Rise of Overdiagnosed ADHD Cases in Adolescents
Ever child wants their child to be special. They put them in Little League baseball or even ballet so they can unlock their full potential. However, what happens when a parent realizes that their child isn’t the extraordinary superstar that they thought they would be? What happens when their child is average? Or even below average? Could the child be specially challenged or just plain lazy? Could this child have ADHD or are they just bratty?
A simple way to describe Attention Deficit Hyperactivity Disorder is that it’s a neurological condition where there is an imbalance of the brain's chemicals dopamine and noradrenaline. These chemicals are responsible for things such as self-control and the slowing down of impulses (Lakhan 1). People with ADHD will experience impulsive, hyperactive behavior as well as inattentiveness with short term memory, and in some cases, learning difficulties. Recently, there has been an extreme increase in attention-deficit/ hyperactivity disorder diagnoses. And there is a growing discussion of whether or not these diagnoses are in fact correct. ADHD is overdiagnosed in teens, because symptoms can easily be confused as regular behaviors, poor malpractice actions, and finally the influence of social media.
When identifying ADHD there are two main aspects: hyperactivity-impulsivity, and inattention. Each aspect has a checklist that needs to be evaluated when contemplating if a child has the disorder. This system is called DSM-IV, which stands for Diagnostic and Statistical Manual of Mental Disorders (Hontelez 3). A meta-analysis of around 102 studies worldwide indicates about a 4-6% prevalence among kids and teenagers, with about 3.4 percent affecting adults when using the DSM 4 criteria for the diagnosis.
Even though ADHD usually develops around childhood through adolescence, scientists and researchers have in fact concluded that ADHD can be hereditary; caused by an imbalance of noradrenaline chemicals and dopamine in the brain. RS30282102 is found in the FOXP2 gene on chromosome 7. This gene has been associated with language acquisition and is important in synapse formation in the brain. The wildtype of this sequence contains GTC” and the mutant that is associated with ADHD in Europeans has a deletion of the TC. So although the wildtype is TAAGTCTGATATTT, the mutant sequence is TAAGTGATATT (Rochester).
However, symptoms can also express themselves later in life and in a number of formats. For example, ADHD manifests symptoms of hyperactivity, disorganization, restlessness, clumsiness, and lack of attentiveness. Doctors and healthcare professionals then use said symptoms to determine a diagnosis. While there is no specific test for ADHD, there are a multitude of steps to go through that conclude in evaluating for ADHD.
But since most of the general public, old and young, can easily relate to most of the symptoms, iIt can often lead to an over diagnosis of the disorder (Wilens 409-413). One of the main reasons ADHD is overdiagnosed is how easy it is to confuse normal behaviors with actual ADHD behaviors. For instance, if a child is having trouble focusing in school, it may be that they are simply immature or, crazy idea now, bored in class; and will not necessarily have ADHD, even if the symptoms are displayed. There’s a fairly thin line between being “hyperactive” or simply just being a 6-year-old child. Dr Sam Goldstein says, “just as not every sneeze is indicative of a cold, so too not every restless, impulsive and inattentive behavior is indicative of ADHD.” (Goldstein 870-874)
In young children especially, the slight few months can make the gravest of differences; whether it be in skills, personality, or maturity. Even small things like a child's favorite toy or binkie can become forgotten or discarded within days. A child's maturity level can change within months, meaning that if they were to be diagnosed as ADHD it would be incorrect since it's simply a phase of restlessness.
An additional reason for severe over diagnosis is diagnostic inaccuracy. Some psychologists fail to completely assess their patients correctly and barely take into account DSM-IV evaluations (Goldstein 869). Since ADHD is so common, it can be easy to simply diagnose after a brief and impersonal assessment. Such encounters lead to false positives. Poor malpractice also leads to wrongful diagnosis and the incorrect prescription of medication. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the impact of prescription drugs can be particularly harmful to a developing adolescent brain and body (Curie 8). The brain continues to develop until around the mid-twenties. With this in mind, prescription medicines can be extremely harmful to children.
