No evidence ADHD is being over-diagnosed, say experts
12h 42m ago by lemmus.org/u/Beep in science from www.cam.ac.uk
Overdiagnosis is not a problem, but misdiagnosis may be as people are driven into the private sector by long waits, and sadly, missed diagnoses remain common —Tamsin Ford
Experts are warning that far from being over-diagnosed, people with ADHD are waiting too long for assessment, support and treatment.
Isn't it strange how we discovered a lot more stars after inventing telescopes?
Obviously there was an unrelated increase in stars born at that exact time.
To try to explain the increase of stars in the universe without it's correlation with vaccine rates is just disingenuous. \s
Everyone knows that if the nebula takes paracetamol during pregnancy it increases the chance of K-type star creation.
The nebula: "Cut me sing some slack, i had an astronomical headache"
This is actually the most apt analogy for the whole "sudden increase in diagnosis" bullshit line that anti-vaxxers and anti-science people continually vomit out.
A culture where people believe ignoring your mental health issues makes you more strong, more independent, more of a role model… They think people have been fine for generations, and all of a sudden “fine” people are now being diagnosed with all kinds of problems.
I can understand their logic when I first understand their mistakes.
I'm in no way an anti-vaxxer or anti-science (I'm a researcher myself). I still think it can be justified to look closely at the large increase in, and volume of, various mental disorders. First of all: There's no doubt that a lot more people are being diagnosed due to better diagnosis tools.
However, a major difference between psychological and somatic illness is that the divide between sick and healthy is (typically) a lot sharper in the latter case. Either you have an injury or infection, or you don't, and we can measure that. In the case of e.g. depression or ADHD, there's a much wider gray zone from e.g. "healthy person having a bad day" to "clinically depressed".
The point I'm getting at is this: When a certain percentage of the population is diagnosed with a disorder, you have to ask whether we've started diagnosing ordinary human existence as a disease. Alternatively, you have to start looking at a systematic level for why an enormous portion of the population has a certain disorder. Where that limit should be is an open question, but I would argue that when something like 10-20 % of the population has a specific disorder, we're no longer just looking at individual cases of disease but rather at (a) the possibility that the criteria for diagnosis are two wide, so we're catching "healthy" people with it, or (b) we have a society-level problem (e.g. an epidemic).
I know of areas with ADHD-rates around 20 %. For a somatic illness, we would never let that kind of infection rate pass without taking a closer look at what's going on at the societal level.
You cannot equate ADHD and spectrum mental conditions with disease. For one they are not a disease, you cannot catch them and you cannot give them to other people. They are the way people's brains work. People are just born that way, same way people are born gay or trans, smart or dumb, handsome or ugly. You can't have an outbreak of ADHD or autism the same way you have an outbreak of the flu or covid.
People have been searching for environmental factors for autism, ADHD, depression, and all kinds of mental conditions for years. Other than crackpot anti-vaxxers and people like RFK Jr who try to throw life saving vaccines and common medications like Tylenol under the bus with literally no literature whatsoever to back it up, there has been no links discovered. Genetics and fetal gestation is weird and people just get born different sometimes. We as a society need to accept that and stop thinking these are diseases that need to be "fixed".
My cousin was diagnosed by a brain scan. She signed up to be part of a clinical trial for something else, got kicked out of the trial because her fMRI showed she had ADHD.
So if we can literally scan someone's brain and diagnose them from a picture instead of all these vague "describe your symptom" guessing... why don't we?
Money
It's quite costly to run an fMRI. Not needed if you can get the same results more or less from a questionnaire.
In my professional experience, it can be hard to tell between ADHD symptoms and CPTSD symptoms. The checklist is not a great way to diagnose people. We usually do a lot more assessments, I also use a computerized test to measure reaction time and error commission.
I wish we (therapists) at least had the option to order an MRI or recommend a doctor orders one in difficult cases (I can do the latter but they will just laugh at me).
Ya, it could be better. Maybe a compromise would be to go with EEG machines which are less costly and can probably still differentiate fairly well (maybe).
