Attention Deficit Hyperactive Disorder commonly referred to, as ADHD is one of the most commonly diagnosed conditions of childhood. Attention Deficit/ Hyperactivity Disorder is composed of three major components: inattentiveness, impulsivity, and motor hyperactivity. Symptoms ADHD include excessive fidgeting with hands or feet, difficulty remaining seated, following through on instructions, difficulty in attempting to play quietly, and excessive interruption of conversations. Attention Deficit/hyperactivity (ADHD) affects a broad range of society with a prevalence rate between 2% and 7% (American Psychiatric Association, 1994). The ADHD prevalence has grown drastically over the last three decades. The rate of drug treatment for behavior problems has increased in the prescription of ADHD drug treatment for children for at least 5 to 6 million American Children annually (Diller, 1998; Sinha, 2001). There are clear indications of over diagnosis and overtreatment in a growing number of communities. This paper provides background information regarding the ADHD epidemic and its treatment.
According to Bruchmiller, Katrim, (2011), there is some evidence that these increases are associated with changes in ADHD diagnostic criteria that make the condition easier to recognize. “However possible over-diagnosis and overtreatment of ADHD in the United States was recently recognized by the national institutes of Health as an important public health problem” (Gretchen B. Le Fever, 1999). Although only a few studies have addressed the question of over diagnosis, it is considered a rising trend.
According to the DSM-IV-TR in order to diagnose ADHD six symptoms of inattention and hyperactivity/impulsivity must be present. The onset must occur before 7 years of age, clinically significant impairment must occur in two or more settings, and the symptoms must not be accounted for by another disorder. Could it be that the label is being given out too easily? “There is strong evidence that therapists in their clinical routine do not strictly adhere to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders” (Bruchmiller, 2011, p.127).
A study in a specialized ADHD clinic showed that examined 92 children showed that only 22% of them were given a diagnosis of ADHD and only 37% was given a secondary diagnosis (Coutono, 1993). In a similar study it was found that among referrals 62% were not confirmed as ADHD cases after further diagnostic evaluation (Wolraich, 1990). These studies suggest that ADHD might, in some cases be over diagnosed.
Controversy has also been noted relating to the prescription of Methylphenidate. Methylphenidate, a Central Nervous Stimulant has been found that Ritalin can produce severe withdrawal symptoms, Irritability, suicidal feelings, headaches and Tourette’s. ADHD slows children down and gives them the appearance of behaving normally, but it does not prevent the cause of problems, does not work for everybody (Breggin, 1995).
The APA has established that methylphenidate is similar to cocaine and amphetamines and that the abuse patterns are similar for these types of drugs. Even after all the negative attention Ritalin is receiving in the neuropharmacology industry, it is still being passed out like some kind of magical fix-it-all candy. Children are being given the schedule II drug; One of the most addictive kind of drugs according to the USDA. “The high prevalence rates suggest that ADHD was over diagnosed and over treated in some groups of children” (Le Fever, 1999, p. 274). Furthermore, according to Novartis, there is no single diagnostic test that can definitively diagnose ADHD in human populations (Novartis, 2006).
- A checklist of behaviors diagnoses ADHD. The questionnaires answers are limited to 1.Never 2.Rarely 3.Sometimes 4. Often 5.Always. The questions contained in the ADHD assessment questionnaire are also highly subjective, as indicated by the following (Breggin, 1995)
“Often fidgets with hands and feet” (What is the operational definition of fidgets”?)
- “Often runs or climbs excessively” (How do we know when running or climbing becomes “excessive”?)
- “Often has difficulty playing quietly” (What culture expects that children play “quietly”
- “Often fails to give close attention to details or makes mistakes in schoolwork” (Children are notorious for paying “close attention to that which interests them.) (Stolzer, 2007, p.21).
One factor that is often not taken into consideration is, whether the tests are measuring adult’s frustrations with the child’s behavior (Baughman, 2006). Other factors are tolerance level, personality type, education, gender, and age of the parent or teacher reporting. The person reporting is usually not under a controlled environment (Carey, 2002). This being said, A diagnosis of ADHD is an excuse for placing the blame on the child, and not focusing on the parents, teachers and specific cultural practice.
Other Correlates that point to the over diagnosis of ADHD are the economic gains. Not only do the drug companies have financial gain due to this, but also “Under the 1991 amendment to the American with disabilities act, Individual public schools receive additional federal monies for each child that has been diagnosed with a behavioral and/or psychiatric disorder. Clearly stated, the more children who are diagnosed. The more money the individual school receives” (Cohen, 2004,p.345). This raises the question, are children being diagnosed with ADHD although showing only some symptoms, for financial gain? According to Stolzer, ADHD in America is a big business. You can tell by comparing the numbers of children diagnosed between private and public schools. Public schools receive funding for students with learning disabilities, and typically have higher rates of ADHD diagnosis. Private school diagnostic rates are really low. Private schools don’t receive funding for educating children with learning disabilities.
The current ADHD model needs improvement and more research in the complex ways growing up in present day America affects life. It needs to address the deeper and more complex behaviors and not focus so much on the use of psychotropic drugs. Humans have evolved from an environment that required hard levels of activity to the sedentary life of sitting on a sofa and playing video games. Is ADHD a reliable and valid diagnosis or an excuse to control undesirable behaviors from children without using discipline and simply using medication? Could this be the problem?
As a closing statement; much of the evidence mentioned in this paper suggests that there is the possibility of over diagnosis in ADHD. Whether it is for financial gain from the pharmaceutical companies, Poor discipline, subjective testing, economic opportunity for public schools, or just simply the way humans have evolved. This does not mean that the condition ADHD does not exist, it just means that before medicating children, more research and precautions should take place.