1 OVER DIAGNOSIS OF ATTENTION DEFICIT DISORDER

The Over Diagnosis of Attention Deficit Disorder in Young Boys Aaron Conner Samford University

2 OVER DIAGNOSIS OF ATTENTION DEFICIT DISORDER Abstract This paper speaks to the ever growing diagnosis of Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD) in the children of the United States. It draws from five online sources, two peer-reviewed articles, one article addressing the peer-reviewed article and providing more information, one fact page from the Attention Deficit Disorder Association, and one data page from the Center for Disease Control and Prevention. The articles all build a case for the gender targeting and over diagnosing of young boys in America and provide some startling information on the growth rate of ADD and ADHD in the nation. The online webpages provide solid data on the breakdown of ADD cases in children across the country as well as a percentage of ADD/ADHD cases that are currently being prescribed medication as the primary means of treatment. The peer-reviewed articles bring attention to the gender targeting and the overmedication done across the world. Keywords: Attention Deficit Disorder, Attention Deficit Hyperactivity Disorder

3 OVER DIAGNOSIS OF ATTENTION DEFICIT DISORDER The Over Diagnosis of Attention Deficit Disorder in Young Boys One might be led to believe that the young boys in America are getting more and more wild and less and less focused all at the same time. The number of diagnosed cases of Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder in children has increased 3.2% from 2003 to 2011 according to the Center for Disease Control and Prevention (CDC). To make matters worse, boys are far more likely to be diagnosed for ADD or ADHD than girls are. The CDC reports that boys were 13.2% likely to be diagnosed with either of the two while girls were only at a 5.6% chance. The CDC also reports that the average age of children who are diagnosed with ADD or ADHD was seven years old. Out of all of the states in the United States, the Southeast region had the states with the highest percent of ADD/ADHD ever diagnosed in children ages 417 with Alabama, Mississippi, Louisiana, Iowa, Tennessee, North Carolina, South Carolina, Kentucky, Ohio, Arkansas, Indiana, Delaware, and Rhode Island all above 13% in 2011 (CDC). Now the main question at this point is how are so many young boys being diagnosed? The Attention Deficit Disorder Association (ADDA) defines ADHD as the presence of impulsive, distractive, and hyperactive features in the patient that are excessive, pervasive, and long term. These behaviors must emerge before the age of seven and continue for at least six months afterwards. In addition, the ADDA states that the behaviors must cause some real problem in two areas of the persons life such as school, work, social life, or life at home. The ADDA talks about a test that is given to evaluate behaviors for possible diagnosis of ADD/ADHD and it lists that, According to the DSM-IV (the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) some common symptoms of ADHD include: often fails to give close attention to details or makes careless mistakes; often has difficulty sustaining attention to tasks; often does not seem to listen when spoken to directly; often fails to follow instructions

4 OVER DIAGNOSIS OF ATTENTION DEFICIT DISORDER carefully and completely; losing or forgetting important things; feeling restless, often fidgeting with hands or feet, or squirming; running or climbing excessively; often talks excessively; often blurts out answers before hearing the whole question; often has difficulty awaiting turn. Finally the article written by the ADDA states that not all cases of ADHD are similar or are the same level of severity and that one third of the people diagnosed with ADHD are not hyperactive or overactive. ADD and ADHD are screened and reviewed by therapists who utilize the DSM-IV. This paper will look at some critical data that shows how the DSM-IV has changed over time and how therapists are ready to diagnose children, especially boys, with ADHD even if the main characteristics are lacking in that child. Some of the statistics for the overall ADHD situation in the country are shocking. The rate at which children are being diagnosed is growing rapidly which either means that the children in America are becoming more ADD or the therapists are misdiagnosing a frightening amount of children who are likely to be prescribed medication as a remedy.

Problem

The problem is simple and unfortunately it is growing at an alarming rate as seen earlier in this paper. Boys are being over diagnosed by doctors and physicians with ADD/ADHD and are being given an increasing amount of drugs. According to Science Daily, the number of diagnoses in Germany rose 381% from 1989 and 2001, the number of Methylphenidate prescriptions has increased 30% and the average daily dosage of medication has increased 10%. In 2011 the percent of ADHD patients taking medication rose from 4.8% in 2007 to 6.1%

5 OVER DIAGNOSIS OF ATTENTION DEFICIT DISORDER (CDC). Of the children who were diagnosed with ADHD in 2011, at least 66% of them are on medication in the Southeast with the exception of South Carolina. The majority of Southern states had over 76% of diagnosed children receiving medication. To go along with this alarming data, significant research and evidence on this topic is critically lacking. Many therapists are misdiagnosing their patients because they are using their bias and their opinions to write and fill the prescriptions rather than following the standards set up as criteria to diagnose a person with ADD or ADHD. Instead of following these criteria, many physicians are basing their findings on prototypical symptoms, says Science Daily. Basically, physicians are looking at traits such as restlessness, impulsiveness, and lack of focus as the main indicators and often times the male patients will be diagnosed with either ADD or ADHD when a female patient will not.

