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What
is the cause of the
misdiagnosis of ADHD, and how devastating are the effects of
misdiagnosis?
by Nick L. Exhibitions
Home | Introduction | Research Paper | Works Cited | Exhibition
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Research
Paper
PDF Version | Introduction | Why I'm interested | What is ADHD? | Possible causes | Diagnosis Treatment | Medication | Coexisting conditions | Subjectivity | Conclusion | Works Cited | Introduction Imagine you are an average high school student sitting in class. As you look around the room you realize that 1 in 7 of your classmates is under the influence of a powerful drug that has properties in common with both cocaine and speed. No, it’s not the newest teenage drug craze, it’s legally prescribed
stimulants. Between 1995 and 2000 the overall use of Ritalin and
other stimulant drugs for Attention Deficit/Hyperactivity Disorder
(ADHD) has increased by 700%. Even the diagnosis of this disorder
has become much more common. ADHD is the most common neurobehavioral
disorder in children, and one of the most common public health
problems in children between 6 and 12 years old (Haber 3-4). Due to
their sometimes heavy side effects and addictive properties, the use
of stimulant drugs to treat disorders like ADHD is very
controversial, especially in young children. According to a study by
the American Academy of Pediatrics, about 3-5% of children have had
ADHD constantly since about 1940, however in most schools, about 15%
of students take ADHD medications every day (Haber 1). This means
that twice as many people who don’t have ADHD are taking
medications than people who do have it. How could this be? It is
my belief that the misdiagnosis of ADHD is caused by a combination of
incomplete diagnoses, other afflictions being mistaken for ADHD, and
the sheer subjectivity of the diagnostic criteria. Why I'm interested I was diagnosed with ADHD when I was 6 years old, and have been on some form of stimulant medication for almost all of my life since then. I started taking Ritalin in first grade, and since then I’ve taken a plethora of other medications including Adderall, Adderall XR and Concerta. When I was 8, I went to a semester of group therapy sessions used to treat young children (ages 6-10) with ADHD and teach them to control their behavior on their own. In seventh grade as well as in the past few months, I’ve served as an assistant to Dr. Jeff Sosne, the pediatrician who runs the group. I watched the children learn the same lessons I once learned, as well as observed them and the way they act. I spent a lot of time talking to the children’s parents as well, in some cases talking about their children and their experience with ADHD so far. My favorite part of working with the group was talking to the parents and observing their attitudes towards their children and ADHD. Seeing how the parents interact with their children and vice versa was a very interesting learning experience for me, and I’m glad I got to talk to them firsthand. Almost all of the children in the group were on some form of stimulant medication. I’ve been interested in the diagnosis and treatment of ADD/ADHD essentially since I was old enough to understand it. I’ve always had a bit of a bias towards the argument that it is diagnosed too easily, and that most people who take them don’t actually need them, but I’ve tried my best to save my personal opinions for the conclusion. I’ve also tried very hard to keep a wide variety of sources showing different opinions on the subject. (back to top)What is ADHD? Attention Deficit/Hyperactivity Disorder, or ADHD, is characterized by a loss of the ability to concentrate on certain tasks, unpredictable behavior and hyperactivity (Newton, Olendorf, Jeryan and Boyden 97-98). When hyperactivity is not present, it is known as ADD (Newton, Olendorf, Jeryan and Boyden 97-98). It is also known as hyperkinetic disorder (HKD) outside of America (Newton, Olendorf, Jeryan and Boyden 97-98). Symptoms of ADHD can present themselves as early as age two or three, but most commonly shows up and is diagnosed around adolescence (Newton, Olendorf, Jeryan and Boyden 97-98). Often the hyperactivity and other more severe symptoms of ADHD will lessen with age, but the more subtle ones such as inattention to detail may well stay with the patient until adulthood and throughout the patient’s life (Newton, Olendorf, Jeryan and Boyden 97-98). A child with ADHD may be very smart, but still receive poor grades due to their inability to focus on their work (Newton, Olendorf, Jeryan and Boyden 97-98). Common symptoms of ADHD in children include being overly active, constantly moving, running, climbing, squirming and fidgeting (Newton, Olendorf, Jeryan and Boyden 97-98). It is thought to be hereditary as statistics show that children of people with ADHD are much more likely to have it (Newton, Olendorf, Jeryan and Boyden 97-98). Some believe that it is caused by an imbalance in the brain’s neurotransmitters, which are chemicals that send messages from one’s brain to the rest of one’s body (Newton, Olendorf, Jeryan and Boyden 97-98). (back to top)Possible causes (back to top) Diagnosis -Often has difficulty sustaining attention in tasks or play activities -Often does not seem to listen when spoken to directly -Often has difficulty organizing tasks and activities -Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort -Often loses