tell you your child is ADD/ADHD.

LaCi - posted on 04/01/2010

I believe its overdiagnosed. They've also expanded the criteria for many behavioral disorders to make them more inclusive.







"six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is

maladaptive and inconsistent with developmental level:



Inattention

1. often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities

2. often has difficulty sustaining attention in tasks or play activities

3. often does not seem to listen when spoken to directly

4. often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace

(not due to oppositional behavior or failure to understand instructions)

5. often has difficulty organizing tasks and activities

6. often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or

homework)

7. often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)

8. is often easily distracted by extraneous stimuli

9. is often forgetful in daily activities"







According to that I have ADD. 1,4,5,7,8,9.







"six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is

maladaptive and inconsistent with developmental level:



Hyperactivity



1. often fidgets with hands or feet or squirms in seat

2. often leaves seat in classroom or in other situations in which remaining seated is expected

3. often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults,

maybe limited to subjective feelings of restlessness)

4. often has difficulty playing or engaging in leisure activities quietly

5. is often ìon the goî or often acts as if ìdriven by a motorî

6. often talks excessively



Impulsivity



7. often blurts out answers before questions have been completed

8. often has difficulty awaiting turn

9. often interrupts or intrudes on others (e.g., butts into conversations or games) "







I believe most disorders are overdiagnosed. For instance, the criteria for being bipolar require at least 7 consecutive days of documented mania, and 2 weeks of documented depression. When I consider how many people I know who have been "diagnosed" bipolar that have actually had both of these it's obvious some of these doctors have forgotten the rules.



Another thing I think interferes with diagnosis is the note that these symptoms are supposed to be "inconsistent with developmental level." how many little boys have I seen that don't exhibit these hyperactivity symptoms? none. so behaving this way, in my opinion, is natural for kids. kids are rambunctious, they don't like to sit still for long periods of time, they talk a LOT. I mean seriously? what 7 year old kid doesn't display some symptoms?



Medicating children is becoming a form of social control. I'm absolutely not denying that some people have problems with this and some people benefit from medication, I'm simply agreeing that its extremely over-diagnosed and circumstances need to be considered.



One of my psych professors (was a clinical psychologist) was asked by a little boys parents to shadow him at school one day, because the school said he had adhd and needed to see a doctor. So she sat in the back of the classroom and watched as a little girl behind the little boy would pester him every time the teacher turned her back, resulting in chatter and noise, the boy standing up, interrupting the teacher, etc. Last time I checked elementary school teachers don't generally possess degrees in psychology, so who gave them permission to start diagnosing/referring kids to doctors for medication anyway?



The whole thing pisses me off. Here's a pretty good video:



http://milledrive.com/videos/28766/Gener...



Hope that link works ;)

Meghan - posted on 04/01/2010

Being a person with ADHD and knowing several family members and friends that have ADD or ADHD I strongly believe that it is not over diagnosed. I have been on medication since I was 9 years old, I have been both on the medications and off. I have been on both Ritalin and Adderall in several different forms. Without the medication I am lost I can not focus and if someone gives me a list of tasks to do verbally I freak out and shut down. If a student is properly tested and determined to have ADD/ADHD than they deserve to have the help of medications. Instead of being over diagnosed I believe that ADD/ADHD is overused as an excuse why a person can not do something.