ADHD diagnoses are on the rise. While getting a diagnosis and access to treatment can be life-changing for many, are those huge upticks in diagnoses always a good thing? A misdiagnosis could be life-changing as well, but with negative ramifications as opposed to positive outcomes.
Misdiagnosis may involve being diagnosed for ADHD incorrectly, or being diagnosed with a different disorder or condition when ADHD is the actual cause. Depending on the circumstances, it’s important to consider what types of factors may lead to a misdiagnosis of ADHD in children and adults.
ADHD Diagnosis Trends
The number of ADHD diagnoses have skyrocketed in recent years. According to a 2019 study by BlueCross BlueShield, the number of ADHD diagnoses increased by over 30% during a period of just eight years. On a larger scale, another study found that the estimated prevalence of diagnosed ADHD increased from 6.1% to 10.2% between 1997-98 and 2015-16.
Much of this rise in cases has been attributed to the increased awareness of ADHD symptoms over the last several decades. Education efforts in medical and educational communities have helped to refer more children for screening when they exhibit possible ADHD behaviors. Furthermore, the Diagnostic and Statistical Manual of Mental Disorders has expanded upon what those behaviors may include. For example, more educators and medical professionals are now aware of the inattentive type of ADHD, which has led to an increase in diagnoses for girls.
How Many Children Are Misdiagnosed with ADHD?
When looking at these statistics, it’s easy to appreciate that there are fewer children falling through the cracks when it comes to ADHD diagnoses than there were previously. But the increased public awareness around ADHD can also lead to a misdiagnosis in some cases, especially when age is a factor.
According to research from Michigan State University published in 2010, there were nearly 1 million children in the U.S. who were potentially misdiagnosed with ADHD. This study found that children who were the youngest in their kindergarten class were more likely to be diagnosed and prescribed behavior-modifying stimulants as treatment for their ADHD.
The age difference between the diagnosed student and their classmates was critical here. Researchers discovered that the youngest students in kindergarten classes were 60% more likely to receive an ADHD diagnosis compared to the oldest children in the same grade.
Because the child is younger relative to the other students in class, their teacher may perceive their symptoms to be unusual. For example, their fidgeting or inattention might be much more noticeable than that of their peers. This may cause the teacher to believe that the child is a good candidate for ADHD screening.
However, in some cases, the behavior differences may largely stem from the difference in age than a neurodevelopmental disorder like ADHD. There is a significant amount of emotional and intellectual development that takes place from age 5 to age 6, so the youngest students may simply behave differently than the oldest.
Taking a Closer Look at Teacher Perceptions
Because there is no blood test for ADHD or neurological markers which can be checked, medical professionals base their diagnoses primarily on observed behaviors. When assessing a child’s behavior, teachers are instrumental in determining what symptoms are present and how frequently they take place. They also have the added benefit of seeing how a child’s behavior compares with their peers, which can assist in recognizing when things like hyperactivity and impulsivity are beyond the norm for a certain age group.
In this Michigan State University study, researchers looked at the way teacher perceptions can affect ADHD diagnosis rates. Clearly, it’s not the teachers who are making the actual diagnosis for a student. However, their input is weighed heavily when doctors consider whether an ADHD diagnosis is applicable. Often, it’s a teacher who first refers a child for evaluation by a mental health professional for a possible ADHD diagnosis.
It's important for teachers and doctors alike to be aware of the potential for a misdiagnosis among the younger students in their class. In these situations, professionals must consider whether a student’s behavior could be linked to an age-related maturity level that stems from school start cut-offs for each grade.
Sex-Based Diagnosis Differences
In addition to age, sex can also be a factor in ADHD misdiagnosis. Boys are much more likely to be diagnosed with ADHD than girls. Girls tend to have less disruptive symptoms related to inattention and adapt better in school settings. Meanwhile, boys have more noticeable symptoms that are closely associated with the prototypical idea of ADHD, namely hyperactivity and impulsivity.
