She's Just a Daydreamer: The Bias in Diagnosing ADHD

Is ADHD overdiagnosed? In recent years, tons of articles, hour-long news specials, even full documentaries and books have been focused on this question. It’s hard to ignore the panic surrounding the issue, and it’s easy to understand why so many people aren’t exactly trusting of the ties between the pharmaceutical industry and the doctors who may diagnose their children. 

Plenty of reasons exist for the concern surrounding ADHD diagnosis and treatment. Some studies show the prevalence of ADHD increased by almost 42% from 2003 to 2011. Another reason for concern is the fact that stimulants are usually the standard for treating the symptoms of ADHD. A study showed that in 2016, of the approximately  5.4 million (or 8.4% of all) U.S. children between the ages of 2 and 17 who were currently diagnosed with ADHD, almost two-thirds of them were taking medication as part of their ADHD treatment. As more kids are being diagnosed and treated with stimulants at younger ages, more and more people are raising questions concerning the diagnostic criteria and methods. 

Although the examination of overdiagnosis of ADHD is very much warranted, these calls for concern often forget to mention who exactly it is that is most likely to be overdiagnosed with ADHD and who’s most likely to be under or misdiagnosed.

As a young adult, I had read plenty of these articles with sensationalized titles like: “Infants on Adderall” or “Playing Pretend is Now a Symptom of ADHD.” So by the time I was diagnosed, I was wondering how I’d somehow been missed by this “epidemic” period of diagnosing ADHD. 

After talking to the doctor who diagnosed me, as well as doing my own research, I learned that it’s not so uncommon for girls to make it into adulthood before being diagnosed with ADHD. Those socialized as girls often have different expectations and standards set out for them that they are expected to conform to even at a young age. The pressure to perform in a specific manner means many girls end up internalizing their symptoms, seeing their disorganization or carelessness as personal flaws rather than a possible medical issue that may be treated through medicine or therapy. Not only do the expectations for girls’ behavior alter the way ADHD may manifest, but the entire diagnostic criteria weren’t made with them, or many others in mind.

The book Understanding Girls with AD/HD explains that ADHD was first diagnosed in young, white boys, determining hyperactivity was a key indicator. Because of this, the diagnostic criteria and guidelines were written all around how ADHD manifests in these specific boys, and most of this research is almost exclusively focused on boys (only about 1% is specific to girls, Ellen Littman says).

It also materializes much later in girls, which created some problems when the American Psychiatric Association’s diagnosis criteria called for symptoms to be visible by age 7. However, it did recently changed the age to 12, allowing more girls to be captured.

This isn’t just an issue for women. Although diagnosis rates have risen among nearly all demographics children of color are also far less likely to be diagnosed. A 2013 study showed that “by the time the study’s subjects reached eighth grade, African American children were 69 percent less likely — and Latino children 50 percent less likely — to receive an ADHD diagnosis than their white counterparts.” Black and Latinx students were not only less likely to be diagnosed, but also, once diagnosed, they were also less likely to be taking medication or given proper treatment for their ADHD. 

So while the abundance of panic surrounding the overdiagnosis of ADHD and image of Adderall and Ritalin being pumped into the school systems isn't that off the mark, it should not overshadow the fact that there are still many children feeling inadequate and struggling to focus every year who are simply seen as a “problem child” or “too chatty.” These children deserve just as much of a chance as any.

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