Is ADHD overdiagnosed?

1. Where do you stand on the diagnosis of ADHD – do you think it is overdiagnosed? Why or why not?

2. What factors might lead to overdiagnosis of ADHD? What about underdiagnosis?

3. What problems might result from underdiagnosis or overdiagnosis?

Initial questions/myths to be addressed

• Is ADHD a relatively new disorder?• Are ADHD symptoms fairly common; are

we merely labeling normal behavior as a disorder?

• Is ADHD/inattentive type similar to the traditional combined type?

• Has the rate of ADHD increased in the last twenty years?

Core Symptoms• Inattention OR• Impulsivity• Hyperactivity• (recent DSM change)

• Central role of impairment• Must be present before age 7• Impairment in 2 or more settings

Associated features of ADHD

• Learning problems• Peer problems• aggression, noncompliance

Diagnostic Issues• Diagnosis based on history of disorder

– Rating scales– Interviews– Observations– Best with two sources

• No medical test or lab measure to determine diagnosis

Prognosis• Chronic disorder extending into

adulthood• 3 common outcomes:

– Minimal problems– Some moderate problems– Severe problems

Ineffective Treatments• “talk” therapy• Play therapy• Elimination diets• Allergy treatments• Chiropractics• Pet therapy• Dietary supplements• Perceptual or motor training/sensory

integration training

Effective TreatmentsEvidence-Based

1. Psychostimulant medications• Ritalin (methylphenidate),

Dexedrine, Cylert• Concerta, Adderall• Strattera is new nonstimulant med

2. Behavior therapy

Main Benefits of Meds• 2/3 of children show benefits; another

10% benefit from other; rest show no response or adverse response

• Less classroom disruption• Better behavior as rated by teacher• More compliant with adult requests• Increase in on-task behavior• Better peer interactions

Other important points• Needs to be long-term• Few dysfunctional attributions• No increase in risk for later

substance abuse• Not sufficient

Limitations of drug treatment

• Rarely sufficient• Not effective for all• No impact on some family variables• Removes incentives for behavioral

tx• No long-term effects

Adverse Effects• Irritability, moodiness• Stomaches, headaches• Insomnia• Loss of appetite – less growth• Motor movements, tics• Rebound effect

Behavior Modification• Only psychosocial tx• Should be implemented first• Train parents and teachers• Extensive• Difficult• Punishment/response cost needed

Parent Training1. Establish house rules2. Praise appropriate behavior3. Use appropriate commands4. When…then contingencies5. Time out6. Points/token systems7. Continually evaluate and modify

School Interventions• Clear classroom rules• Similar to parent stuff• Near teacher• Focus on academic performance• Home report cards

Combined interventions

• Produce better short-term effects• Often preferred by parents