Sunday, June 24, 2012

Overdiagnose this!

So The Atlantic had an interesting article out the other day titled "Are You Listening? Your Child May Not Actually Have ADHD." First of all, ha ha ha, laugh riot of a headline. What do they title an article about blindness -- "Hey, Look At This"?

The point of the article is that, per the FDA, prescriptions for ADHD medications jumped 43 percent from 2002 to 2010, but a recent Penn State study of 1,473 ADHD, autistic and neurotypical kids found that the kids scored roughly the same on a diagnostic test as kids from 1983. Ergo ipso facto etc., the number of kids with ADHD is the same as in 1983 (their baseline info), so the soaring meds rate must be because ADHD is overdiagnosed. The end.

OK, really, one study? One study that didn't even just focus on ADHD kids? That used precisely one diagnostic test as the basis for its conclusion?

Hey, I'm perfectly willing to believe that there were just as many ADHD kids in 1983 as now. Except back then they were called troublemakers, problem kids, bad seeds or stupid, and were either kicked out of school or just failed out. I went through the public school system, and believe me, if you're at all different or quirky, if you have trouble learning the slightest thing in the standard pre-approved way, you get trashed for it, or you get ignored, or you fail. And for the record, I was a "gifted" kid in honors classes.

I didn't know any kids with ADHD growing up. But I did know kids who were smart and creative but struggled anyway, who were great in all classes but one, or who did the homework and learned the material but froze at test time and failed. And if anyone with an ounce of expertise had bothered to really look at these kids, maybe they would have seen something that explained the problem, and could have helped improve things. But hey, easier to write the kids off as stupid, right?

The article also says: "For one thing, it's become one of the world's most overdiagnosed diseases, increasing by an average 5.5 percent a year in the United States. There's no comprehensive clinical test for ADD and ADHD -- usually, doctors simply assess the disorder by intuition and rules of thumb."

Uh, no?  We went through a whole series of tests the first time we brought kiddo to the hospital, observing his motor skills, his problem-solving skills, his ability to transition, checking his reflexes and his hearing and his ability to make eye contact, in addition to the questionnaires his teachers and we had to fill out about specific behaviors. And then we did the questionnaires again the next year when his behaviors had gotten worse. I don't think the neurologist was diagnosing him by "intuition."

The writer's basis for that comment is an Atlantic article from April, titled "Study: Why Attention Deficit Disorder Is Over-Diagnosed." (Oh, and nice stock photo of a stoned-looking kid they used to illustrate it.) Seems a university study of 473 psychotherapists/psychiatrists in Germany determined that they were making ADHD diagnoses even though most of the "case vignettes" they were given didn't meet the diagnostic criteria. Says the article, "Many mental health practitioners seem to proceed heuristically and base their decisions on unclear rules of thumb."

So if I'm reading this correctly ... these doctors were given a piece of paper describing a mythical child's alleged symptoms, told to make a diagnosis, then knocked for diagnosing something that wasn't there?

Come on, my pediatrician won't even diagnose my kid with a cold unless I physically bring him in.
I'm sorry, but I don't buy this. These studies don't seem comprehensive to me. Not enough people participating, not enough variables taken into account. Way too skimpy to make sweeping conclusions like "ADHD is overdiagnosed!"

And I wouldn't get so worked up about it except I've heard "ADHD is overdiagnosed!" from a few people myself, usually in the context of "The teachers don't know how to discipline anymore and they just want the kids on meds to shut them up!" And I feel like the corollary to that is "The parents don't know how to discipline anymore and they're throwing a pill at the problem!"

Yeah? Here's the thing. My son has ADHD and he isn't on meds. Maybe he'll need them in the future, in which case we'll deal with it then. But clearly the automatic assumption with people is, ADHD = drugs. And then the next assumption is, ADHD drugs = zombie  children. And because I know some kids who are on meds, I know that isn't true either. The meds are supposed to focus them, not brainwash them.

I never like it when people make assumptions about things based on their own biases. I especially don't like it when it involves my son.

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