Running head: THE OVERDIAGNOSIS OF ADHD IN THE U.S.
The Overdiagnosis of ADHD in the U.S.
Gino Salazar-Noratto
A&M Consolidated High School
CCMA
Willis
April 25, 2020
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Attention Deficit Hyperactivity Disorder, also known as ADHD, is a disorder that affects
as much as 6.4 million children and adolescents (ages 4-17) across the United States. In the past
two decades, there has been a significant increase of more than 10% in the number of children
affected by ADHD nationwide. Could it be that with more advanced diagnostic measures the
disorder is more common than was once thought? Or is it likely that physicians are
overdiagnosing this condition? Inattentiveness and/or hyperactivity are common characteristics
seen among all age groups especially young children whose brains have not fully matured yet.
As a means of getting these children to behave like responsible students in the classroom,
medical professionals resort to drugging them with powerful stimulants that have the same
potency as Cocaine. To avoid this unethical phenomenon, physicians, psychiatrists, and school
counselors need to be more meticulous when diagnosing children who have short attention spans
or seem feverish as these traits can be in fact caused by other factors and not just ADHD.
Over the years, the time required for a psychiatrist to diagnose someone with ADHD has
diminished tremendously. The first two versions of the “Diagnostic and Statistical Manual of
Mental Disorders,” the DSM I and DSM II, were based around the psychoanalytic approach to
diagnosing and treating mental illness. However, a little before the publication of the DSM-III,
the psychoanalytic theory of psychiatry was soon dethroned by the biological theory due to loss
of credibility, loss of funding, and the success of new psychiatric drugs. As a result of the
biological approach being adopted by psychiatrists around the nation, the subsequent versions of
the DSM focused on diagnosing psychological disorders based on a checklist of symptoms
instead of causes. In addition, the past few recent versions of the DSM have made the diagnostic
process quicker by lengthening the number of symptoms listed on the checklist and shortening
the amount of symptoms required to be checked off in order to receive a confirmed diagnosis.
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For example: the DSM III-R required that a child had to have eight of the fourteen symptoms
listed to warrant a diagnosis of ADHD, but later with publication of the DSM-IV eligibility for
an ADHD diagnosis was widened by reducing the number of symptoms from eight to six out of a
new checklist of eighteen symptoms (Wedge, 2015). The prevalence of inattentive and
hyperactive-impulsive symptoms of children ages 6, 9, and 16 according to the DSM IV is
depicted below (Krasner et al., n.d.):
With the diagnostic process becoming more and more shortened, it has reinforced psychiatrists
around the nation to diagnose ADHD after a mere twenty minute interview, without accurately
analyzing the patient’s medical history, background, or other factors that could mimic ADHDlike symptoms. To stop this American epidemic, psychiatrists must recognize that the same
behaviors could occur in a plethora of other non-related scenarios.
Neurotypical children who have experienced traumatic events or who have occuring
problems at home can translate their distress into academic, social, and alertness problems. These
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behaviors can be easily confused as being ADHD-like symptoms, resulting in a misdiagnosis.
When a child is exposed to traumatic events, parts of the brain that assist in communication may
get enlarged as an outcome of the exposure. In one research study that evaluated 214 children
from ages 9 to 13 years old,the brain volume of children who experienced such events varied in
three regions: the internal capsule, the tissue transglutaminase (TTG), and the Inferior Temporal
Gyrus (ITG). The results of the variations in the brain regions are depicted below (Humphreys et
al., n.d.):
Specifically, the study observed that the greater the number of stressful experiences (whether in
early or late childhood), the greater volume the three brain regions had, indicating a higher level
of ADHD-like symptoms. At the same time, children and adolescents who have existing
problems at home may exhibit problems staying motivated and/or focused in the classroom. In
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the case of Eric Montoya, a five year old with difficulties learning how to read, little Eric had
been diagnosed with ADHD prior to being evaluated using McCarney home and school scale
used frequently by school counselors. It was only after Eric’s physician had tried unsuccessfully
treating him with several different stimulants that Eric was referred to a developmental
pediatrician who evaluated his family medical history. In doing so, it was discovered that Eric’s
mother had severe Diabetes and had been hospitalized three times in the past year for cardiac
failure and kidney problems. In her current state, she had to undergo dialysis three times a week.
Eric’s trouble learning how to read was not caused by a learning disability but instead by the
turbulent situation he was facing (Haber, 2000, p.57). Psychiatrists and physicians must take a
step back and look at the whole picture to dismiss whether a child’s problems concentrating is a
product of his social environment rather than automatically rushing to the conclusion that the
child requires medication in order to focus. These children will then be able to receive the
emotional support they need to navigate through their overwhelming situations.