One of the main prescription medicines are amphetamines. An amphetamine is a central nervous system stimulant that is used in the treatment of attention deficit hyperactivity disorder and narcolepsy (Widens 409). Basically, a stimulant is a drug that speeds up the messages traveling between the brain and the body. It also has a high classification level of dependency, which means that someone can easily become susceptible to addiction. In Brown University’s Child & Adolescent Behavior Letter, Jennifer Setlik used teen and pre-teen ADHD medication sales data from IMS Health’s National Disease and Therapeutic Index database; and found that frequent drug usage at a young age alters brain development heavily. While amphetamines regulate the apparent imbalance of dopamine and noradrenaline in an actual ADHD patient, when taken incorrectly it can harm multiple parts of the brain’s functions like language acquisition and speech (Setlik 4). Putting people on medications for ADHD like Methylphenidates such as Ritalin or Adderall or Dexamphetamine psychostimulants, can also lead them to become essentially dependent on those in order to even do simple tasks throughout the day (Setlik 3). Now, this definitely does not mean that these conditions do not exist; they certainly do, however it is hard to argue that there isn’t an extreme overdiagnosis of these conditions.
And even in those over the age of 25, continued usage of amphetamines can cause increased risks of substance abuse, increased health care utilization, depression, alcoholism, stroke, heart attack, and may cause new or worsening psychosis and even premature mortality. Substances like Adderall can even be found on the street. In fact, Adderall is often known as a “study drug” almost used recreationally. “Misuse of stimulants by ADHD and non affected individuals has dramatically increased over recent years based on students' misconceptions or simple lack of knowledge of associated risks” (Lakhan 1)
A major problem with the DSM-IV system is that ADHD can be underdiagnosed and over-diagnosed. A study done in 2017 by the Centers for Disease Control and Prevention better known as the CDC, showed that caucasian children are more x4 times more likely to be diagnosed and treated for ADHD than children of color(Bozinovic 6). And Black and Hispanic children are less likely than their caucasian counterparts to meet the criteria for ADHD (Bozinovic 6). One of the reasons being is that most POC communities have a strong stigma for mental health issues. POC children can also be at a strong disadvantage for receiving help because of financial problems or wrong evaluations. Children of color can be labeled as “troublemaker”, “class clown” instead of actually receiving the help they need. Another problem that jeopardizes proper assessment is gender (Widens 410). Studies have shown that in nearly all aspects of healthcare symptoms can be expressed differently between the two.
There is also a population that exists that is neither overdiagnosed or underdiagnosed because they are in fact not diagnosed at all. They exist under a sub-group of teenagers on the popular app TikTok. What used to be an area for communities of people with mental health disorders, where people could vent or even seek help in regards to their disabilities; has now turned into a cluster of uninformed teenagers. The romanticization of mental illnesses, including ADHD, depression, and neurodivergence is a dangerous slope that leads to insensitivity, confusion, and circulation of misinformation.
Another illness known to be ill-represented in the media for today's youth is Tourette’s. Reports of especially female teenagers apparently “getting or rather catching” Tourette’s is significantly on the rise. It's seen as cool to be “different”. They ask questions to an extremely susceptible audience like, Does your hand get jittery? Do you ever feel restless? Do you sometimes feel fidgety? It’s simple, I, a stranger who has never met you, know that you have ADHD. Are you a naturally clean person? Well, then you must surely have OCD. Quick ten second Buzz Feed quizzes like Are you Mentally ill? What symptoms of Anxiety do I have? These false advertising, easy clickbait tests and discussions encourage misdiagnoses from the teenagers themselves (Mellor 1).
Servers like “r/fake disorder cringe” on the social media platform Reddit, discuss topics of severe insensitivity towards disabilities, physical or mental. And yes, while this phenomenon may in fact be a positive sign of a generation and culture more open to mental illnesses and disabilities discussions; it calls to concern on whether these diagnoses are true. And what seems like a safe open discussion may actually be an ADHD epidemic.
But if teenagers are self diagnosing then surely some of them actually relate to symptoms listed? Sure, it is highly possible to indeed identify a disorder yourself; so can self-diagnosing be good? On one hand, some people simply cannot afford to get diagnosed. Being able to get professionally diagnosed is a luxury with today's American healthcare system. And for most people a neurological condition such as ADHD might not even impact someone in their day to day life like a physical injury would. And so it might just not be worth it, to pay thousands of dollars for treatment, medication, and consultations on a disorder that might not even be there in the first place (Bozinovic 6). “The circulation of misinformation is not the root of all problems, but shifting the focus from fiction to fact will positively impact all involved.”. (Nelson 1)
In conclusion, the general public and healthcare workers alike must recognize the problem of misdiagnosis due to misinformation, poor malpractice, and teens susceptibility to social media influences. Unlike ever before, people live in an era where one can access a plethora of information at one’s fingertips. One click and anyone can look up symptoms and get immediate results. It is important that as a society people are informed about correct diagnoses, so they can get the actual help they need.
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