We have been exploring the theme of ADHD diagnosis this month on ADHD Central. We began with a heated discussion of Why Some People Do Not Believe in ADHD. You gave your opinion and we listened. Next I followed up with an Interview with Michael Laskoff, a writer for the Huffington Post who has been diagnosed with Adult ADHD. Michael's interview points out that ADHD is not just a disorder of childhood and that adults can have it too. There are some experts who say that Adult ADHD is underdiagnosed.
Last week I reported on the news that there will be some major changes made to the Diagnostic and Statistical Manual of Mental Disorders with the new edition of the DSM-5. It seems there may be some big changes for how ADHD, Autism Spectrum Disorders and Pediatric Bipolar Disorder will be diagnosed. They are still in the process of revising the manual and nothing is set in stone as of yet.
Today I wish to continue this theme on diagnosis by discussing the problems which have historically plagued the process of diagnosing ADHD. One of the reasons I feel that some people question the validity of ADHD as a formal diagnosis is due to the overdiagnosing or underdiagnosing of this disorder. Then to add further confusion are the lengthy lists of co-morbid and coexisting conditions which may accompany a diagnosis of ADHD. Not to mention, many of the symptoms of ADHD overlap with other conditions and disorders. What is sometimes diagnosed as ADHD may in fact be something else. One hope is that the streamlining of the diagnostic criteria for ADHD in the newly revised DSM-5 will clear up this confusion and make the process more credible.
In 1998, The Journal of the American Medical Association Council on Scientific Affairs had this to say about the validity of ADHD diagnostic criteria:
"ADHD is a childhood neuropsychiatric syndrome that has been studied thoroughly over the past 40 years. Available diagnostic criteria for ADHD are based on extensive empirical research and, if applied appropriately, lead to the diagnosis of a syndrome with high interrater reliability, good face validity, and high predictability of course and medication responsiveness. ADHD is one of the best-researched disorders in medicine, and the overall data on its validity are far more compelling than for most mental disorders and even for many medical conditions."
This statement was made over ten years ago. Does it hold true today?
The following information is from our ADHD Diagnosis section entitled, Difficulties in Identifying Children with ADHD: "There are currently no laboratory or imaging tests to reliably diagnose ADHD. A diagnosis relies only on behavioral symptoms and ruling out other disorders." So basically we are relying predominantly upon a behavioral checklist. My question about ADHD has always been: how does one reliably rule out other disorders? Why can't a child have both autism and ADHD, for example? Again, there are hopes that the newly revised DSM-5 will address these issues.