Children who have neurological conditions with similar symptoms of inattentiveness and
hyperactivity could be misdiagnosed as having ADHD. The frightening danger to this is that
children who are given an inaccurate diagnosis are treated with strong stimulant drugs that only
worsen their condition. Consider the case of Maria (not the patient’s real name) as an example of
this misfortune. According to Florida psychiatrist Dr. Manuel Mota-Castillo, Maria, a hispanic
teenager, had been experiencing hallucinations, racing thoughts, insomnia, elevated mood, and
grandiose ideation. Because of Maria’s increased energy and arousal as well as disruptive
behavior and distractibility in the classroom, Maria’s previous psychiatrist had given her an
ADHD diagnosis and prescribed her with mixed amphetamine salts. Given a look at Maria’s
symptoms and family history, Castillo became suspicious of whether or not Maria had a
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psychotic disorder, especially after finding out that her father had Bipolar disorder and her
grandma was Schizophrenic. Castillo then decided to discontinue the mixed Amphetamine salts
and start giving Maria Quetiapine. Sadly however, the psychotic process had been ongoing and
could not be stopped in its tracks. A week later, the girl’s mother called Castillo in desperation
since Maria had just run into oncoming traffic in response to the command auditory
hallucinations she was experiencing. Castillo advised her mother to drive her to the hospital
immediately while he spoke with the doctor on call about how Maria’s hallucinations are a
common side effect of amphetamines when they are prescribed to people with Bipolar spectrum
disorders. Despite the warning signs, Maria was hospitalized with a final diagnosis of ADHD. In
her mental status examination report, the psychiatrist treating her at the hospital admitted that
Maria was “hearing voices.”Yet this doctor also wrote that it was not clear whether Maria was
really psychotic or “just trying to get what she wants and using the symptoms to her advantage”
(Mota-Castillo, 2007). These types of problems find their roots within the newest versions of the
DSM. These diagnostic manuals commonly utilized by psychiatrists have such a broad,
indeterminate checklist of symptoms that they fail to distinguish among conditions with similar
symptoms, but that emerge from completely different disorders. To make matters worse, the
problem is aggravated by diagnostic conclusions according to the clinician’s best recollection of
DSM-IV wording, requiring only 10 to 15 minutes to reach an evaluation. In scenarios like
Maria’s, the tendency to label people with symptoms of impulsivity as having ADHD may open
the door to blaming the victim for behavior that he or she can not control and further preventing
them from receiving the medical services they require.
With clear examination of different cultures, Americans should consider introducing new
alterations in parenting styles and school systems so that ADHD type behaviors among children
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are able to subside over time without the child receiving a confirmed diagnosis. In the U.S.,
parents try to act more like friends to their children rather than authority figures and because of
this, many children do not develop the self-discipline needed so that they may control their
behavior in quiet classroom settings. In France, children are held to a higher standard and are
provided with a firm system of structure right away from the time they are born. They are
primarily strict about a few things: bedtime, the amount of television their kids watch, and
mealtimes. Additionally, French children do not explode with rage if they do not get their way.
They have learned that a tantrum, no matter how loud or embarrassing, won’t change their
parent’s opinion. Within the basic structure, children are given a few appropriate choices. For
example, while the child may not be allowed to snack between meals, at the traditional afternoon
snack time they can eat either small helpings of cookies, chocolate, or cake. This arrangement
grants kids choices, but not total freedom.The consistent structure and parental expectations
sequentially condition the children to behave respectfully in the presence of adults. A study by
psychologist Tiffany Field of the University of Miami School of Medicine found that French
three year olds behave admirably in restaurants compared to American three year olds. They eat
their meals quietly and do not argue, throw food, or refuse to eat, as many American children do.
Most importantly, French parents are still able to have loving relationships with their children
despite the implicit hierarchy of authority within French families (Wedge, 2015, pg. 31-33). The
family structure common among French families, therefore, reinforces discipline to where
children learn to behave themselves well, while at the same time providing them with the love
and compassion they need to develop good self-esteem.
While American families should preserve traditional attitudes and conventions about
child rearing like French families do, American school systems must develop a more progressive
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system of education that accommodates children with different learning styles. One country that
stands out for having one of the best education systems and for also having the lowest rate of
ADHD diagnoses worldwide is Finland. In Finland, students don’t start school until the age of 7
allowing their cognitive processing to develop more before entering the classroom. This is
because Finnish doctors and educators acknowledge that when there is little pressure to hurry a
child’s learning and no anxious parents urging for Adderall prescriptions, children are much
more likely to grow out of hyperactivity and inattentiveness. In addition, school schedules are
adjusted for every forty-five minutes of lessons, Finnish children get a fifteen minute break for
free play. After school, these children typically have no or very little homework allowing them to
join two-thirds of Finland’s children in an after school sports association. Those who question
the legitimacy of Finland’s high ranking school systems due to its ironic light load of homework
should know that teaching in Finland is considered a prestigious and even noble profession
recruiting some of the best qualified professionals for the job. In elementary schools, teachers
spend four hours a day in the classroom leaving the rest of the time for them to dedicate to
assessing their students’ progress and providing extra help to those who need it. Special help is
especially given to troubled children whose grades start to slip. The school’s team of special
educators, which include a social worker, a psychologist, and a nurse would coordinate the best
learning solution for him/her.This may mean special tutoring or simply giving them plenty of
one-on-one encouragement and support. Schools in Finland understand that not all children can
behave like quiet, compliant students and so they try to work with these kids in hopes that they
can learn how to control their impulses (Wedge, 2015, pg. 117-123). Schools in the United
States, on the other hand, have very little consideration towards this well-known fact and try to
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use “mental steroids”like Adderall to contain the problem. This in turn prevents children and
adolescents from developing the emotional skills necessary to cope with life’s challenges.
