Some kids kick off the new school year with their best behavior. Others squirm, fidget, run about excessively, fail to pay attention, make careless mistakes, interrupt, lose their homework, and forget their books. That's normal childhood behavior. Yet those are also the symptoms of one of the most common behavioral disorders diagnosed among school-age children in the U.S.: attention-deficit hyperactivity disorder (ADHD).
That blurry line makes ADHD hard to diagnose. As a result, some children who don't have ADHD or have only mild problems will be unnecessarily labeled and medicated, according to a recent analysis by researchers in Australia and the Netherlands published in the British Medical Journal. That can do your child more harm than good. So it's important to get an accurate diagnosis and make sure your child's symptoms are serious enough to require a drug. Here's what you need to know.
Read the Consumer Reports Best Buy Drugs report for more on drugs used to treat ADHD.
There is no MRI, CT scan, or any other objective test for ADHD. Instead, parents and teachers typically check off the child's symptoms on questionnaires that are used to help doctors diagnose ADHD. But many people have ADHD symptoms without having a disorder. To distinguish between normal and abnormal behavior, guidelines for diagnosing ADHD also require that symptoms occur often and in several locations, for example, at home, in the classroom, and in the playground. Symptoms should persist for at least six months, and make it difficult for the child to get along with others or do well in school.
Yet many children get an ADHD diagnosis without meeting all of the requirements, the BMJ study authors say. They're also concerned that new criteria could potentially lead to more uncertain diagnoses. For example, symptoms can now start by age 12 instead of age 7. As a result, difficult behavior that normally crops up during puberty might be confused with ADHD.
Diagnoses of ADHD among children and adolescents have increased, along with prescriptions for drugs to treat it, reports suggest. A 2013 study by the national Centers for Disease Control and Prevention found that the number of diagnoses of ADHD in American children ages 4 to 17 jumped 42 percent in the previous eight years. More than one in 10 kids in the U.S. have received a diagnosis of the disorder.
The increase may reflect better detection of ADHD, but it may also stem from inappropriate diagnoses. The number of diagnoses of ADHD varies widely between states in the U.S. and between countries, raising questions about how carefully and consistently the disorder is diagnosed. The requirements for a diagnosis of ADHD have also changed several times, each time expanding to include more children. In addition, studies show that the youngest children in a classroom are more likely than older children in the same classroom to be given an ADHD diagnosis. Younger children are typically less mature, and their comparative immaturity may be mistaken for ADHD.
Most American children with ADHD have mild or moderate forms of the disorder, yet the majority of those with the diagnosis are prescribed medication. A 2014 report from the CDC on ADHD care in Georgia, 4- and 5-year-olds in the Georgia Medicaid system with the disorder diagnosis were more likely to receive medication than behavioral therapy, even though therapy—not drugs—is the treatment of choice for very young children.
Even more disturbing, the CDC estimates that at least 10,000 toddlers in the U.S. may be medicated for ADHD. There are no guidelines for diagnosing and treating ADHD in children younger than 4 and most of the drugs aren't even approved for children younger than 6.
Read about other drugs used to treat ADHD: Are too many kids taking antipsychotic drugs?
The main drugs used to treat ADHD are stimulants. While generally safe, they may have troubling side effects. The drugs can suppress your child's growth (long-term growth effects are being studied), cause psychotic symptoms such as hallucinations or manic behavior, and worsen other conditions, including tics and bipolar disorder. They may cause liver damage and suicidal thoughts, and have been linked to rare cases of sudden death in children and adolescents with heart problems.
A label of ADHD can lead to additional harms. Other kids may assume the child is less intelligent. Teachers and parents may expect the child to do poorly in school, and that could create a self-fulfilling prophecy.
• If you suspect your child has ADHD, an appointment with a pediatrician can be a good place to start. The child should have a medical exam, including hearing and vision tests, to rule out other conditions that can cause symptoms similar to ADHD's.
• Your pediatrician may refer you to a specialist, such as a pediatric neurologist or mental-health professional, who is experienced with ADHD. The pediatrician or specialist should explore other possible explanations for your child's behavior, such as learning disabilities, anxiety, sleep problems, stress at school, or tensions at home.
• A thorough diagnosis should involve talking to the child's parents and teachers, and if appropriate, the child. It usually includes a review of school records and direct observation of the child in various situations. The doctor or specialist should question all of the parties to make sure the child meets all the requirements for ADHD.
It can take months and multiple visits to determine whether a child has ADHD, and you may want to get a second opinion. Be skeptical if a doctor or therapist diagnoses ADHD and prescribes a drug at the first visit.
This article is the first of a series on the overdiagnosis of common conditions, and completed in partnership with other groups working on this topic, including researchers at Dartmouth Institute for Health Policy and Clinical Practice in Hanover, N.H., Bond University in Brisbane, Australia, and The British Medical Journal in London. See here for more detailed information.
This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).