Overdiagnosis For ADHD is a Frequent Problem Among Children With Mild Symptoms: Study

A new study warns that attention deficit hyperactivity disorder (ADHD) is frequently overdiagnosed among children, which negatively affects those with milder symptoms.

In findings published April 12 in the medical journal JAMA Network Open, researchers from the University Of Sydney School Of Public Health indicate overdiagnosing ADHD among individuals who only suffer mild symptoms may cause harm, due to risks associated with treatment paths meant to treat those with more extreme cases.

Researchers gathered data from peer-reviewed primary and secondary studies involving children and adolescents from January 1, 1979 to August 21, 2020, conducting a systematic review of 334 studies.

Of those, 45 studies found an increase in ADHD diagnosis, and 25 studies showed those additional diagnoses could be on the milder end of the spectrum. However, 83 different studies showed an increase in pharmacological treatment of ADHD.

The studies appeared to indicate there were both benefits and harms in the newly diagnosed milder cases. As a benefit, the diagnoses appear to empower individuals who have been struggling to understand their ADHD, gave them a sense of legitimacy and decreased guilt, blame and anger. However, in some cases the diagnoses resulted in a decreased sense of power, an excuse for problems and behaviors and resulted in inaction and stagnation.

“This view can also deflect from other underlying individual, social, or systemic problems, which can prompt a self-fulfilling prophecy, wherein the perceived inability to change reduces opportunities as well as promotes hopelessness and passiveness,” the researchers warned. “This loss of control may be especially high when the diagnosis is used as a step toward coercing young people into correcting arguably problematic behaviors.”

Some studies found treatment substantially benefited severe cases, but those benefits diminished significantly in milder cases. Some studies found the only benefit in milder cases was an improvement in academic outcomes.

“Several important research questions emerged during this review. Larger studies need to be conducted to confirm whether the additional ADHD cases now being diagnosed have milder symptoms,” the researchers concluded. “Future research is also required to evaluate whether diagnosing and treating milder ADHD cases may carry net harm. To reduce health and educational inequities, resources must be shifted from the overdiagnosis and overtreatment of ADHD to the needs of youths with more severe symptoms and who are more likely to benefit, including those currently underdiagnosed.”

ADHD Overdiagnosis and Treatment Concerns

Research published in 2017 warned that many children with ADHD are overmedicated and prescribed unnecessary antipsychotics and antidepressants, despite having no other mental illness diagnosis. This is especially troubling considering a report published last year indicating more children and teens are overdosing on ADHD medications, including prescribed stimulants.

Asian, Black, and Hispanic children were significantly less likely to be diagnosed with ADHD compared with white children, according to a study published last month in the same medical journal. Compared with other groups, white children were more likely to receive some kind of treatment than children of color. Asian children had the highest likelihood of receiving no treatment at all.

In recent years, poison control centers across the U.S. have received on average about 200 phone calls a week involving children exposed to attention deficit/hyperactivity disorder (ADHD) drugs, stating calls related to accidental ingestion have been steadily rising since 2000. However, for children who are prescribed stimulant medications, researchers have called for evidence-based prevention programming and an evaluation of the dosing guidelines on opioids for teenagers, which past studies have found can lead to life-long dependencies on the drugs.