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Is ADHD overdiagnosed?

Is ADHD overdiagnosed?. Where do you stand on the diagnosis of ADHD – do you think it is overdiagnosed? Why or why not? What factors might lead to overdiagnosis of ADHD? What about underdiagnosis? What problems might result from underdiagnosis or overdiagnosis?.

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Is ADHD overdiagnosed?

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  1. Is ADHD overdiagnosed? • Where do you stand on the diagnosis of ADHD – do you think it is overdiagnosed? Why or why not? • What factors might lead to overdiagnosis of ADHD? What about underdiagnosis? • What problems might result from underdiagnosis or overdiagnosis?

  2. Initial questions/myths to be addressed • Is ADHD a relatively new disorder? • Are ADHD symptoms fairly common; are we merely labeling normal behavior as a disorder? • Is ADHD/inattentive type similar to the traditional combined type? • Has the rate of ADHD increased in the last twenty years?

  3. Core Symptoms • Inattention OR • Impulsivity • Hyperactivity • (recent DSM change) • Central role of impairment • Must be present before age 7 • Impairment in 2 or more settings

  4. Associated features of ADHD • Learning problems • Peer problems • aggression, noncompliance

  5. Diagnostic Issues • Diagnosis based on history of disorder • Rating scales • Interviews • Observations • Best with two sources • No medical test or lab measure to determine diagnosis

  6. Prognosis • Chronic disorder extending into adulthood • 3 common outcomes: • Minimal problems • Some moderate problems • Severe problems

  7. Ineffective Treatments • “talk” therapy • Play therapy • Elimination diets • Allergy treatments • Chiropractics • Pet therapy • Dietary supplements • Perceptual or motor training/sensory integration training

  8. Effective TreatmentsEvidence-Based • Psychostimulant medications • Ritalin (methylphenidate), Dexedrine, Cylert • Concerta, Adderall • Strattera is new nonstimulant med • Behavior therapy

  9. Main Benefits of Meds • 2/3 of children show benefits; another 10% benefit from other; rest show no response or adverse response • Less classroom disruption • Better behavior as rated by teacher • More compliant with adult requests • Increase in on-task behavior • Better peer interactions

  10. Other important points • Needs to be long-term • Few dysfunctional attributions • No increase in risk for later substance abuse • Not sufficient

  11. Limitations of drug treatment • Rarely sufficient • Not effective for all • No impact on some family variables • Removes incentives for behavioral tx • No long-term effects

  12. Adverse Effects • Irritability, moodiness • Stomaches, headaches • Insomnia • Loss of appetite – less growth • Motor movements, tics • Rebound effect

  13. Behavior Modification • Only psychosocial tx • Should be implemented first • Train parents and teachers • Extensive • Difficult • Punishment/response cost needed

  14. Parent Training • Establish house rules • Praise appropriate behavior • Use appropriate commands • When…then contingencies • Time out • Points/token systems • Continually evaluate and modify

  15. School Interventions • Clear classroom rules • Similar to parent stuff • Near teacher • Focus on academic performance • Home report cards

  16. Combined interventions • Produce better short-term effects • Often preferred by parents

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