Overdiagnosing ADHD

Why I'm questioning the new CDC report

I was scrolling on Instagram when I stumbled upon a link to a CDC report revealing that 1 in 9 children has a diagnosis of ADHD. This number struck me immediately, and a brief statistics lesson might help explain my reaction.

Cognitive abilities generally approximate a normal distribution, meaning most people fall within the average range, with fewer individuals displaying exceptionally strong or weak abilities. If you visualize this on a graph, you'd see a bell curve where the majority of scores cluster around the middle, and fewer scores appear as you move away from the center.

Standard deviation measures variability around the mean, and most tests of neuropsychological functions have an average score of 100 and a standard deviation of 15. This means about 68% of the population scores between 85 and 115, considered average. Only about 16% score below 85 (below average) or above 115 (above average).

Given these numbers, it's perplexing that 11% of children are diagnosed with ADHD, assuming only 16% should theoretically exhibit below-average attention and executive functioning. This leads to two possible conclusions: either our diagnostic processes are incredibly precise, or many, many kids who are functioning within normal limits are being diagnosed. While I'd like to commend our field's accuracy, I suspect that overdiagnosis is the culprit. And the trend isn’t harmless: it invalidates the struggles of people who truly have ADHD, and it diverts finite educational and therapeutic resources away from those who really need them.

Discussions with colleagues have led me to believe that the reasons for this overdiagnosis vary between children from low and high-resource communities. Specifically, schools lacking cultural responsiveness might lead to a higher diagnosis rate among students of color from low-income families, not because these students inherently have ADHD, but because their educational needs are not being adequately met. Conversely, in high-income areas, there's an intense pressure to succeed academically, prompting families to seek ADHD diagnoses as a means to access academic support and services for their children who are underperforming.

Regardless of the underlying reasons, the approach to diagnosing ADHD needs reform. Currently, the process can resemble a checklist, where a diagnosis is made if behavior rating forms or clinical interviews indicate that a child meets the criteria. This method lacks robust scientific backing to distinguish between normal variations in functioning and true pathology. 

Instead, diagnosticians should integrate standardized, norm-referenced tests with behavioral rating scales and clinical interviews. This would help accurately demonstrate when a child's attention and executive functioning are genuinely below average. Comprehensive neuropsychological assessments should become the gold standard for diagnosing ADHD, ensuring that diagnoses are not only scientifically rigorous but also genuinely reflective of the children's needs.

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When I was younger, my mom forced me to watch this, and I thought it was so nutty, but the indoctrination worked; now, I make my own daughter watch musicals. Yikes!