ADD Overdiagnosis Introduction It s not very common to hear about a disease being overdiagnosed, particularly one that mostly affects children. However, this is happening on quite a large scale with attention deficit disorder. The rate of diagnosis increased 5.5% between 2003 and 2007 (1). This paper will discuss the finer reasons behind the overdiagnosis and what it means for parents and children alike. Trying to Medicate Childhood? Many parents and teachers mistake normal childhood behaviors for symptoms of ADD or ADHD. All children occasionally get hyperactive and occasionally are inattentive. It s when the hyperactivity or inattentiveness or both are incredibly frequent or interfere with the child s life that ADD or ADHD should be considered (2). However, this can be a tough distinction to make. This could be part of the cause of the overdiagnoses. Some of these children may not have ay disease at all. Obviously, this can be incredibly dangerous at worst and expensive at best. If the child wasn t hyperactive before, he certainly will be after regularly taking Ritalin. Hard to Test Many people think that testing for diseases is very straightforward and black-and-white. I even believed this before I started this paper. However, I learned that this is rarely the case. Medical tests are themselves tested on two different
aspects, which are their sensitivity and their specificity. Specificity is the ability of a test to tell who does have the disease, whereas sensitivity is the ability of test to tell who does not have the disease (6). The problem with testing for ADD and ADHD is that the tests have a high sensitivity and a fairly low specificity. I can relate my own experience as an example. I was in therapy for a little less than a year before I was even given the actual test. The test itself took around five or six hours, and was very bizarre. I was told to do tasks such as solving the Tower of Hanoi several times, writing a short story based on a picture of some cavemen hunting down a mammoth, and sitting at a computer and pushing the space bar only when the letter T appeared. Although these tests seemed very bizarre to me at the time, I learned that they did actually serve a purpose. The computer test was to test if my impulses were out of control. If I had the hyperactivity of someone with ADHD, I would have pressed the spacebar instinctively whenever I saw anything resembling a T. Since I was able to stop myself before I pressed it, they concluded that hyperactivity was not a part of my problem. The mammoth story was used to test my focus. Someone with attention problems would not have been able to solely focus on writing the story. They would have gotten distracted, or written about something completely unrelated, or just had a hard time with it in general. I was able to write the story with mostly no problem, so they thought I did not have attention problems. However, I was told the Tower of Hanoi test was the most conclusive in showing I had some sort of problem. I was fine with the easier variations, but once they moved it up to five discs, I started having major problems. I could not figure out how I could possibly solve it.
Something seemed to be obscuring my view of the answer. The tester had to bring to my attention that I had done the same three moves over seven times, and I had no idea. This, along with my difficulty focusing on math-related tests, made the diagnosis even harder than it already was. I did not test negative, but they still could not say for sure whether I had the disease. I was told I did have some sort of disorder in the frontal lobe of my brain, but they could not say for sure that it was ADD or ADHD, and they said it would be best if I did not take any medicine for it, even though I felt I needed it. This is the major issue with the testing. The testers can tell you quite clearly if you do not have it, but cannot tell you for sure if you do. This can lead to someone who got a more vague answer to demand medication that they do not need, or parents to think they still need the medication for their child to do well. Pharmaceuticals One specific brand of medicine is used the most often to treat ADD and ADHD, despite a variety of medicines available for the disease. That drug is methylphenidate, or Ritalin. This drug works by increasing dopamine levels, which increase motivation and help with focus (7). This raises concern, seeing as many recreational, addictive drugs such as cocaine also increase dopamine levels. While Ritalin has not been shown to be nearly as addictive as these kinds of drugs as it cannot get into the bloodstream fast enough when taken in pill form, it can be addictive if it is injected (7). This could lead to people claiming to have ADD or ADHD simply to get ahold of the drug.
