Rethinking ADHD Diagnoses


iStock_000026350212Medium-800x533Over the past two decades, there has been a spike in the diagnoses of attention hyperactivity deficit disorder (ADHD) in children. Are there more kids with ADHD or are they being over-diagnosed and, ultimately, overmedicated?

“Attentional issues are common experiences among all children, so most people endorse having some symptoms and end up increasing the likelihood of an incorrect ADHD diagnosis,” said Dr. Sonia Krishna, a Seton Mind Institute expert in child and adolescent psychiatry.

On the flip side, actual ADHD symptoms might not be taken seriously.

“People sometimes minimize symptoms and make excuses for these behaviors, such as ‘boys will be boys,’ ” she said.

A University of Washington pediatrics professor wrote an editorial this month addressing this question for the Journal of the American Medical Association Pediatrics. He concluded the current process is subjective and doesn’t provide support for kids considered borderline ADHD.

He suggested thinking about it as a spectrum of “attentional capacity,” which is the ability to delay gratification, manage time and attention and stay on a path toward a goal. This spectrum should vary based on the individual and situation, as reported on National Public Radio.

“ADHD diagnosis is currently based on clinical interviews and reports from parents and teachers with rating scales commonly being used, so this process can be subjective,” Krishna said.

There are three types of ADHD and baseline criteria for diagnosis.

  • Inattentive: Difficulty paying attention or following instructions – ADHD diagnosis identifies at least 6 out of 9 inattentive behaviors.
  • Hyperactive-Impulsive: Feeling restless and having trouble with impulsivity – ADHD diagnosis identified at least 6 out of 9 hyperactive-impulsive behaviors.
  • Combined: Exhibiting both inattentive and hyperactive-impulsive characteristics – ADHD identifies at least 12 out of 18 inattentive and hyperactive-impulsive behaviors.

ADHD behaviors are somewhat ambiguous, and can make it difficult to diagnose. Once kids get an ADHD diagnosis, they are often prescribed medications.

“For kids with ADHD, medications overall are safe, effective and work quickly to manage symptoms,” Krishna said. “For kids that are incorrectly diagnosed with ADHD, we want to be cautious not to overprescribe medication because all treatments can have potential side effects.”

Along with these challenges of diagnosing ADHD, there is no official diagnosis and treatment plan for kids who are on the borderline of an ADHD diagnosis. This potentially leaves kids who may need help without access to care.

“For kids that are borderline ADHD, we still recommend support such as organizational and behavioral therapy,” Krishna said. “This can include making schedules and providing more one-on-one attention with assignments. We can try medications in borderline patients if they have significant impairments such as difficulties functioning in school.”

Given the complexities of diagnosing ADHD, the idea of a spectrum of attentional capacity makes sense, Krishna believes.

“Brain maturity isn’t complete until the mid-20s,” she said. “The brain is constantly evolving its executive functions, such as planning, focusing attention and multi-tasking. This spectrum allows for a more holistic approach to treating children where we recognize the various levels of abilities and help optimize overall health.”

Looking to the future, Krishna hopes “that we can provide individualized support for each child without requiring labels, and identify concerning behaviors to begin treatment early.”

Seton offers behavioral health care services to adults and children in Central Texas. Visit Seton Behavioral Health for more information.