What experts and the public have already long suspected is nowsupported by representative data collected by researchers atRuhr-Universitat Bochum (RUB) and University of Basel: ADHD , attention deficit hyperactivity disorder, is over-diagnosed. Thestudy showed that child and adolescent psychotherapists andpsychiatrists tend to give a diagnosis based on heuristics, unclearrules of thumb, rather than adhering to recognized diagnosticcriteria. Boys in particular are substantially more oftenmisdiagnosed compared to girls. These are the most importantresults of a study conducted by Prof. |
Dr. Silvia Schneider andProf. Dr. J rgen Margraf (both from RUB) and Dr. KatrinBruchm ller (University of Basel) as reported in the Americanperiodical Journal of Consulting and Clinical Psychology.
Leon has ADHD, Lea doesn't The researchers surveyed altogether 1,000 child and adolescentpsychotherapists and psychiatrists across Germany. 473 participatedin the study. They received one of four available case vignettes,and were asked to give a diagnoses and a recommendation fortherapy. In three out of the four case vignettes, the describedsymptoms and circumstances did not fulfil ADHD criteria. Only oneof the cases fulfilled ADHD criteria based strictly on the validdiagnostic criteria.
In addition, the gender of the child wasincluded as a variable resulting in eight different case vignettes.As the result, when comparing two identical cases with a differentgender, the difference was clear: Leon has ADHD, Lea doesn't. Male and conspicuous: the "prototype" makes the difference Many child and adolescent psychotherapists and psychiatrists seemto proceed heuristically and base their decisions on prototypicalsymptoms. The prototype is male and shows symptoms such as motoricrestlessness, lack of concentration and impulsiveness. Inconnection with the gender of the patient, these symptoms lead todifferent diagnoses.
A boy with such symptoms, even he does notfulfil the complete set of diagnostic criteria, will receive adiagnosis for ADHD, whereas a girl will not. Also the therapist'sgender plays a role in the diagnostic: male therapists givesubstantially more frequently a diagnosis for ADHD than theirfemale counterparts. Diagnostic inflation, more medication, higher daily doses In the past decades the diagnoses ADHD have become almostinflationary. Between 1989 and 2001, the number of diagnoses inGerman clinical practise increased by 381 percent. The costs forADHD medication, such as for the performance-enhancerMethylphenidate, have grown 9 times between 1993 and 2003.
TheGerman health insurance company, Techniker, reports an increase of30 percent in Methylphenidate prescriptions for its clients betweenthe ages of 6 and 18. Similarly, the daily dosage has increased by10 percent on average. Remarkable lack of research Considering these statistics, there is a remarkable lack ofresearch in the diagnostic of ADHD. "In spite of the strong publicinterest, only very few empirical studies have addressed thisissue", Prof.
Schneider and Dr. Bruchm ller point out. While inthe 70s and 80s a "certain upswing" of studies on the frequency andreasons for misdiagnoses could be observed, current research hardlyexamines the phenomena. The current study shows that in order toavoid a misdiagnosis of ADHD and premature treatment, it is crucialfor therapists not to rely on their intuition, instead to strictlyadhere to defined, established diagnostic criteria.
This is bestpossible with the help of standardized diagnostic instruments, suchas diagnostic interviews. Additional References Citations.
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