I would be down with that as long as it’s a viable way to diagnose (I don’t know enough off the top of my head about it).
Basically anything other than self-report and the clinician’s opinion would be nice.
Wait, is there an actual chance to "see" ADHD in an MRI image? I was under the impression that we can't do that (yet) and the only way to diagnose was through questionnaires, attention testing and such. That's what I was told by the doctor who ultimately diagnosed me two years ago
Wait, is there an actual chance to "see" ADHD in an MRI image?
Only fMRI, which is different, and even more expensive. It's basically the same as asking you a bunch of questions but then seeing which parts light up. Brain can't lie.
Do you know if there any studies on whether the effects of the medicine used for ADHD could have similar positive effects on people with CPTSD?
It's also worth noting that ADHD, as a condition, is mostly a Gordian knot of maladaptations. Built up over childhood (and beyond). While there are a lot of commonalities, you need to do a detailed investigation to pick out what bits are a problem to the individual.
If you're going to go through that process, then you might as well not tie up an MRI machine for no reason.
Drugs can treat the base problem, but don't work well without the follow-up care to repair the behavioural damage.
All of this applies to Autism, as well.
It’s almost as if we’ve gotten better at understanding the condition overall and in nuance.
According to the administration at a school I’m familiar with, at least 50% of the 5th grade class has ADHD.
So, not having ADHD is the disorder.
Their source is they made it up. Getting diagnosed is a pain and there is no way 50% of any sizable population has gone through that process, let alone received a diagnosis.
50%?
The national stats are ~1:10 people have it. 50% is a huge anomaly. Something isn’t right.
Yes, what isn’t right is that it’s an upper class private middle school full of wealthy parents with access to psychiatrists who are financially motivated to provide a fashionable diagnosis.
It’s also a way to get extra time (accommodations) on standardized tests (time and a half or even double time) which further widens the success gap between rich and poor students.
It’s also a way to get extra time (accommodations) on standardized tests (time and a half or even double time) which further widens the success gap between rich and poor students.
A prescription for Ritalin /Adderall would probably help too
Vanity diagnosis.
I know a 5 year old that the teachers at her private school complained that they were spending to much time talking to other children instead of doing school work so the teachers recommended that she be put on medication.
Now apparently she just has horrible night terrors that has her rip at her skin each night but she's much more calm now... Anyways the teacher ended up hitting her and the 5 year old got expelled for being a nuisance anyways.
This…doesn’t make much sense. Teacher struck the child and the child got expelled? Where do the night terrors come in? This sounds very little like ADHD.
The night terrors came after starting the medication.
But also yeah, some real bullshit with the school and the teacher. The only thing on record was that she was obstinent and difficult to deal with. Due to multiple issues with apparently that she was expelled. But afterwards her friends came forward to ask if it was about her being hit that she wasnt in class anymore.
Its honestly bad all around.
ADHD meds absolutely can cause bad dreams in kids, I don’t know about bad enough to “tear at skin”, that’s outside my knowledge area. We had to get a different script for a family member because of scary dreams and racing heart, difficulty sleeping, even after adjusting dosage. It was doing more harm than good. After the med swap it got way, way better.
Yeah, the parents were warned about the night terrors and supposedly hanging outside the room to be there to cuddle her as soon as she starts screaming is enough to subside them and get her back to bed but jeeze that is a horrible symptom to be ok with or even struggle through. Flailing and scratching, if it leaves marks I would call that instastop bad.
I am on the side of med swap but they supposedly like the results of the medication otherwise which I feel is not worth it.
Oh no, she's got the bugs. If you're on the wrong dose, or that particular stimulant doesn't work well for you, it can start to feel like you've got bugs crawling under your skin.
Oh... Ew.
She was never able to voice the issue just said it was scary so.. Thank you.
I spent a number of years doing care for developmentally disabled adults, and saw it there. It's a terrifying situation to be in, and I hope they can get it figured out for her!
No, that isn’t worth it. That’s just wrong and f’d up putting your kid through that. Damn, just get a different script. Odds are another will do the job.
