A question came up in class the other day: do I believe ADHD is over-diagnosed?
Students ask this question every semester. Parents ask me the same question in my counseling office on a regular basis.
I’ve always had a problem with the term over-diagnosed. I keep thinking of a retailer who has over-stocked a particular item. He thought he could move 100 units; instead, he only sold 50. Oops. It’s an honest mistake that I’m sure happens to many retailers. The solutions are simple: have a sale, repackage the product, or bundle it with something else that customers want. The retailer needs to do something to move that product.
In mental health, we’re not moving a product. A person either has ADHD or they don’t. So it isn’t a question of over-diagnosis. It’s a matter of mis-diagnosis. Do I believe kids without ADHD are misdiagnosed with the disorder? Yes. The best evidence suggests that somewhere around 3% of children in the US could be accurately diagnosed with ADHD. That means maybe one child in a class of 30 has an Attention Deficit problem.
Look around classrooms today and you’re likely to find many more than 3% labeled with this diagnosis. And that’s not just an honest mistake. A mis-diagnosis could mean the child sees himself as damaged goods, adults in his life may treat him differently, parenting and behavior problems could be overlooked, and – the worst case scenario – he could be on medications he doesn’t need to be on.
Over-diagnosed implies “oops!”. Mis-diagnosis implies professional incompetence and potential harm to kids.
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