If a confirmed diagnosis is obtained, there are several alternative therapies that can be
used in place of stimulants to treat the symptoms of ADHD. Based on the results collected from
studies compiled by Psychology professors Alan W. Brue and Thomas D. Oakland, two
alternative therapies stood out the most in effectively treating ADHD-like symptoms (Brue &
Oakland, 2002):
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These therapies were, neurofeedback and homeopathic remedies. Neurofeedback or EEG
biofeedback training uses a technique for repeatedly exercising the pathways of attention and
impulse control. In children with ADHD, it has been specifically found to ameliorate the
underlying condition of physiological under-stimulation that occurs in impulsive-hyperactive
behavior. In each of the three studies that Brue and Oakland analyzed regarding neurofeedback,
there was a significant decrease in inattentiveness, impulsivity, and hyperactivity among
participants. Thus, there is convincing evidence to support that neurofeedback is an effective
alternative to stimulant medication. Homeopathic treatments have also been shown to be
effective for both common and chronic ailments, including hyperactivity. In a double-blind,
placebo-controlled study of 43 children diagnosed with ADHD conducted by Lamont,
homeopathic remedies were used to treat the participants. These treatments included
Stramonium, a treatment for nervousness and terrors, Cina, a treatment for restlessness, and
Hyoscyamus niger, a treatment for poor impulse control. Children were given either the
homeopathic remedy or a placebo for 10 days, afterwards parents evaluated the number of
symptoms relating to hyperactivity and/or impulsivity in each participant. Those receiving the
homeopathic remedy displayed significantly fewer behaviors. Even after the treatment was
discontinued, over half of the children still felt improvements in their symptoms. Beyond this
research study, Judyth Reichenberg-Ullman and Robert Ullman, doctors of naturopathy and
authors of several books on homeopathy, insist that there is a 70% success rate when using
homeopathic methods for at least one year thus supporting homeopathic treatment as a viable
alternative for treating ADHD. The compiled studies, overall, show how some alternative
treatments can be almost as effective if not just as effective as stimulants in treating ADHD-like
symptoms. To prevent robbing children of their authentic selves, psychiatrists and physicians
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must inform parents that there are other ways to treat ADHD without using potent stimulants
with unwanted side effects.
Overall, it may be said that it is the responsibility of physicians and psychiatrists to be
meticulous when confirming a diagnosis of ADHD as there are several scenarios that can mimic
impulsive and inattentive behavior in children. School counselors must also be aware of the risks
involved in referring a child for an ADHD diagnosis, because the child could simply be
projecting distress from problems at home or traumatic events in his/her past.This American
epidemic is only producing unnecessary agitation in schools and homes over a speculated mental
disorder people are still debating about. With all things considered, adjustments need to be made
so that children are no longer the victims of this long-standing national crisis.
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Works Cited
Brue, A. W., & Oakland, T. D. (2002). Alternative treatments for attention-deficit/hyperactivity
disorder: does evidence support their use? Alternative Therapies in Health and Medicine,
8(1), 68.
Haber, Julian Stuart. ADHD: the Great Misdiagnosis. Taylor Trade Publishing, 2000.
Humphreys, K. L., Watts, E. L., Dennis, E. L., King, L. S., Thompson, P. M., & Gotlib, I. H.
(n.d.). Stressful Life Events, ADHD Symptoms, and Brain Structure in Early
Adolescence. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY, 47(3), 421–432.
https://doi-org.srv-proxy1.library.tamu.edu/10.1007/s10802-018-0443-5
Krasner, A. J., Turner, J. B., Feldman, J. F., Silberman, A. E., Fisher, P. W., Workman, C. C.,
Posner, J. E., Greenhill, L. L., Lorenz, J. M., Shaffer, D., & Whitaker, A. H. (n.d.).
ADHD Symptoms in a Non-Referred Low Birthweight/Preterm Cohort: Longitudinal
Profiles, Outcomes, and Associated Features. JOURNAL OF ATTENTION DISORDERS,
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Mota-Castillo M. (2007). The crisis of overdiagnosed ADHD in children. Psychiatric Times,
24(8), 12–13.
Wedge, Marilyn. A Disease Called Childhood: Why ADHD Became an American
Epidemic.Avery, an Imprint of Penguin Random House LLC, 2016.