Overdiagnosing ADHD leads to 'pills and privileges'

For kids who aren’t truly disabled by ADHD, the risks from the disorder’s treatment cast ominous shadows over its unnecessary rewards.

Originally published in the Moultrie News.

Your article about ADHD being overdiagnosed contains so many useless, misinformed stereotypes and ignorant judgments. It is careless hubris that allows you to spew toxic opinions so confidently about something that you clearly don't have a clue about. 

That column obviously touched a nerve with some. But having based my opinions on experience and research, I stand by the conclusion that ADHD is overdiagnosed. 

Here’s a criticism that was a bit more specific:

Watching a child engage in a preferred activity is not a good screening tool for ADHD. The basic problem in brain function for those with ADHD is not their ability to focus. In fact, those with ADHD are known to “hyperfocus” on preferred activities. 

ADHD is subjectively diagnosed. No blood test, MRI, or CT scan is required. The CDC simply states that certain behaviors must be conditionally observed — not necessarily by doctors, but by teachers, parents, or other caretakers. Among the potential symptoms are “trouble holding attention on tasks or play activities” and “unable to play or take part in leisure activities quietly.” I would describe “play” and “leisure activities” as “preferred” for children.

“Hyperfocusing,” on the other hand, is not an official symptom of ADHD, at least not according to the CDC, the DSM-5, or even WebMD, which defines it as concentrating on something so hard you lose track of everything around you. Some call that “ordinary behavior.” WebMD says while it may come more naturally to those with ADHD, “just about anyone can get lost in something that interests them.” 

A similar blurry prevalence applies to ADHD’s actual symptoms, suggesting a possible weak spot for overdiagnoses. Observers must gauge the frequency and intensity of behaviors relative to other children. What distinguishes ordinary behavior from a crippling neurodevelopmental disorder is sometimes in the eye of the beholder.

It seems wise to candidly consider if the ADHD label might be too loosely applied. As there is no cure for ADHD and scientists are unsure of its causes, we’re left to manage its symptoms. In schools, that’s usually accomplished with pills and privileges. Both can have negative long-term consequences if not carefully regulated.

Privileges can include handing in assignments days after they’re due, leaving class when bored, and completing half as much work as all the other kids. That sort of thing may be okay for children afflicted with true ADHD, but for those who aren’t, it can entitle kids with a “get out of jail free” mentality toward inconvenient responsibilities and instill a damaging (and false) perception of their inability to attain independence.

And about those pills … They bring global pharmaceutical companies over 13 billion dollars annually. The CDC says over 3.5 million U.S. kids are medicated for ADHD, most commonly with amphetamines like Adderall and methylphenidates like Ritalin — psychostimulants that force the child’s brain to produce more dopamine. Side effects are common.

For what it’s worth, the multitude of teens I’ve taught who take ADHD medication almost universally hate it. Many will go to extremes to avoid it. They complain that it changes their moods, makes them feel like “zombies,” saps their appetite, or makes it difficult to sleep. 

The long-term impacts are still being studied. Past research has raised the possibility of neurotoxic effects like damaged motivation, depressed mood, increased anxiety, and cognitive deficiencies. A 2019 study found that some ADHD drugs may affect the development of the brain’s white matter in children but not adults. This tracks with common sense: before adulthood, the brain is building itself on the fly, so any drug that tampers with its construction could seriously harm the final product. “Take the pills and see if it helps” is a cavalier strategy to impose on children too young to calculate the potential costs.

Thus Dr. Liesbeth Reneman, the author of the study, concluded, "the use of ADHD medications in children must be carefully considered until more is known about the long-term consequences of prescribing methylphenidate at a young age. The drug should only be prescribed to children who actually have ADHD and are significantly affected by it."

That’s what worries me most about the problem of overdiagnosis. For kids who aren’t truly disabled by ADHD, the risks from the disorder’s treatment cast ominous shadows over its unnecessary rewards.

Read the original column here.