Overdiagnosis of ADHD in children and adolescents

“He is very restless”, “he is unable to stay focused for a long time”. These are some of the common complaints from teachers and adults who teach children. Yet, isn’t he a child? How do we seek to encourage and promote learning? Although in the first case the answer is usually a diagnosis of ADHD, for the following questions it is worth thinking about other factors that come into play. On this point, professionals agree that we are overdiagnosis of ADHD in children and adolescents. Let’s see what it’s all about.

What is ADHD in children and adolescents

ADHD is a neurodevelopmental disorder that is characterized by a combination of inattentiveness, hyperactivity and impulse control difficulties. There is a genetic component, but that is also moderated or influenced by the environment.

When making a diagnosis, it is important to keep in mind that the ADHD occurs more in boys than girls. Likewise, an interdisciplinary approach is necessary, precisely to avoid overdiagnosis. A priori, if the little one is distracted at school but is able to complete a task or concentrate on an activity at home, then it is possible that it is another situation and not of this diagnosis. We often confuse a nervous child with a hyperactive child, although these are different cases.

Are we confronted with the presence of an overdiagnosis of ADHD in children and adolescents?

Through various publications, professionals on the subject suggest that we are facing a situation of overdiagnosis of ADHD in children and adolescents. Some of the facts that stand out are:

• A biomedical view of the problem which neglects the other influencing factors.
• By ruling out other illnesses or disorders, we we find ourselves faced with non-specific symptoms that have a certain subjectivity. With these, the particular circumstances of the child or adolescent are often overlooked. For example, technology-dominated learning during the pandemic or even returning to the classroom after more than 2 years without attending face-to-face classes are circumstances that cannot be ignored at the time of assessment.
• In many other cases, the fact that children and adolescents are constantly “activated” by television, cell phones, social networks and endless stimuli is ignored. However, we hope that at school they can stay still, quiet and focused for longer and longer days. The school as well as the teaching and learning methods must be revised and adapt to new times.
• With regard to the previous point, the General Council of Psychology, in Spain, pointed out that in a nursery there were children of different ages and that those who were younger, not being able to achieve the same achievements as older people were more likely to be diagnosed with ADHD. It showed that the entire population of children is assessed with the same criterion or the same expectations, instead of adapting the criteria.
• Subject matter experts also mention that, depending on the textbook used, there is more or less chance of being diagnosed with ADHD. For example, DSM-V criteria make the diagnosis more likely compared to ICD-10.
• Finally, professionals also agree that we often consider a behavior as a pathology without considering external factors who maintain this situation.

Beware the power of labels

Occasionally, what appears to be a solution is nothing more than the continuation or intensification of the problem. For example, when the diagnosis of ADHD in children and adolescents seems to come as a response and a relief, since it makes sense for parents to seek to understand what is happening to their children.

However, working on a diagnosis does not modify the conditions that favor or not its expression. As we have pointed out from the results of various surveys, ADHD has an environmental component that is essential. We must therefore not be satisfied with a uniform answer, but commit ourselves to change.

On the other hand, it is essential not to stigmatize and to pay attention to the labels with which we identify children and adolescents. For example, saying “you’re unruly” or “you’re very restless” can work against them into thinking they’re like that and there’s nothing you can do about it. It can even be a reason to justify the self-fulfilling prophecy: “if you don’t concentrate, you’re going to have a bad time”. However, what influences is that no one takes the time to explain or devote a little more attention to this child, when this is precisely what he needs.

This might interest you…