Overdiagnosis or Underdiagnosis of ADHD

Mental health is a hot button issue in society today — which is excellent, because having frank discussions is important in the fight against stigma. However, the subject of diagnosis does not often form part of popular discussion. We have a tendency to overlook the sometimes challenging mechanics of psychiatric diagnosis.

Attention deficit hyperactivity disorder (ADHD) is an apt example of the difficulties inherent in our cultural relationship to mental health diagnoses. This is a condition that has received a lot of attention in the media, primarily focused on childhood diagnoses. We are all familiar with the stereotypical symptoms: disruptive behavior, lack of focus, et cetera. These childhood symptoms have spurred popular discussion on whether the psychiatric industry is over-diagnosing the condition. To put it simply, the public is asking whether doctors and parents are treating a medical condition, or simply stopping children from being children.

For all our supposed popular discourse on the condition, we are also facing a deficiency with regard to adult treatment, particularly for women. While the childhood ADHD treatments are perceived as being overblown, adults are still suffering without assistance. So, what is the true state of ADHD diagnosis today, what are some of the causes, and are there practical solutions?

Women and ADHD

Diagnosis of mental, neurobehavioral, and cognitive disorders in women has historically been lacking. This is especially evident in Autistic Spectrum Disorder (ASD), where until recently it was overlooked because girls’ symptoms didn’t fit those stereotypically evident in boys. When it comes to ADHD, women are frequently subjected to under- and misdiagnosis, leading to a multitude of difficulties.

So why are women the primary victims of ADHD underdiagnosis? As with many of the problems surrounding women’s mental health, much of the popular research of symptoms has been based on the experiences of boys and men. For a long time, ADHD was considered a primarily male disorder; elementary school teachers were usually the first to flag behavior, and in these cases it was usually boys who were disruptive. Even though girls exhibit many of the same symptoms, their behaviors are often overlooked. There is also a propensity for girls to mask the symptoms, working harder than their male counterparts to compensate in their studies.

As a result, it is often not until adulthood that women seek medical assistance. Unfortunately, there is then a tendency for women to be misdiagnosed with anxiety or depression. ADHD often occurs together with anxiety, and can have similar disruptive influence on the performance of daily tasks and thought processes. Anxiety also has a similar tendency to cause difficulties in the workplace, leading to an average of 4.6 work days lost per year. Distinguishing between the two requires expertise, and misdiagnosis results in women not receiving the most appropriate or effective treatment.

Misinformation

Misinformation has long been the bane of psychiatric fields. Between historical superstition, representations in popular culture, and widespread fear, mental health has been viewed through a warped lens. When it comes to ADHD, a lack of reliable information has contributed to both perceived over- and underdiagnosis.

It is common for parents to resist the suggestion of ADHD, as they feel their child is just rambunctious or a daydreamer. While disruption and lack of focus are symptoms, the severity of these goes beyond the normal in those experiencing ADHD. Symptoms present themselves as consistently problematic and appear not just at school but in family life and friendships. On the other side of the coin, the abundance of information online and in the popular media may lead to parents erroneously believe their child is experiencing symptoms. Misleading information from caregivers is considered to be one of the factors contributing to overdiagnosis of ADHD.

Whether under- or overdiagnosis is more of a problem, it is clear that there is an urgent need for reliable educational resources regarding the reality of ADHD. This needs to be provided not just to parents, but all those who spend significant periods of time with children. Athletes opening up the dialogue on mental health in sports — such as Olympic swimmer Michael Phelps and NBA All-Star Kevin Love — continue to emphasize the importance of candid conversations on the subject from high school onward. Between professional intervention, physical activities, and therapeutic services, a toolkit of effective measures can be acquired to address symptoms.

Challenges for Industry and the Workplace

Much of the emphasis on ADHD diagnosis is focused upon school aged children. This is certainly important, and the opportunity for mental illness to be identified and treated early can make a huge difference to the patients’ long-term quality of life. However, this has left us with a severe underdiagnosis of ADHD in adults.

A contributing factor is that adults have a tendency to play down the impact the symptoms have upon their lives. Studies also suggest that many undiagnosed adults make lifestyle choices that may compensate for their ADHD-related impairments. This means that there are a number of adults experiencing a serious mental health problem without receiving help that could make a real difference to their lives. Not to mention that untreated or misdiagnosed mental health disorders cause significant disruption to workplace activities. On a wider scale, a 2018 report showed that undiagnosed ADHD symptoms have a serious socio-economic impact, causing frequent drops in productivity, and often an inability for sufferers to hold down full-time employment.

It is often the case that adult ADHD diagnosis only occurs when patients seek medical assistance for co-occurring symptoms. Upon diagnosis, it is vital that they are provided with resources and information about their rights in respect to accommodations in the workplace. Reasonable accommodations — such as noise-cancelling headphones and cubicles with higher walls — can help those with ADHD be productive in the workplace, which in turn can lessen the wider socio-economic implications of their symptoms.

Misdiagnosis, underdiagnosis, and overdiagnosis of ADHD each hold the potential to be damaging. Such situations are indicative of wider systemic problems which place a burden on an already strained mental health system, and prevent those experiencing symptoms from receiving the help they need. Whether the person with ADHD is a child, a young adult transitioning from college to the workplace, or an undiagnosed woman, better mental health literacy is needed. While it is important to address ADHD from an early age, we must also empower those of adult age to identify their symptoms accurately, and seek treatment that will enhance their lives.

If you or someone you know experiences mental health issues, it is important to seek help from a qualified professional. Our Resource Specialist can help you find expert mental health resources to recover in your community. Contact us now for more information on this free service to our users.

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About the Author: Sam Bowman writes about people, tech, wellness and how they merge. He enjoys getting to utilize the internet for community without actually having to leave his house. In his spare time he likes running, reading, and combining the two in a run to his local bookstore.

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