I’m occasionally asked if I think ADHD (attention deficit/hyperactivity disorder) is over-diagnosed. In a word, no. I don’t think ADHD is over-diagnosed.
Over-diagnosis seems to imply a clinician chooses ADHD as a diagnosis when a different, less stigmatizing diagnostic category is available. I have a mental image of a clinician weighing different diagnosis: “If I diagnosis him with ‘A’, then it will be a long, slow road of counseling/therapy. But, if I diagnosis him with ADHD, then his pediatrician can start him on medication and his parents and teachers will appreciate the quick fix, even though he doesn’t really have ADHD.” I don’t think that happens; I really, really hope that doesn’t happen.
I think ADHD is often misdiagnosed; which is completely different from over-diagnosed.
I had always attributed this to sloppy clinical skills on the part of some practitioners. A report from MSNBC suggests there may be more to the story.
Parents want their kids to excel in school, and they’ve heard about the illegal use of stimulants such as Ritalin and Adderall for “academic doping.” Hoping to obtain the drugs legally, they pressure pediatricians for them. Some even request the drugs after openly admitting they don’t believe their child has ADHD.
The scenario is referred to as “acedemic doping”.
Academic doping — using these stimulant prescriptions in an effort to enhance focus, concentration and mental stamina — first started on college campuses, especially Ivy League and exclusive, competitive schools. Now, the problem is filtering down to secondary schools, Yates says, and more parents are playing a role in obtaining prescription ADHD medication for their teenagers.
Parents motives are varied:
(Dr. Nick Yates, a pediatrician and director of medical ethics for Mercy Hospital in Buffalo, N.Y.) isn’t entirely surprised that parents ask for it. He believes that most families simply have a heartfelt — if shockingly misdirected — desire for their children to do their best.
Parents can be overly eager to blame poor grades on a medical condition rather than looking for other explanations, says Dr. Michael Rater, medical director of the Adolescent and Residential Treatment Program at McLean Hospital in Belmont, Mass. “It’s usually that parents are just trying to understand their children’s struggles in a narrative that makes sense to them,†he says.
Yet some parents will do whatever it takes to keep opportunities from slipping through a child’s fingers — even outright lying to doctors to get the drugs, says Rater.
And some pill-eager parents aren’t just seeking to level the playing field, they’re trying to make their kids superstars, says Dr. Martin Stein, a professor of clinical pediatrics at University of California, San Diego.
Pressure from well-intended (and not-so-well-intended) parents isn’t an excuse for sloppy clinical work. Physicians and therapists are paid for our expertise; not for giving kids whatever their parents ask for.
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