ADHD Misdiagnosis: Ways ADHD Can be Misdiagnosed in Children
What is ADHD?
ADHD or Attention-Deficit/Hyperactivity Disorder is a mental disorder commonly diagnosed in childhood. There are varying degrees of ADHD and common symptoms are inattention, hyperactivity, and impulsivity that impairs the normal development of a child. Though it is popularly known by the acronym ADHD, it’s under the umbrella of general disorders in attention categorized into three criteria: those that predominantly have attention-deficits, those that predominantly hyperactive-impulsive, or a combination of both.
This particular categorization is of interest because popular notions of the disorder are skewed. This means that people – experts included – have tendencies to misinterpret the behavior of children, increasing the chances of a misdiagnosis. It is too easy, to say the least, for someone to tag a child as having ADHD and cause negative repercussions to the child and to the child’s family – a misdiagnosis of ADHD is no small matter.
How do we diagnose ADHD?
Before we address the concerns of misdiagnosis, we first have to understand how ADHD is diagnosed. Normally, in a clinical setting, ADHD is diagnosed using a set of evaluation tools that test the attentional capacity of children. Behavior is rated using scales such as the Behavior Assessment System for Children (BASC) and ADHD Rating Scale, the scores of which could tell whether the child has the symptoms of the disorder. Rating scales are usually done during clinical observations and serve to record qualitative information in a standard format. In addition, questionnaires such as the Home Situation Questionnaire (HSQ-R) and School Situations Questionnaire (SSQ-R) are also used to understand the daily behavior of the child. The questionnaires are usually done in conjunction with parent interviews or are completed in writing. What these tools do is to help clinicians to determine if the problematic behavior is consistent enough, maladaptive enough, and broad enough to assure a diagnosis of ADHD.
Five Ways ADHD Could be Misdiagnosed
With this, we could easily see why it’s easy to misdiagnose ADHD. Each misdiagnosis is a wrong derivative of an actual evaluation criterion. With this knowledge, one hopes that more people would be more critical about their assessment, addressing the concern. Here are five ways in which ADHD can be misdiagnosed.
1. Not Considering Duration of Symptoms
From the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) consistency means that attention-deficit and hyperactivity symptoms should have occurred and persisted for at least 6 months. Here lies the root of the problem. Sometimes, people misattribute the ADHD label to a child just for the existence of problematic behavior and not for its persistence. Teachers wrongly have children “checked” just because of problematic classroom behavior without first determining if the behavior has been consistent for the past 6 months. Sometimes, parents become fearful of a child’s behavior just because there are instances of impulsivity and attention-deficit occurring at home.
2. Not Considering Context of Behavior
Since ADHD is evaluated by observing the behavior of the child, it can be misinterpreted by not taking the context of the behavior into account. Did the child fidget because he has ADHD or he’s just nervous about the upcoming test? Was the child unable to finish his schoolwork because he has ADHD or it’s just because his favorite TV program was on? Given the wrong context, normal behavior can be easily misperceived as a symptom of ADHD.
3. Considering Only One Symptom
Sometimes, a misdiagnosis of ADHD could occur if one problematic behavior was taken out of proportion. Problematic ADHD behavior does not occur singly; it’s always seen co-morbid with other symptoms. For example, though the DSM-IV-TR recognizes excessive talking as a symptom of ADHD, it could only qualify if it occurs with other symptoms of hyperactivity (e.g. often runs about, often leaves classroom seat) and only if it occurs over a period of 6 months.
4. Not Considering Age or Developmental Stage
A high activity level and a short attention span are descriptive of children who are under the age of 3, making a differential diagnosis of ADHD very difficult. This means that we have to be careful about labeling young children as having the disorder because chances are, they might be just behaving they way should be behaving at that age.
5. Not Considering Other Possible Disorders
As earlier stated, some symptoms of ADHD could also occur given other mental disorders. For example, the moments of mania reminiscent of bipolar disorder can be misdiagnosed as ADHD by some. Anxiety disorders that include attention-deficit characteristics could also present an opportunity for misdiagnosis. With this, one should be very clear about the assumptions and observation that leads one to a particular diagnosis.