things necessary for tasks or activities -Is often easily distracted by extraneous stimuli -Is often forgetful in daily activities -Often fidgets with hands or feet or squirms in seat -Often leaves seat in classroom or in other situations in which remaining seated is expected -Often runs about or climbs excessively in situations in which it is inappropriate -Often has difficulty playing or engaging in leisure activities quietly -Is often “on the go” or often acts as if “driven by a motor” -Often blurts out answers before questions have been completed -Often has difficulty awaiting turn -Often interrupts or intrudes on others (e.g., butts into conversations or games.) (back to top)Treatment -Adderall (amphetamine mixture) -Methylin ER (methylphenidate) -Adderall XR (amphetamine mixture) (back to top)Medication Stimulant medications are well known for their long list of side effects: -Obsessive-compulsive behavior -Zombie-like (robotic) behavior with loss of emotional spontaneity -Drowsiness or reduced alertness -Abnormal movements, tics, Tourette’s Syndrome -Visual and tactile hallucinations -Agitation, anxiety, nervousness -Irritability, hostility, aggression -Depression, suicide, easy crying, social withdrawal -Confusion, mental impairments -Stimulant addiction and abuse Withdrawal and Rebound Reactions -Rebound worsening of ADHD-like symptoms -Overactivity and irritability Endocrine and Metabolic Function -Pituitary dysfunction, including growth hormone and prolactin disruption -Hypersensitivity reaction with rash -Compulsive persistence at meaningless activities -Increased obsessive-compulsive behavior -Overly narrow or excessive focusing -Social withdrawal and isolation -General dampened social behavior -Reduced communication and socialization -Depressed responsiveness to parents and other children -Increased solitary play and diminished overall play Behaviorally Suppressive Effects -Compliant, instructured environments; socially inhibited, passive and submissive -Somber, subdued, apathetic, lethargic, “dopey,” dazed, and tired -Bland, emotionally flat, humorless, not smiling, depressed, and sad with frequent crying -Lacking in initiative, spontaneity, curiosity, surprise, or pleasure (back to top)Coexisting conditions Coexisting conditions are one of the problems that many people run into when trying to diagnose ADHD. About 50-60% of children with ADHD have at least one coexisting condition, and around 10% have 3 or more of them (AAP 199). The most common types of conditions to accompany ADHD are disruptive behavior disorders, anxiety and depressive disorders, learning disabilities and language impairments (AAP 199). Coexisting conditions often share many common symptoms with ADHD and sometimes even mimic the symptoms of ADHD (AAP 199). When the diagnosis is taking place, these symptoms can attributed to the ADHD while the other symptoms of the coexisting condition are ignored or passed over (AAP 199). This can lead to ADHD being diagnosed when the problem is truly 2 or more disorders, which is known as an incomplete diagnosis (NIMH). In some cases, it may be that the child doesn’t have ADHD at all, but the symptoms of a disorder that usually accompanies ADHD are mistaken for ADHD because it is so much more common (AAP 205). Sometimes, especially when ADHD is diagnosed at a young age, it later turns out that the child only has the coexisting disorder, and doesn’t have ADHD at all (AAP 202). For example, Conduct Disorder is a disruptive behavior disorder that is defined as “a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate social rules are violated” (AAP 205). Aggressive behavior, one of the most common symptoms of Conduct Disorder, could easily be mistaken for the impulsiveness of ADHD by teachers or other adults (AAP 205). Keeping in mind that ADHD is the most common as well as most commonly known childhood behavioral disorder, it is easy to see how something like Conduct Disorder could be mistaken for ADHD. Teachers and parents are usually the people who spend the most time around children, and are usually the first one to notice symptoms. Seeing as most teachers and parents have little to no medical training, there’s a good chance none of them have even heard of Conduct Disorder. ADHD is so common that as soon as a teacher sees a sign of impulsiveness it makes perfect sense for them to think of it before anything else. This can lead to a complete misdiagnosis. Another thing that makes coexisting conditions hard to identify is the fact that children’s behavior is constantly changing as the mind is still developing (AAP 199). Sometimes, the only thing that can be done is to wait a few years and retest the child (AAP 200). (back to top)Subjectivity (back to top) Conclusion (back to top) Works Cited American Academy of Pediatrics. ADHD: A Complete and Authoritative Guide. 2004. American Psychiatric Association. DSM-IV. Washington, DC: American Psychiatric Association, 1994. Breggin, Peter Roger. The Ritalin Fact Book: What your doctor won’t tell you about ADHD and stimulant drugs. Oxford: Perseus, 2002. Haber, Julian Stuart. ADHD: The great misdiagnosis. Lanham: Taylor Trade Pub., 2003. Newton, David, Donna Olendorf, Christine Jeryan and Karen Boyden. “Attention Deficit/Hyperactivity Disorder.” Sick! Diseases and Disorders, Injuries and Infections. 1st ed. 2000. "NIMH: Attention Deficit/Hyperactivity Disorder". National Institute of Mental Health. February 28, 2006 (back to top) |