The Rapidly Increasing Diagnosis of ADHD
So many of us today are inundated on our TVs, phones, iPads, and computers with information on any given topic. The struggle is determining the veracity of this information. Parents of students who are struggling in school are often conducting research on the internet to further educate themselves on any given topic regarding their child.
A recent Good Morning America segment by Dr. Edith Bracho-Sanchez purported that a 20-year study found that ADHD rates have increased dramatically over the last twenty years. Dr. Bracho-Sanchez states- that “the newest criteria allow for the diagnosis to be made if a child has symptoms of either inattention or hyperactivity that interfere with his or her quality of life—as opposed to previous criteria which required the symptoms to be present in multiple environments.”
Both the previous DSM-IV and the current DSM-5 require the symptoms to be present across environments—an individual does not have ADHD while only in the classroom. The difference in the DSM-5 criteria is in the language used to describe the disruptions in each setting. The functional impairments only need to reduce the quality of social, academic, or occupational functioning as opposed to previous language that stated the symptoms must be “clinically significant”. The diagnostic criteria did not change dramatically and, thus, we are now seeing a huge increase in the number of ADHD cases. It would appear that, in keeping up with the latest research and ever-evolving understanding of ADHD, the DSM-5 had to evolve as well.
There seems to be controversy among some as to whether or not ADHD actually exists at all. But why? According to Dr. Russell Barkley, Clinical Professor of Psychiatry at the Virginia Treatment Center for Children and the Virginia Commonwealth University Medical Center, there have been over 6000 studies, that have been conducted on the topic of ADHD. In his ADDitudemag.com article, 7 Executive Function Deficits Tied to ADHD, he argues that, among practicing scientists who have devoted their careers to this disorder, the science speaks for itself. Most agree that ADHD is a neurobehavioral disorder.
There is a serious need to educate parents and teachers (or anyone working with children), as well as the children themselves, to better understand ADHD and the ramifications of it. This condition is not the result of bad parenting, nor is it a defiant and willful child. It is not something a child chooses to do or has control over. After 30 years of working with children and adolescents, I have found that many children with ADHD demonstrate significant levels of anxiety and/or depression, in addition to ADHD . They are aware they are “different” than others in some manner and, unfortunately, may begin to perceive themselves as “broken” in some way and need to be fixed.
How does one know if their child has ADHD? A thorough psychoeducational/psychological assessment can be the first step in determining this. There are several instruments used to help clinicians when assessing an individual who is thought to have ADHD. Information must be gathered from the classroom, home, community settings. It becomes important to know the difference between anxiety, visual processing deficits, sleep deficits, and many other possible conditions that could resemble ADHD symptoms on the surface. Also, these same conditions could exacerbate ADHD symptoms. “Not paying attention” in the classroom is not, by itself, a reason to suspect ADHD. There are many contributing factors involved with attention and concentration and ADHD is only one possibility.
The rapid increase in the diagnosis of ADHD has been attributed to many factors: lack of physical activity in children that closely correlates with too much screen time, reduced opportunities for social interactions, consumption of processed foods that contain dyes and other chemicals, or simply the desire for students to behave and perform better in school. To be thorough in establishing a diagnosis of ADHD, a clinician needs to examine visual processing, auditory processing, diet, sleep habits, behavior across the home, school and social environments, and the possible profile of a “gifted learner". Without a complete psychoeducational evaluation, the diagnosis is simply a shot in the dark and the label becomes an unnecessary burden for a child to carry.
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