Research

Brault and Lacourse did a study with Preschoolers in Canada and found that boys were being prescribed medication at the rate of 63.3% whereas girls with ADHD were only being prescribed medication 49.2% in 2007. The percentage of boys that received medication outweighs the girls by more than fourteen percent and has only been this way after 2001. Brault and Lacourse also talk about the massive increase in ADHD in the United States during the 1990s and the fact that the diagnosis criteria drastically changed from the 1960s to the 1990s. The DSM or Diagnostic and Statistical Manual of Mental Disorders went through three phases in that time: the DSMIII, the DSMIIIR, and the current edition DSMIV. This could explain the increase in diagnoses in young children and how it came at such a massive jump in numbers. Which the standards changing and an emphasis being placed on medication as primary

6 OVER DIAGNOSIS OF ATTENTION DEFICIT DISORDER treatments in the nineties, the newer models of DSM could have more wiggle room for children to be diagnosed with ADHD or ADD even if they lack the appropriate characteristics that would determine if they fit the bill. Another study was done where 473 child therapists were chosen and were given many cases in several vignettes and asked to determine what the child had and what their recommendation was (Bruchmuller, Margraf, & Schnieder, 135). Of those therapists, 16.7% diagnosed ADHD even though the necessary traits were not present. In the second vignette, over 20% of the therapists diagnosed ADHD without two of the necessary traits being present. The case also found that boys were more often diagnosed with ADHD than girls were even when the two had the same characteristics (Bruchmuller, Margraf, & Schnieder, 135). The authors speculate that if they would have tested to see how many therapists diagnosed a case with only one trait absent that the number would be well above 20%. Bruchmuller, Margraf, & Schnieder report that boys that were evaluated were much more false positive than false negative which reinforces that boys are much more readily diagnosed with ADHD than girls are. The misdiagnosis of ADHD and the increase in prescription of medications to treat ADHD results in poor results and possible detriment to the patient as well as large scale negative impact on the society and economy as a whole (Bruchmuller, Margraf, & Schnieder, 135).

Summary

ADD and ADHD are a pair of rapidly growing disorders that are putting more and more children especially boys on medication. Young boys are more likely to be classified and diagnosed as having ADHD than girls partly due to their natural tendency to be impulsive,

7 OVER DIAGNOSIS OF ATTENTION DEFICIT DISORDER hyperactive, and distractive. The change in the DSM has made the criteria for diagnosis easier and as a result more boys are falling into this category. Therapists were tested and one sixth of the test incorrectly diagnosed the child at question with ADHD and in a later test more than 20% misdiagnosed the children with ADHD. This data shows that up to and possibly exceeding 20% of the children that are diagnosed with ADHD may not meet possess all of the characteristics necessary to be truly diagnosed with ADHD. Boys are naturally more energetic, wild, rambunctious, and less focused on tasks such as reading and writing than girls are at a younger age. The fact that such a high percentage of children can be misdiagnosed for ADHD proves that something must be changed. The DSM-IV has gone through many revisions but is that enough to provide a clear and effective means to test and properly identify those children who do need help? In addition to the misdiagnosis of such a large percentage of children, those who have been diagnosed are highly medicated which can be detrimental to their health in the long run and the country as well.

8 OVER DIAGNOSIS OF ATTENTION DEFICIT DISORDER References

Adhd is over-diagnosed, experts say. (2012, March 30). Retrieved from http://www.sciencedaily.com/releases/2012/03/120330081735.htm Brault, M., & Lacourse, E. (2012). Prevalence of prescribed attention-deficit hyperactivity disorder medications and diagnosis among canadian preschoolers and school-age children: 1994-2007.Canadian Journal of Psychiatry, 57(2), 93-101. Retrieved from http://ehis.ebscohost.com.ezproxy.samford.edu/eds/detail?sid=2702a226-04b3-4bd19706ca7d8e595abb@sessionmgr4002&vid=1&hid=4205&bdata=JnNpdGU9ZWRzLWxpdm U= Bruchmuller, K., Margraf, J., & Schnieder, S. (2012). Is adhd diagnosed in accord with diagnostic criteria? overdiagnosis and influence of client gender on diagnosis. Journal of Consulting and Clinical Psychology, 80(1), 128-38. Retrieved from http://ehis.ebscohost.com.ezproxy.samford.edu/eds/detail?vid=8&sid=dedc84fa-80834183-a10cba16119eeb92@sessionmgr4001&hid=4113&bdata=JnNpdGU9ZWRzLWxpdmU= Center for Decease Control and Prevention. (2013, November 13). Attention-deficit / hyperactivity disorder (adhd). Retrieved from http://www.cdc.gov/ncbddd/adhd/data.html Jaksa, P. (1998). Attention deficit hyperactivity disorder (adhd/add) fact sheet. Retrieved from http://www.add.org/?page=ADHD_Fact_Sheet