ABC News Online (Australia) reports that diagnoses labeling children as AD/HD are wrong up to 75% of the time. A Western Australian parliamentary committee reported that misdiagnosis is commonly related to mistaking AD/HD to other conditions. This discrepancy was discovered after careful examination of labeled students by a team specializing in AD/HD. The study also indicated that Western Australia prescribes more dexamphetamines (speed) in the treatment of ADHD than anywhere else in that nation. Special thanks to blogger Dr. James Baker for bringing this story to my attention. It relates to several other stories making press at this time. His perspectives on AD/HD over-diagnosis are quite insightful.
But what if I really have a problem?
The International Herald Tribune (IHT Online) reports that children with true behavioral problems – including AD/HD – frequently are underdiagnosed in the UK because, as a parent in the article said: “I am at the end of my tether,” French said. “Hardly anyone at the National Health Service knows about it, and neither do the educational authorities. People here just don’t want to recognize it. They think ADHD is just an American version of being a naughty boy.”
As opposed to the 5% to 10% of American children diagnosed with AD/HD, the article states, In England, well under one percent carry the diagnosis, although recognition is growing. In countries like France and Italy, many if not most doctors do not believe the condition exists.
According the Dr. Russell Barkley , the average time to get a child diagnosed with ADHD is one to two years in the US. However, the IHT reports that, in Italy, where a recent study found that the lag time from referral to diagnosis was more than three years, medicines to treat ADD were not licensed until this year.
Furthermore, While many leading scientists believe there is excess diagnosis and overmedication in the United States, they concur that the condition has been seriously neglected in Europe – although that trend is changing. “The rate of the condition is probably the same everywhere, but there is big undertreatment here,” said Dr. Eric Taylor of the Institute of Psychiatry at Kings College in London. Gatekeeping in schools and by doctors filters out 90 percent of these children, and tells them they don’t have a disorder.
The article also says, People shy away from the diagnosis of ADD in Britain “because it feeds into panic about the traditional family breaking down,” Taylor said. “In Italy, with its family focus, it is blamed on the upbringing. French psychiatry is very Freudian, so it is all about psychoanalysis. Many doctors basically don’t recognize ADD. There are many very desperate families.”
Like the child mentioned in the ABC Online article, the IHT reports that This is a lesson that has been learned the hard way by some British parents. By the time Monica Harris’s son was diagnosed with ADD at age 12 and started on Ritalin, he had been suspended many times, sometimes for months on end. Teachers told Harris, who is black, that he was rebelling against his parents’ mixed-race marriage.ADHD and the Creative Child
In Understanding ADHD and the Creative Child, Colette Bouchez reports that ADHD students and gifted, creative children frequently share some traits.
People who don’t understand intelligence and giftedness and creativity think that if you’re smart you ought to know how to behave, and if you don’t behave you’re not smart – or you have something wrong with you – but that couldn’t be further from the truth,” says Minnesota child psychologist Deborah Ruf, PhD, National Gifted Children’s Coordinator for American Mensa and author of the book Losing Our Minds: Gifted Children Left Behind.”
Are they over diagnosed or not?
The answer is probably that children are over diagnosed. If we look at the diagnosis cycle, we find that parents commonly get their first recommendation from their child’s teacher. The parent then takes the child to the family practitioner or their pediatrician where diagnosis is made in short order – twenty minutes of interview time. Pediatricians and family practitioners are typically not specialists in ADHD, but they wield the authority to prescribe medication.
Since ADHD is now a common diagnosis, I suggest a battery of tests for both parent and child as standard practice. The battery should include behavioral ratings scales, computerized tests of attention (IVA, TOVA, etc.), a full physical, visual screening, auditory screening, a full parent and child interview, and a learning abilities inventory. This would provide an adequate picture of the child to determine whether he/she is gifted, has learning disabilities, is visually impaired, or is misbehaving because mother and father are in the middle of a divorce. Thoroughness should be the standard, not the exception.
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