Experts say ADHD is over-diagnosed

Researchers at Ruhr-Universität Bochum (RUB) and University of Basel, Switzerland, have found that ADHD may well be over-diagnosed because professionals have a tendency not to diagnose using recognized diagnostic criteria, as per Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM–IV) and International Classification of Diseases (10th rev.; ICD–10). Instead, the researchers hypothesise, the therapists diagnose according to their concept of an ADHD child. ADHD tends to be more prevalent in males, thus a boy might be seen as a more prototypical ADHD child, resulting in a diagnosis more readily than if he was female.

To test this, the researchers sent a vignette in four versions to 1,000 child psychologists, psychiatrists and social workers, asking them to give a diagnosis. The first version, vignette 1, fulfilled all the criteria for a child with ADHD as per DSM-IV/ICD-10, and versions 2-4 included several symptoms of ADHD but not all criteria as per DSM-IV/ICD-10, meaning a diagnosis of ADHD should not be given. As well as this, boy and girl vignettes were also created.

The results showed that in the non-ADHD vignettes 2-4, 16.7% of therapists diagnosed ADHD. The boy versions engendered twice as many ADHD diagnoses as the girl versions. This led the researchers to conclude that therapists are not adhering strictly to the diagnostic manuals, and that this is leading to over diagnosis of ADHD in general, and especially in boys. A thorough diagnostic training would help prevent this.

Source: Journal of Consulting and Clinical Psychology

First published March 2003

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