This has led to two potential problems. First, girls may be underdiagnosed due to the lack of awareness around how this disorder presents in females. And second, boys may be overdiagnosed. As a result, there are concerns that misdiagnosed boys may be treated with stimulant medications for ADHD without actually needing them, essentially medicating them for normal childhood behaviors. It’s important to watch out not just for girls being overlooked in terms of ADHD diagnosis, but to make sure boys are not being diagnosed hastily.
Conditions Which May Be Misdiagnosed as ADHD
Misdiagnosis may also occur due to the symptoms of ADHD overlapping with those of other conditions. When medical professionals assume certain behaviors are evidence of ADHD, they could overlook other potential causes of those symptoms. Some of the conditions which feature symptoms closely associated with ADHD include:
Children with ADHD may struggle in school due to their inattention and trouble with memory. Disruptive behaviors can make it harder for them to succeed in the classroom. Learning disabilities also lead to classroom struggles, but they are not necessarily linked with ADHD.
Autism spectrum disorder
There are several behaviors associated with ADHD which often show up in people with autism spectrum disorder (ASD), like fidgeting, constant movement, impulsivity, frequent frustration, and difficulties with social interactions. Both ASD and ADHD are neurodevelopmental disorders, and both rely on observations for diagnosis, which can make them more difficult to tell apart.
People with bipolar disorder may exhibit excessive talking, impatience, restlessness, and outbursts, all of which are symptoms of ADHD. With bipolar disorder, however, these symptoms usually only arise during manic episodes.
Depression and anxiety
Some of the symptoms of depression and anxiety overlap with those of ADHD, like mood changes, poor concentration, restlessness, and impulsivity. This can lead to a potential misdiagnosis if these symptoms are attributed to ADHD rather than anxiety or depression.
Sleep issues are common among children with ADHD. Furthermore, lack of sleep can lead to problems with concentration, memory, and communication, which are all associated with ADHD.
If a child can’t hear well, they may seem inattentive or have trouble with things like following directions. Hearing problems can also lead to challenges in social situations. Children who are being screened for ADHD aren’t always screened for hearing loss as well, which can lead to a potential misdiagnosis.
It’s important to note that many people with ADHD have comorbidities. In fact, about 50% of people with ADHD also have another condition that requires treatment. So while some people are misdiagnosed with ADHD, others do have this disorder along with another closely linked condition. Medical professionals need to closely monitor the outcomes of treatment since persistent symptoms could indicate a potential misdiagnosis or the presence of comorbidities.
ADHD Misdiagnosis in Adults
Most coverage of ADHD misdiagnosis focuses on children. However, there are more adults being diagnosed with ADHD than ever before, which has some concerned that these adults may be overdiagnosed.
Some studies propose that a greater concern is the fact that ADHD symptoms may be confused for another condition in adults. This could be due to the fact that, by adulthood, some individuals with ADHD have adapted to their disorder and found better ways to minimizing or masking symptoms over the years. In other cases, symptoms of ADHD are mistaken for those of mood or personality disorders, such as depression, anxiety, bipolar disorder, or borderline personality disorder.
Whether or not these other conditions come into play, it’s important to be aware of the potential for overdiagnosis or misdiagnosis in adults. One of the main dangers with this is the possibility of overtreatment, specifically when adults are prescribed stimulants which they don’t actually need.
Is ADHD Overdiagnosed?
Although misdiagnosis can occur, most scientists have found that, in general, ADHD is not widely overdiagnosed. While there are some situations that deserve a closer look, like high rates of diagnosis among the youngest students in each grade level, the overall rates are not rising due to overdiagnosis. Instead, the consensus is that increased public awareness and education about ADHD since the 1990s has led to higher rates of diagnosis. Treatments have also been made more readily available along with additional medication options, which has also helped to get more children and adults diagnosed in a timely manner.
Use this guidance to watch out for potential misdiagnosis pitfalls. The more you know about the ways in which ADHD may be mistakenly diagnosed or confused with other conditions, the better you can advocate for yourself or your child.