Also, Ritalin can have dangerous side effects such as accelerated heartbeat, and can cause stunted growth and even sudden death in children (8), yet according to a study by CNN Health, about 90 percent of people with ADD and ADHD take Ritalin (4). This begs the question of whether the drug company that makes Ritalin has something to do with this overdiagnosis. The answer to this is unclear. If anyone were to outright ask the drug company if they were directly involved with the overdiagnosis, they would deny it. While it seems they are certainly benefitting from the explosion of ADD and ADHD, they do not seem to be the direct cause of it. I feel that this is more of a byproduct of the overdiagnosis rather than the reason for it. Modern Medicine The disease may have first been mentioned in 1798 (as Mental Restlessness ), but neither ADD nor ADHD were studied and given their proper names until well into the 20 th century (5). Very little was known about this condition when it first appeared, and doctors threw themselves into study on the subject. As a result, we now have far more information than we had even 50 years earlier, which means more and more children can be correctly diagnosed. This could easily lead to what seems to be overdiagnosis when in fact it is a spike of correct diagnoses.
What s in a Name? One factor that causes confusion is the name of the disease itself. You may have noticed that throughout this paper I have included both ADD and ADHD when referring to the disease. Many people, scientists and laymen alike, use these abbreviations interchangeably, as if they are the same. In fact, they are very different. ADD is the general name for the disease, whereas ADHD refers to the disease with hyperactivity. Hyperactivity is a must to be diagnosed for ADHD, but not for ADD. However, many people believe hyperactivity must be present in order for a person to be diagnosed with attention deficit disorder. Some even believe this is the key symptom. This is not true at all. The main symptom is difficulty paying attention, hence the disease s name. This is a problem for two reasons. First, it can cause children or adults who are merely hyperactive to be diagnosed with ADD or ADHD when they really have a completely different disease or no disease at all. Secondly, it can lead to those who are not hyperactive and generally quiet people to not be diagnosed with ADD when they do have it. This can lead them to feel that there is something wrong with them that they could fix if they only worked harder, or that they are merely stupid, when in fact they have a medical problem. Both of these can easily lead to overdiagnoses or misdiagnoses. All the Cool Kids are Doing It
I have another small theory of my own about of why it is being overdiagnosed. ADD and ADHD, strange as it sounds, are becoming the cooler diseases to have. It s a bit of an odd Catch 22. People who are diagnosed feel like something is wrong with them, and so look to others for comfort. Because of the vast number of people diagnosed, they find numerous others in their same situation. Many celebrities have it, such as Will Smith, Justin Timberlake, Michael Phelps, Jim Carrey and Ty Pennington (3). This last bit may convince them that having ADD or ADHD is cool, or at least isn t a big deal. This would make them and others more ready to accept that their own children, friends, or even themselves, have this disease, since it does not seem to be much of an obstacle. They may even see it as what made these people famous, rather as an obstacle they overcame to become successful. I would like to stress that I believe that this is a very minor and in most cases subconscious reason, but I believe it is still a valid point to consider. Conclusion This is a very complicated problem. There does not seem to be any one answer as to why so many people are being diagnosed with ADHD. This should not be as shocking of a revelation as it is. To quote author John Green, the truth resists simplicity. I believe all of the reasons I have stated have some bearing as to the cause of this issue. I would say the difficult testing process and the medical advances have the most to do with it. The diagnoses that are correct must have to do with better medicine and understanding of the condition, while the incorrect ones
have more to do with the vague nature of testing for ADHD. Better understanding and more research on the topic would ensure or at least improve the rate of correct diagnoses. References 1. http://www.cdc.gov/ncbddd/adhd/data.html The CDC is a widely known government agency, and thus has reliable information. 2. http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivitydisorder/complete-index.shtml This is also a government-run organization dedicated to educating people on mental health issues. 3.. http://www.parenting.com/gallery/famous-people-with-add-or-adhd This is the website of a reputable magazine that does not have any interest in providing false information. 4. http://articles.cnn.com/1999-09- 01/health/9909_01_adhd.overdiagnosis_1_adhd-ritalin-attention-deficithyperactivity-disorder?_s=PM:HEALTH This is the website of a reliable news station that has done their own studies on the subject.
5. http://www.adhdsupport.com/history-of-adhd.aspx This website offers support and valid information to those with ADHD. 6. http://www.cebm.net/index.aspx?o=1042 This website is based out of the respectable, well-known University of Oxford. 7. http://www.bnl.gov/bnlweb/pubaf/pr/2001/bnlpr011501a.html This is a government website interested in education of the public. 8. http://www.ncbi.nlm.nih.gov/pubmedhealth/pmh0000606/ This is the official website of US medicine.