Yup, but being a parent doesnt make you know things and "the doctor said we should expect this" makes apparently people (at least these ones close to me) complacent to the harm. I am just against the suffering and it makes me upset. While I know this isn't a likely common story its one that is close to home and happening so... Yeah. I dunno. It does at least once. I am happy you are on the right side of empathy to try again with something new to help someone. There should never be 1 answer only and it feels wrong to just accept it.
I dunno this is such a failure of people with authority in my case but authority figure doesnt mean all knowing. And I have no authority to make it stop.
Glad to know that because of this one totally believable piece of anecdata, ADHD doesn't fucking exist.
That wasnt stated. You are not responding to me but your own internal issues with other conversations
At what point does it just become a personality trait, like introversion vs extroversion?
When it causes active problems with life. It's also worth noting that it's a brain chemistry change. Where on the sliding scale you pick is, ultimately, a little arbitrary.
I personally suspect modern life isn't helping. The pressures on children are quite different now. I suspect many children who wouldn't develop symptomatic ADHD in earlier years now do.
When it stops having negative outcomes on peoples' lives.
Do we ever stop and think that the negative consequences are from our newly constructed hyper engagement focused society?
And maybe we are blaming the individuals for failing to live up to an impossible standard of productivity at the behest of our abusers?
It's the other way around. ADHD gives people an evolutionary advantage in crisis situations. Surviving through war, famine, and all the worst situations that humanity has survived through.
ADHD isn't incompatible with modern life because it got too hard. It's incompatible with modern life because it got too easy.
Hmm. Yeah, we as a society want people who can at tedium repeat a basic task and then not interact with the world much more than that or what is sold to them.
So I wouldn't say easy as much as easy as it is very difficult for those with it but simplified. And the toys we have created to play with to distract them/us from how basic our life is are incredibly dangerously good at mimicking progress.
If you want to completely fucking ignore science and be an ingorant fuck, then yes, you can say those things.
Let's be clear about this shit.
Because of my undiagnosed ADHD, when I failed fourth grade and the school board tried to get my parents to sign custody of me over to the state to be put in an institution until the STATE decided to release me, when my parents said "Fuck no", they tried to put me in a private school, but there wasn't one close enough, so I got to be homeschooled. Which went poorly with my undiagnosed ADHD.
I managed to get to 2nd and 3rd college year level in all subjects except math (where I was at 11.5th grade level) by the time we were in the middle of the tenth grade school year, because I was "blessed" by high IQ - which is fucking useless, except it measures how quickly you can learn, and I managed to pick up enough even with all the struggles.
I got into college, but I failed - three attempts at it.
I had trouble keeping jobs, thanks to my ADHD.
I finally got my ADHD diagnosis at age 30. The therapist who diagnosed me said I was the most severe case he'd ever seen.
It was after that that I tried college a third time, but thanks to IRS stupidity - long story - we got screwed and I lost my scholarships because we couldn't prove we didn't owe $14k to the IRS that we didn't owe.
Meanwhile, I still had trouble keeping jobs, so I had no healthcare. So when I was diagnosed with diabetes, they put me on metformin. I didn't get any education. I knew to cut out sugar but I didn't understand carbs. And what do you live on when you're poor? Carbs. So the metformin alone did hardly anything.
So I lived for ten years with unmanaged diabetes because the metformin was all I could apparently afford. Thanks to the US healthcare system and to my ADHD.
I had a saddle pulmonary embolism and nearly died, and that's what enabled me to convince my wife to let me look for work nationally. We ended up in Virginia from Florida and I have insurance and have my diabetes under control, but the damage was done. I've had six heart attacks and my kidneys failed so I'm now on dialysis. I also had to have a below-knee amputation, so I'm a wheelchair user on top of that because with the fucking anemia I couldn't walk, so I've lost that ability.
Thanks to all of that, I'm 50 and I'm maybe going to see 60 if I'm lucky, but probably not.
Thanks in large part to my ADHD. I strugle every single fucking day with my ADHD and its effects.
