The continued rise in the diagnosis of attention-deficit hyperactivity disorder (ADHD) is catching the attention of researchers, doctors, healthcare providers and parents alike.
A recent analysis of ongoing research, however, suggests that the situation is not as it seems. Indeed, researchers are finding that children with autism spectrum disorder are being incorrectly diagnosed with ADHD.
The Problem of Over-Diagnosis
The Centers for Disease Control and Prevention (CDC) is reporting that recent surveys suggest that as much as 11% of children 4-7 years of age have been diagnosed with ADHD. This alarming report shows a steady increase in ADHD diagnosis being tracked in recent years.
“The percentage of children with an ADHD diagnosis continues to increase, from 7.8% in 2003 to 9.5% in 2007 and to 11.0% in 2011,” states the CDC report. “Rates of ADHD diagnosis increased an average of 3% per year from 1997 to 2006 and an average of approximately 5% per year from 2003 to 2011.”
While these statistics are raising eyebrows, not all are convinced of their accuracy.
“What is going on here?” asks Sanford Newmark, MD, head of the Pediatric Integrative Neurodevelopmental Program at the Osher Center for Integrative Medicine at the University of California in San Francisco. “Have 11% of our children always had ADHD and we just missed it? Has some cataclysmic genetic or epigenetic shift taken place, causing ADHD to be the most prevalent childhood disease, second only to obesity? I don’t think so.”
The CDC statistics can be explained by two factors, says Newmark: One, “Over-diagnosis through inadequate evaluation and societal pressure for treatment,” and, two, “A significant increase in the demands being made on our children, schools and families.”
Newmark goes on to say how an accurate diagnosis of ADHD takes time and resources to examine the child’s environment. Thereafter, conditions with similar symptoms can be ruled out. Referencing other studies, Newmark feels that doctors are often not distinguishing between ADHD and something as simple as immaturity.
Looking back on his childhood, Newmark finds that he had much less required of him in school than is required of children in today’s world.
“Kindergarteners are now expected to learn to read. Of course, most of them can do so — although studies indicate there is no overall cognitive benefit to this earlier training — but there are some children whose neurodevelopmental level is just not high enough for this level of challenge,” Newmark states.
Newmark is not the only one concerned that ADHD is diagnosed too often.
“One of our best current screening measures for ADHD may be over-diagnosing ADHD in children with autism,” says Benjamin Yerys, a researcher at the Center for Autism Research at Children’s Hospital of Philadelphia and leader of a study published in the Journal of Autism and Developmental Disorders. “This is important because medications that work for ADHD may be less effective for a child on the autism spectrum.”
So, what is the difference between ADHD and autism?
Differences Between ADHD and Autism
While ADHD and autism share many symptoms, it’s generally agreed that these disorders are actually quite different from one another.
“Both disorders may affect sufferers’ social interactions, their ability to follow directions, and to stay focused,” reports Reader’s Digest. “But neither autism nor ADHD has one symptom that makes making a diagnosis easy. Both disorders display a combination of symptoms, and thus a professional evaluation is necessary to clarify whether someone suffers from autism or ADHD.”
Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder of childhood. Children have difficulty focusing, listening to direction, and keeping themselves organized. While diagnosed when a person is a child, it usually lasts until he becomes an adult.
On the other hand, autism spectrum disorder (ASD) is a developmental disorder that impairs a child’s ability to communicate (more so than ADHD). It also causes the child to have problems with socializing and behaving. A child with ASD will be less likely to understand how their actions or an external event will affect other people (especially in comparison to a child with ADHD).
“People with ASD may communicate, interact, behave and learn in ways that are different from most other people,” says the CDC. “The learning, thinking and problem-solving abilities of people with ASD can range from gifted to severely challenged.”
ADHD Rating Scale
A current tool often used in the diagnosis and management of a child, teenager or adult with ADHD is the ADHD Rating Scale. This scale comprises approximately 20 (or even as many as 90) questions that are based on direction from the Diagnostic and Statistical Manual of Mental Disorders (DSM). The questions identify symptoms such as talking too much, interrupting others and being impulsive.
The issue researchers are currently finding is children with autism spectrum disorder may get diagnosed as having ADHD. And this can result in disappointing results in treatment as well as wasted resources.
“This is important because medications that work for ADHD may be less effective for a child on the autism spectrum,” says Yerys.
Fixing the Scale
As the cases of ADHD continue to escalate, many are calling for all parties involved to work together to find a testing solution that is more accurate than what is currently in place.
“Until we’re able to develop and validate a new rating scale that takes symptoms of autism into account, parents who are concerned should seek out clinicians who are conducting evaluations for ADHD and are also taking into account the possibility of autism,” says Yerys.
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