ADHD

02 April 2012

ADHD is over-diagnosed

A study shows that child psychotherapists and psychiatrists tend to overdiagnose ADHD in boys substantially more often than they do in girls.

0

What experts and the public have already long suspected is now supported by representative data collected by researchers at Ruhr-Universität 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 recognised diagnostic criteria. Boys in particular are substantially more often misdiagnosed compared to girls.

These are the most important results of a study conducted by Professor Dr Silvia Schneider and Professor Dr Jürgen Margraf (both from RUB) and Dr Katrin Bruchmüller (University of Basel) as reported in the American periodical "Journal of Consulting and Clinical Psychology".

How the study was done

The researchers surveyed altogether 1 000 child and adolescent psychotherapists and psychiatrists across Germany. 473 participated in the study. They received one of four available case vignettes, and were asked to give a diagnoses and a recommendation for therapy.

 In three out of the four case vignettes, the described symptoms and circumstances did not fulfil 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 motoric 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 fulfil the complete set of diagnostic criteria, will receive a diagnosis for ADHD, whereas a girl will not.

Also 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 diagnoses ADHD have become almost inflationary. Between 1989 and 2001, the number of diagnoses in German clinical practise increased by 38%. 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% in methylphenidate prescriptions for its clients between the ages of six and 18. Similarly, the daily dosage has increased by 10% on average.

Remarkable lack of research

Considering these statistics, there is a remarkable lack of research in the diagnostic of ADHD. "In spite of the strong public interest, only very few empirical studies have addressed this issue", Professor Schneider and Dr Bruchmüller 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 in order 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 best possible with the help of standardised diagnostic instruments, such as diagnostic interviews.

(EurekAlert, March 2012)

Read more:

Managing ADHD

  

 

Read Health24’s Comments Policy

Comment on this story
0 comments
Comments have been closed for this article.

Ask the Expert

ADHD Expert

Dr Renata Schoeman has been in full-time private practice as a general psychiatrist (child, adolescent and adult psychiatry) since 2008, currently based in Oude Westhof (Bellville). Renata also holds appointments as senior lecturer in Leadership (USB) and as a virtual faculty member of USB Executive Development’s Neuroleadership programme. She serves on the advisory boards of various pharmaceutical companies, as a director of the Psychiatric Management Group (PsychMG) and is the co-convenor of the South African Society of Psychiatrist (SASOP) special interest group for adult ADHD, and co-founder of the Goldilocks and The Bear Foundation (www.gb4adhd.co.za) She is passionate about corporate mental health awareness and uses her neuroscience background to assist leaders in equipping them to become balanced, healthy and dynamic leaders that take their own and their team’s emotional, intellectual, social health and physical needs into account. Renata is academically active and enjoys research and collaborative work, has published in many peer-reviewed journals, and has presented at local and international congresses. She is regularly invited to present at conferences and to engage with the media. During her post-graduate studies, she trained at Harvard, Boston in neurocognition and neuroimaging. Her awards include, amongst others, the Young Minds in Psychiatry award from the American Psychiatric Association, the Discovery Foundation Fellowship award, a Thuthuka award from the NRF, and a MRC Fellowship. She also received the Top MBA student award and the Director’s award from USB for 2015. She was a finalist for the Businesswomen’s Association of South Africa’s Businesswoman of the Year Award for 2016, and received the Excellence in Media Work award from SASOP during 2016.

Still have a question?

Get free advice from our panel of experts

The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical exmanication, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.

* You must accept our condition

Forum Rules