So pardon me if I feel a little rage when you suggest that perhaps modern day life is "causing" this shit, because fuck anyone who says that. I'm sick of hearing people deny ADHD. I'm sick of people saying "we ALL are a LITTLE ADHD". NO YOU ARE FUCKING NOT AND HOW CAN I TELL? BECAUSE IT DOES NOT FUCKING IMPACT YOUR LIFE TO THE SAME DEGREE IT DOES THOSE OF US WITH ADHD. SO HOW ABOUT SIT DOWN AND SHUT THE FUCK UP ABOUT THINGS YOU DON'T KNOW ANY FUCKING THING ABOUT AND STOP DENYING THE SHIT I HAVE DEALT WITH ALL OF MY FUCKING LIFE.
So there. You shitty people want to downvote something? Go ahead and downvote that. Feel better about yourselves, but you can also fuck off and be wrong.
STOP FUCKING TRYING TO DENY ADHD. LOOK AT THE GODDAMN FUCKING SCIENCE. OR SHUT THE FUCK UP AND FUCK OFF.
I didn't read that comment so uncharitably. I think they're saying that society is unkind to people with ADHD.
Yeah we don't exactly have an equal world. Or one that even allows for much deviation without heavy punishment as basically seen by... Well above comment.
Sounds rough. Don't take it out on me.
I spent most of my life undiagnosed, because it used to be believed that only boys could have ADHD. But I knew, and was formally diagnosed as an adult only at the insistence of my partner.
Most data suggests it is under diagnosed.
Especially in women, like by a lot.
Serious question: how would we be able to detect if we’ve over diagnosed a mental disorder such as ADHD? What would evidence for that look like?
From the linked research article:
‘Over-diagnosis’ is observed when the prevalence of diagnoses made in clinical services, referred to as administrative prevalence (based on healthcare databases or insurance claims) exceeds prevalence estimates based on accurate assessments in representative population-based samples. Over-diagnosis may occur when diagnostic criteria are not applied with sufficient rigour, leading to false-positive cases. Over-diagnosis may also happen when people inappropriately self-diagnose. Notably, for individuals with milder or subclinical symptoms, a diagnosis can sometimes do more harm than good, creating stigma or leading to low-benefit treatments with significant side-effects.
So is Admin Prevalence > Prevalence Estimates where the estimates are made based on representative population-based samples?
I was diagnosed in my late 50's. It was a complicated process because there is another mental health co-morbidity that shares some traits.
After going through the more than a year long process, we are working on dialing in the meds.
One of the challenges for diagnosis is that the attention economy is shortening a lot of people's attention span, causing many people to feel that they have ADHD, and diverting resources from diagnosing people who actually have ADHD. Not saying that the issue shouldn't be addressed. The combination of these factors, and the rather long and complicated process of a proper diagnosis is a challenge.
I believe that we are diagnosing at an appropriate rate (maybe even still under). I do think that we are getting better at recognizing the signs, having resources, and finding support. But I also think there is an increase not only attributed to better diagnosing. I think that the amount of unstructured screen time before kids are able to develop an independent thought is also creating a myriad of neurological disorders. Not saying that kids with ADHD or anything else aren’t more susceptible, because they definitely are, but I think we’ll start to find that it’s also part of the cause and not just a symptom.
This is a recurring issue. Too many trans people? Liberal agenda spreading!
It’s like they don’t understand causations.
it is still undoubtedly the case, however, that there are plenty that self-diagnose because people on social media make it seem "cool" or to be special in some way, without any basis on actual symptoms. Same happens for a lot of other mental health conditions too.
ADHD may not be over-diagnosed by professionals. But did they also check if it was self-over-diagnosed?
I personally suspect environmentally caused ADHD could be a thing.
Ultimately, if the treatment methods and suggestions help, I have no issues with it being treated.
It's also worth noting that ADHD (and sub diagnosis ADHD) are disproportionately represented in certain groups. My wife didn't realise she had a problem till well into adulthood. Since she was diagnosed, over half her friendship group are either diagnosed, or in the process.
That’s probably most likely yes for just about any disorder, I’d think. Diagnoses should become more accurate as you visit more professionals and get more information. Having less of that would mean less accuracy. Having none of that is, well…