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A lot of US children are being diagnosed with ADHD improperly

Many doctors aren’t following professional guidelines

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A lot of children are being diagnosed with ADHD in the US — but improperly. One in five are diagnosed based on information provided by family members alone, in violation of the guidelines set by the American Academy of Pediatrics, according to a report from the US Centers for Disease Control and Prevention.

6.4 million school-aged children diagnosed with ADHD

About 6.4 million school-aged children have been diagnosed with ADHD in the US as of 2011 — or one in every 10 school-aged child. That’s a 42 percent jump in ADHD diagnoses in children since 2004. The rapid increase in diagnoses led some doctors to question whether children really do have the disorder. That’s why the CDC wanted to find out how kids were being diagnosed.

So the CDC researchers conducted a survey in 2011 and 2012, asking parents about how their child’s ADHD diagnosis occurred. Then, they followed up in 2014 with some of the families.

The median age for diagnosis was seven years, the researchers found. A third of children were diagnosed before the age of six — a red flag, since few diagnostic tools are effective in children that young. The data also show that 18 percent of kids received an ADHD diagnosis based solely on information provided by family members. That’s against AAP guidelines — which say that a child should be impaired in more than one setting, say at home as well as in school. Still, most children, nine out of 10, were diagnosed using rating scales. About three-quarters diagnosed before the age of six and two-thirds of older kids also underwent psychological testing.

18 percent of kids diagnosed using information provided solely by the family

There’s a lot of room for improvement, says Thomas Brown, a psychologist at Yale University. But in the majority of cases, health care providers followed the AAP guidelines. In fact, Brown was surprised by how many kids underwent psychological testing. Practitioners "aren't just listening to parents who say 'hey my kids have ADHD' then going 'okay here's a prescription.'" Most of the time, "they're using standardizing tests and doing some interviewing and involving the parents and getting data from the school."

The data are "loaded in the direction of hyperactive kids."

The fact that the age at diagnosis is so young suggests to Brown that the data are "loaded in the direction of hyperactive kids," Brown says. Children that are "quiet and spacey tend to be missed at that age." If the age at diagnosis were higher, it would suggest that children who are quiet but still have trouble focusing aren’t being overlooked.

Kids between the ages of six and 11 who are diagnosed with ADHD should receive behavior therapy or stimulants approved for ADHD — preferably both — according to the American Pediatrics Association. For kids under the age of six, however, therapy alone is favored over treatments that include medication.

Though most kids are being diagnosed using the guidelines recommended by doctors’ professional groups, plenty aren’t being diagnosed the right way. Today’s findings will hardly quiet the groups concerned that the increased rate of ADHD diagnosis has little to do with an increasing number of children who are actually sick.