ADHD wildly overdiagnosed; new study finds kids born in August 75% more likely to be diagnosed

Miscellaneous and Personal Stuff I Must Share
1

The Journal of Pediatrics recently published a study conducted over 15 years in Taiwan:

Influence of Relative Age on Diagnosis and Treatment of Attention-Deficit Hyperactivity Disorder in Taiwanese Children

Summary/analysis of the results here:

ADHD is vastly overdiagnosed and many children are just immature, say scientists

Youngest Kids In Class At Higher Risk Of ADHD Diagnosis

I’ve long thought ADHD diagnoses, especially among children, are absurdly prevalent and that’s caused me to doubt the validity of it as a real mental condition at all. This study confirms, at the very least, that there are an enormous amount of diagnoses made on faulty pretenses (i.e. relative maturity and development of classmates rather than any sort of objective measurement). If it were a real condition that was being diagnosed correctly, we would expect to see a roughly even distribution of diagnoses across all potential months patients were born in. But not only is that not the case, there’s such a huge discrepancy, that it really makes the mental health profession look like a bunch of yokels who don’t know what they’re doing.

Is no one else concerned about all this speed that they have been doling out to kids while minting money for Big Pharma to support false diagnoses throughout the ADHD fad? Will these findings lead to any sort of reform or at least a more critical look at the diagnostic process? I’m willing to concede that ADHD might be real, but it’s just hard to take it seriously (and by extension, mental health medicine as legitimate science), when we see how shaky the foundations of diagnosis really are.

2

OK, so ADHD is overdiagnosed in Taiwan. I think you’d need some evidence to extrapolate that resut from Taiwan to, say, the U.S.

For all I know, it may be true here as well, but I’d also be quite surprised if cultural factors didn’t greatly affect diagnosis of ADHD, and east Asia and the U.S. have very different cultures.

3

This is almost a perennial story. I’ve posted a couple of very similar articles like this over the years and the invariable response is parent dopers saying “Well… yeah… but my child is literally unfocused and uncontrollable without ADD drugs.”

Were kids bouncing off the walls in the 1970’s and before? I’m 57 and I grew up in grade school classes in the 60’s and 70’s without ADD drugs being used and I did not see it. Sure you occasionally had disruptive kids, but it wasn’t an epidemic.

I think there is a point that some people make that kids are vastly under-exercised in modern school systems and forced grade advancement puts immature and more mature kids together in lockstep which is a real problem. I think with more exercise and more common sense used in grade assignment a lot of the ADD ascribed behavioral issues would recede.

4

A lot of criticisms of Common Core and modern pedagogy are off-base. But there’s a real truth to the criticism that common core does not allow either for normal stages of maturity, or for variations in maturation, of students.

Kindergarten today is what first or even second grade were, thirty years ago. No naps, half an hour of recess (if that!), lots of seatwork with phonics worksheets, lots of standardized tests (erm, excuse me, “common formative assessments”).

A kid that could function just fine in the kindergarten of yore might have real trouble in today’s kindergarten, and might be drugged therefore.

Okay, that’s one factor. But then there’s another: we’re no longer allowed to ignore kids.

Used to be, a kid that acted up and was a bozo? You had the parent-teacher conference, told them the kid was a cutup, and your duty was discharged. If the kid wanted to learn, he knew where the lesson was.

Today, the teacher is responsible for proving the learning of all children. In my state, part of our evaluation is based on test scores. There’s a lot more pressure to make sure that the kid who doesn’t pay attention starts paying attention.

5

We did not bother to have my daughter diagnosed until 10th grade - and then discovered that she tested off the charts. She was smart enough to get by fine until that, but 9th grade she started to hit a wall where she actually needed to pay attention in math.

We were told over and over again by teachers that her behavior was fine. I wish I’d have followed up on my first instinct in kindergarten because she wasn’t fine and now she has the habits of ADHD to break.

Testing her was not easy, it was about five hours worth of testing.

