Although children diagnosed with ADHD can qualify for individualized education plans, and those with moderate to severe symptoms who take stimulant medications show improvements in math and reading performance, the benefit of diagnosing a child with mild symptoms is less clear. Harms of an ADHD diagnosis include labeling, disempowerment, lowered school expectations, the opportunity costs of medical visits (e.g., missed work for parents), and medication adverse effects, including insomnia. In an accompanying patient perspective, Helen Haskell and John James expressed concern that “medicating children to change their behavior may help them sit quietly at school, but viewing medication as a first-line solution may mask problems with the school or home environment and inhibit the development of important life skills.”
A recent episode of the Pharmanipulation podcast, featuring interviews with a licensed clinical psychologist and an investigative journalist, further explored the subjectivity involved in ADHD diagnoses and educational and societal pressures that may be driving these diagnoses in borderline cases. For example, the Vanderbilt Assessment Scales that are completed by a child’s parents and teachers to assist with diagnosing ADHD “[take] a subjective impression and quantify it so that it makes it seem objective.” If the parent or teacher already thinks that the child has ADHD, they will be more likely to complete the questionnaire in a way that leads to the diagnosis. Having ADHD makes a child likely to receive pharmacologic treatment, even though psychosocial interventions such as parent training in behavioral management and classroom behavior interventions can also be effective, particularly in younger children.
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This post first appeared on the AFP Community Blog.
