Is ADHD Being Over-diagnosed?

Main Digest

What experts and the public have already long suspected is now supported by representative data collected by researchers at Ruhr-Universitat Bochum (RUB) and University of Basel: ADHD, attention deficit hyperactivity disorder, is over-diagnosed. The study showed that child and adolescent psychotherapists and psychiatrists tend to give a diagnosis based on heuristics, unclear rules of thumb, rather than adhering to recognized diagnostic criteria. Boys in particular are substantially more often misdiagnosed compared to girls. These are the most important results of a study conducted by Prof. Dr. Silvia Schneider and Prof. Dr. Jurgen Margraf (both from RUB) and Dr. Katrin Bruchmuller (University of Basel) as reported in the American periodical "Journal of Consulting and Clinical Psychology".

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Leon has ADHD, Lea doesn't

The researchers surveyed altogether 1,000 child and adolescent psychotherapists and psychiatrists across Germany. Four hundred seventy-three participated in the study. They received one of four available case vignettes, and were asked to give a diagnosis and a recommendation for therapy. In three out of the four case vignettes, the described symptoms and circumstances did not fulfill ADHD criteria. Only one of the cases fulfilled ADHD criteria based strictly on the valid diagnostic criteria. In addition, the gender of the child was included as a variable, resulting in eight different case vignettes. As the result, when comparing two identical cases with a different gender, the difference was clear: Leon has ADHD, Lea doesn't.

Male and conspicuous: the "prototype" makes the difference

Many child and adolescent psychotherapists and psychiatrists seem to proceed heuristically and base their decisions on prototypical symptoms. The prototype is male and shows symptoms such as motor restlessness, lack of concentration and impulsiveness. In connection with the gender of the patient, these symptoms lead to different diagnoses. A boy with such symptoms, even he does not fulfill the complete set of diagnostic criteria, will receive a diagnosis of ADHD, whereas a girl will not. Furthermore, the therapist's gender plays a role in the diagnostic: male therapists give substantially more frequently a diagnosis for ADHD than their female counterparts.

Diagnostic inflation, more medication, higher daily doses

In the past decades, the diagnosis of ADHD have become almost inflationary. Between 1989 and 2001, the number of diagnoses in German clinical practice increased by 381 percent. The costs for ADHD medication, such as for the performance-enhancer Methylphenidate, have grown 9 times between 1993 and 2003. The German health insurance company, Techniker, reports an increase of 30 percent in Methylphenidate prescriptions for its clients between the ages of 6 and 18. Similarly, the daily dosage has increased by 10 percent on average.

Remarkable lack of research

Considering these statistics, there is a remarkable lack of research in the diagnostic of ADHD. "Despite the strong public interest, only very few empirical studies have addressed this issue", Prof. Schneider and Dr. Bruchmuller point out. While in the 70s and 80s a "certain upswing" of studies on the frequency and reasons for misdiagnoses could be observed, current research hardly examines the phenomena. The current study shows that to avoid a misdiagnosis of ADHD and premature treatment, it is crucial for therapists not to rely on their intuition, instead to strictly adhere to defined, established diagnostic criteria. This is the best possible thanks to standardized diagnostic instruments, such as diagnostic interviews.

Publications

Psychotherapeut 2012, DOI: 10.1007/s00278-011-0883-7

K. Bruchmuller, J. Margraf, S. Schneider: Is ADHD Diagnosed in Accord With Diagnostic Criteria? Over-diagnosis and Influence of Client Gender on Diagnosis. Journal of Consulting and Clinical Psychology, 2012, DOI: 10.1037/a0026582

Additional information

Prof. Dr. Silvia Schneider, Clinical Child and Adolescent Psychology, Ruhr-Universitat Bochum, Tel. +49 234 32 23168, silvia.schneider@rub.de

Editorial: Jens Wylkop

Attribution/Source(s):

This quality-reviewed article relating to our ADHD and ADD section was selected for publishing by the editors of Disabled World due to its likely interest to our disability community readers. Though the content may have been edited for style, clarity, or length, the article "Is ADHD Being Over-diagnosed?" was originally written by Ruhr-University Bochum, and published by Disabled-World.com on 2012/03/30 (Updated: 2022/04/08). Should you require further information or clarification, Ruhr-University Bochum can be contacted at ruhr-uni-bochum.de/en. Disabled World makes no warranties or representations in connection therewith.

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