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Wrong diagnosis: ADHD

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A wrong diagnosis can be harmful because it can label an individual and subject him or her to inappropriate treatment. Some young children are incorrectly diagnosed with attention-deficit/hyperactivity disorder (ADHD). A new study by researchers at Harvard University evaluated this situation. They published their findings online on March 17 in the journal Pediatrics.

ADHD is a behavior disorder, usually first diagnosed in childhood, which is characterized by inattention, impulsivity, and, in some cases, hyperactivity. These symptoms usually occur together; however, one may occur without the others. The symptoms of hyperactivity, when present, are almost always apparent by the age of 7 and may be present in very young preschoolers. Inattention or attention-deficit may not be evident until a child faces the expectations of elementary school. Estimates of the prevalence of ADHD range from 4% to 12% of children. Boys are two-to-three times more likely to have ADHD than girls. Many parents of children with ADHD experienced symptoms of ADHD when they were younger. ADHD is commonly found in brothers and sisters within the same family. Most families seek help when their child's symptoms begin to interfere with learning and adjustment to the expectations of school and age-appropriate activities.

The researchers had two goals: (1) to determine estimates of diagnostic stability (a diagnosis that would hold up over time) for a group of young children diagnosed with ADHD after undergoing comprehensive multidisciplinary assessments; and (2) to identify baseline child and family characteristics that predict diagnostic stability over time.

The study group comprised 120 children aged 3 to 6 years, 11 months who were diagnosed with ADHD after multidisciplinary consultations at a tertiary care clinic between 2003 and 2008. The subjects were re-contacted in 2012 and 2013 (N = 120). At the follow-up visit, the primary outcome measurement was the proportion of children who continued to meet diagnostic criteria for ADHD. The investigators conducted a statistical analysis to identify predictors of diagnostic stability. They also subclassified the children into distinct clusters.

The investigators found that 70.4% of the children contacted at follow-up continued to meet the diagnostic criteria for ADHD. Predictors of diagnostic stability included: externalizing and internalizing symptoms at baseline; parental history of mental disorder; and family socioeconomic status. The subclassification identified three distinct profiles: (1) children who no longer met ADHD criteria; (2) children with persistent ADHD and high parental psychopathology; and (3) children with persistent ADHD and low family socioeconomic status.

The authors concluded that young children who underwent comprehensive developmental and psychological assessments before receiving an ADHD diagnosis, had higher rates of diagnostic stability than in previous studies of community samples. They noted that child and family factors that predict diagnostic stability have the potential to guide treatment planning for children diagnosed with ADHD before 7 years of age.

Take home message:

This study stressed the importance of obtaining a correct diagnosis for ADHD. If your child receives such a diagnosis, it is prudent to verify the diagnosis at a tertiary medical center that can conduct a comprehensive exam. UCLA Health System is a tertiary facility that can fully evaluate your child for the disorder.

The following are the most common symptoms of ADHD. However, each child may experience symptoms differently. The three categories of symptoms of ADHD include the following:

Inattention:

  • Short attention span for age (difficulty sustaining attention)
  • Difficulty listening to others
  • Difficulty attending to details
  • Easily distracted
  • Forgetfulness
  • Poor organizational skills for age
  • Poor study skills for age

Impulsivity:

  • Often interrupts others
  • Has difficulty waiting for his or her turn in school and/or social games
  • Tends to blurt out answers instead of waiting to be called upon
  • Takes frequent risks, and often without thinking before acting

Hyperactivity:

  • Seems to be in constant motion; runs or climbs, at times with no apparent goal except motion
  • Has difficulty remaining in his/her seat even when it is expected
  • Fidgets with hands or squirms when in his or her seat; fidgeting excessively
  • Talks excessively
  • Has difficulty engaging in quiet activities
  • Loses or forgets things repeatedly and often
  • Inability to stay on task; shifts from one task to another without bringing any to completion

The symptoms of ADHD may resemble other medical conditions or behavior problems. Bear in mind that many of these symptoms may occur in children and teens who do not have ADHD. A key element in diagnosis is that the symptoms must significantly impair adaptive functioning in both home and school environments. Always consult your child's doctor for a diagnosis.

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