Is ADHD being falsely diagnosed?

The important thing is for the profession, and society as a whole, to remain aware of the extent to which we still rely on subjective assessments.

Take the example of Attention Deficit Hyperactivity Disorder (ADHD). The condition is now widely recognised around the world, but diagnosis rates vary between and within countries. Certainly, there has been a big increase in diagnoses in recent years – and in the prescription of ADHD medication. Whether that means that the condition was under-diagnosed in the past or is being over-diagnosed now is open to argument (or it should be).

Indeed, depending on context, under and over-diagnosis could be happening at the same time.

A possible example of the latter is the subject of a study by the medical researchers Anupam B Jena, Michael Barnett and Timothy J Layton. In an article for the New York Times, they begin by explaining the context of their research:

“The rate of diagnosis of attention deficit hyperactivity disorder among children has nearly doubled in the past two decades. Rates of A.D.H.D. diagnoses also vary considerably across states, with nearly three times as many children getting the diagnosis in Kentucky (where one in five children are said to have the condition) as in Nevada. More than 5 percent of all children in the United States now take an A.D.H.D. medication. All this raises the question of whether the disease is being overdiagnosed.”

The authors go on to describe a study they conducted into differences in the rate of ADHD diagnosis between the oldest and youngest children in particular year groups:

“In a study published in The New England Journal of Medicine, we found that among several hundred thousand children who were born between 2007 and 2009 and followed until 2016, rates of A.D.H.D. diagnosis and treatment were 34 percent higher among children born in August than among children born in September in states with a Sept. 1 school entry-age cutoff.”

There seems to be no medical reason why ADHD should more prevalent among the August-born children than their September-born classmates. There, is however, an obvious reason why the first group might, on the whole, be more likely to struggle than the second group: they’re the best part of year younger, which, in infancy, amounts to a substantial gap in physical and mental development. The implication is that issues arising from this age difference alone are being inappropriately medicalised – and inappropriately medicated too.

This is not an argument that ADHD does not exist at all or that it lacks a medical basis. Indeed, there is evidence for genetic markers associated with the condition and for its heritability. There’s also the fact that it is much more prevalent among boys than girls (though I’ll leave it to others to argue the nature-versus-nurture of that one).

This whole issue is a deeply sensitive one because for many parents a medical diagnosis comes as a relief – and a defence against those who might stigmatise the behaviour of their children. But there are sensitivities on the other side of the argument too – especially the concern that natural behaviours are being labelled as a disorder and that the problem isn’t with the child, but the classroom cultures they’re being expected to conform to.

It strikes me that everyone would benefit if we did more to tailor the provision of education to the individual – recognising and responding to the full diversity of aptitudes, personality traits and all the other things that influence how a child learns.

For instance, instead of managing pupil intake by year group, it could be done using half-year groups – thus narrowing the age range in each class. Obviously, this would require the school year to be reorganised – abolishing the archaic long summer break to allow a more even pattern of terms and holidays.

Such reforms aren’t easily implemented – we’re stubbornly attached to educational practices that were established in response to the needs of the 19th century.

The more that we can get away from the one-size-fits-all model of education, the more we’ll be able distinguish genuine cases of conditions like ADHD from inappropriate diagnoses – and target help accordingly.

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Peter Franklin is Associate Editor of UnHerd. He was previously a policy advisor and speechwriter on environmental and social issues.

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