She was never literally unfocused and uncontrollable, but ADHD meds have meant that she gets her math tests done in the time allotted, she is capable of thinking before she speaks, and she can think without requiring motion.

I also agree with LHOD. If your last exposure to school was the 60s and 70s, you really have no idea what school is like now. For one thing, kids weren’t mainstreamed to the extent they are now in schools. The school day is half an hour longer and there are more days than when my own kids started twelve years ago. In my district, all day kindergarten is mandatory. The schoolroom is much more diverse, and that diversity brings different ideas of what appropriate interactions are and what interactions are ok.

6

I think it’s very likely that ADHD is overdiagnosed. I’ve heard of classes where a third of the kids are on meds for ADHD. If you decide that a behaviour pattern that’s common to a third of all kids is a disorder, we’ve got some of thisgoing on.

But there’s a big leap from ‘it’s overdiagnosed’ to ‘it doesn’t exist at all’.

Not necessarily. Birth month shows links to everything from asthma through various types of heart disease to schizophrenia. And all of those pretty definitely exist.

7

I suspect its actually more parentally driven “in order to get my kid any special attention in a room of 38 kids, they need an IEP, to get the IEP, they need a diagnosis.”

We were discouraged year after year by teachers from pursuing my daughters inattention “she’ll grow out of it.” The reason, a diagnosis drives an IEP, and IEP drives more work for the teachers, teachers who already have 38 kids in a classroom, half a dozen of whom they have IEPs for.

8

Am I reading this right, the teacher is the one who makes the “diagnosis” of ADHD? That can’t be right.

9

Not around here. Its a battery of tests given by a pediatrician or mental health professional.

Teachers are often the ones who ask for the diagnosis - or, as in our case, discourage it. They are the ones seeing the kid in a setting with other kids. But the professional who did my daughters evaluation said that in her area - a wealthy suburb - parents are bringing their kids in before school even starts to have the battery of tests (which includes autism spectrum screening) run so their kids hit the ground with the proper assistance in school.

10

I don’t understand.

A lot of people are diagnosed with ADHD in their late adolescence and adulthood. Are these people just late bloomers too?

A number of disorders are associated with birth in a particular season or month. Like deficit schizophrenia. The hypothesis is that these conditions likely stem from genes interacting with environmental factors with a certain seasonality (like influenza infections). So I don’t think the association with August births means ADHD is “overblown” at all. The correlation is perfectly consistent with a biologically-based explanation.

Are there some hyperkinetic kids who later outgrow their symptoms as their bodies and brains mature? Sure. But that doesn’t mean these kids still aren’t at a real disadvantage. In some idyllic yesteryear, maybe they could have dropped out of school and gone on to get somewhat okay jobs. But now everyone is expected to make it through college prep courses. Everyone is expected to do well on standardized tests. There are few “somewhat okay” jobs left for people who just can’t do the book learnin’ thing. So not being able to pay attention in class really is an actual disability in today’s rat race.

11

I wonder about the long term effects of the children that are fed Ritalin from childhood.

Some studies say it causes long term changes in the way the brain works but it’s not clear cut:

http://m.livescience.com/32044-adhd-drug-treatment-brain-changes.html

Anecdotal I know but I have a friend, who was on the stuff for years and he says he thinks it permanently changed him in some way and describes how at one point it made him feel like a zombie and he says he thinks it’s made him awkward socially and he has a difficult time communicating with others and expressing himself. Sometimes he says he wishes he was never put on the Ritalin. Could have nothing to do with the medication. I have a stepdaughter on the stuff and I have no say in her medical care as I’m the step-parent but I will say when she isn’t on the stuff she drives everyone else crazy with her non-stop talking but I feel she can’t help it.

12

All true, but still I think there should be a healthy skepticism about a mental disability crisis that in historical terms has erupted virtually overnight in modernity to become this towering pile of mental and behavioral malfunction. Medicine and Psychology as sciences have very checkered histories in the way they have addressed mental issues over time, and the supposition that a good chunk of school age kids need to be on various forms of amphetamines in order to progress and be normal is (IMO) a highly questionable treatment paradigm.

