Tougher Academic Standards May Contribute to Increase in ADHD Diagnosis
As the number of ADHD diagnoses increases, the question of why continues to surface. The critics, those who don’t believe that ADHD is a legitimate condition or those who believe it is used as an excuse for poor behavior, believe the increase is because of laziness or a way for “big pharma” to make more money. The rest of us, those who have seen the impact of ADHD first hand, attribute the increase to more knowledge, greater understanding and awareness of ADHD.
A new book, The ADHD Explosion: Myths, Medication, Money, and Today’s Push for Performance, by Stephen P. Hinshaw and Richard M. Scheffler, offer a different explanation. According to their research, the increase in ADHD diagnoses directly correlates with tightened academic standards, school accountability and the need for adults to perform at higher levels than before.
This isn’t necessarily a bad thing. The authors both accept ADHD as a legitimate condition and acknowledge the immense difficulties those with ADHD must overcome and manage. Their research, as does much other research, shows that stimulant medications are immensely helpful in reducing symptoms and helping people with ADHD manage the problems associated with the condition. The following is, in part, some of the reasons the authors cite as contributing to the increase in ADHD diagnoses over the past two decades.
How Academic Testing and Standards Contributes to the Increase of ADHD Diagnoses
Since 2003, when the U.S. Centers for Disease Control and Prevention (CDC), starting keeping track of the number of ADHD diagnoses, the number has risen dramatically. In 2003, it was estimated that 7.8 percent of children were diagnosed with ADHD. In 2007 this number grew to 9.5 percent and the most recent statistics showed another increase with 11 percent of school age children receiving a diagnosis of ADHD at some point.
Beginning in the 1990s, the authors explain, some states began instituting education accountability laws. In other words, they started standardized testing and teacher accountability to make sure that children were being educated. Many of the first states to do this were in the Southeast United States. As these laws were implemented, there was a dramatic increase in the number of ADHD diagnoses. This isn’t necessarily because everyone wanted an excuse as to why the students weren’t performing but because as standards tightened, symptoms of ADHD became more apparent.
In 2003 the law, No Child Left Behind, was implemented and all states needed to have educational standards in place. When this happened, the states that did not yet have standards in place also saw an increase in the number of ADHD diagnoses.
The results showed a double edge sword. On one hand, when children failed at school or did poorly on standardized tests, parents were more willing to seek help and have their child diagnosed with ADHD. This was a good step and many children who needed help received it. On the other hand, there were benefits to schools if children were diagnosed with ADHD. They were able, in some cases, to omit those scores from their overall scores. In other cases, they could provide longer test times and other accommodations, which increased scores. Again, this resulted in children who needed help receiving it, but also resulted in overdiagnosis in some areas.
Adults and Increased Performance
It wasn’t only our children who were expected to perform at higher standards over the past couple decades. The global economy increased work expectations and performance. We weren’t competing with only the company down the street or across town. Companies began competing with other companies across the U.S. and around the world. They needed to offer better products and services and that meant the employees were expected to work harder and to a higher standard. Again, symptoms of ADHD became more apparent and adults couldn’t keep up with the demands, they sought a diagnosis of ADHD. Many adults who never understood why they lagged behind their colleagues could suddenly pay attention and accomplish more. Treatment for ADHD increased productivity and performance. The number of adults being diagnosed with ADHD increased substantially.
Overdiagnosis and Underdiagnosis
The obvious benefit from all of this is that children who have ADHD, who need treatment and educational accommodations, are identified and receive help. Many children who would otherwise be struggling or failing school have received accommodations and medical treatment that have increased their ability to pay attention, reduced their impulsiveness and hyperactivity, and allowed them to succeed. There is no doubt that those who have ADHD have reaped the benefits of an increased awareness of ADHD.
But in some cases, children are diagnosed without a proper evaluation and this causes the risk of overdiagnosis. When family doctors and pediatricians conduct a short office visit, without going through the evaluation suggested by the American Medical Association, there is more of a chance of inaccurate diagnosis. There are a number of medical conditions and environmental factors, such as sleep disorders, learning disabilities, depression and abuse that can cause symptoms similar to ADHD and a quick office visit doesn’t allow for excluding other possible reasons for school failure or behavioral difficulties. The authors believe that some doctors contribute to the overdiagnosis by not insisting they complete a thorough evaluation or referring the child to a specialist to complete the assessment before prescribing medication.
This same procedure can also result in underdiagnosis. If a child doesn’t exhibit certain behaviors, such as hyperactivity, a doctor may dismiss the idea of ADHD and send the parents and child on their way.
Although there are guidelines for diagnosing ADHD, there is no standard, and it can vary from doctor to doctor, from state to state. Parents need to insist on a thorough evaluation. A proper diagnosis offers the best chance for proper treatment.