13

Kids could also be punished for misbehaving in the 60s and 70s. It’s possible that besides a lack of exercise, we also have a lack of corrective intervention that is needed for some people to be able to modulate their behavior.

14

Aren’t those differences barely statistically significant? The difference shown by this study is massive.

15

According to the paper the results obtained are consistent with similar studies conducted in the US and Canada.

16

Not at all likely. My first news article link has a graph image in it of the data, and you can see there’s a very steady and consistent climb starting with September births (i.e., the oldest children in a school year grade) being the least diagnosed, with a very steady, consistent, and dramatic climb toward August (i.e., the youngest children in a grade). It’s clearly an extremely strong artificial correlation based on the cutoff dates for grade placement.

17

That was one of the reasons we waited to diagnose. Medicating kids - medicating anyone actually - isn’t my thing unless the risks are outweighed by the results.

18

I imagine a similar situation in which a nation decides to eliminate all recess and physical activity from schools, and then discovers an alarming number of children with muscular atrophy; in response, the nation starts prescribing steroids to children to improve muscle acquisition.

When an illness suddenly strikes a huge percentage of the children in your culture, before you start medicating those children, it may be worth considering whether recent cultural changes have brought on the illness, and whether the illness should be treated by changing the culture, not by medicating the children.

19

Until I actually scanned the OP, I assumed that the poster was referring to US students. I thought that one of my pet theories about the age of students starting school was to be discussed.

Why would I think that? Because, since school now starts in August, those born in August will likely be the youngest kids in the class, and therefore, the kids with the least social training. If there’s a problem in the class, it will probably be from one of the less socialized kids.

But since the OP was NOT about American schools, but Taiwan, I won’t mention that.

When I was in elementary school, we were taught to respect our teachers. We knew that if we misbehaved, we would not only be punished in class, but notes would be sent home with us, so our parents could discipline us again.

But, somewhere along the line, when little Jimmy’s parents were informed that he had been punished in school and that they were expected to do the same at home, they got all butt hurt about how their precious child was being abused by the school system and raised a huge ruckus about the whole situation.

Then other parents saw that Jimmy was being given special treatment that they wanted for their own child. So, when Bobby does something, Bobby’s mom and dad tear the teacher, her principal, and the entire school board a new one.

Now, we have schools that are no longer allowed to even hint that someone may be disrupting their classes. But teachers have learned that by labeling a child as ADHD, they can regain some control over the classroom when half the class is drugged.

20

I agree, but I’m a realist. We’ve got a lot of things we need to change in our culture and we have yet to get to around to doing any of them. When every other article out there is about how the Chinese are eating our (American) lunches and how competitive the job market is, it is going to be very hard to encourage parents to stop pushing their kids to conform to the prevailing standards. I don’t have a kid, of course, but I can imagine how hard it must be to watch Junior turn in Cs and Ds when you know he’s capable of more. Changing the culture means, for a lot of people, learning to embrace mediocrity. It means accepting that your genius will not get accepted into a “good” college. It means accepting that he or she will likely not have the kind of career that you can brag about.

Or it can mean making the family’s life a lot harder. It means no one in the family can have sweets in the house, because you suspect sugar exacerbates Junior’s symptoms and it’s unfair that his siblings get ice cream after dinner while he can’t. It means instead of coming home after a long day and working with Junior on his homework for only an hour, you spend the entire evening trying to get him to concentrate. It means having to summon up an infinite amount of patience whenever Junior flies off the handle or does something impulsive. It means having to treat Junior for anxiety and depression because he feels “stupid” all the time even though everyone is telling him he’s perfectly fine.

So yeah, I agree that the solution is to change the culture. But that will take how many decades to accomplish? In the meantime, you’ve got a kid and he’s only a kid for a few years. And so much is riding on those years. So I guess I don’t blame people for turning to medication first.