ADHD diagnoses have increased significantly over the last few decades. While overdiagnosis is a concern, the rapid rise may also be due to increased awareness and changing definitions.

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition that affects children and adults. Doctors often diagnose ADHD in childhood, but many people don’t receive a diagnosis until adulthood.

Among parents and in the medical community, there’s some concern about overdiagnosis in children and adolescents. The concern grows from the steadily increasing number of children diagnosed with ADHD.

Read on to learn more about the possible overdiagnosis of ADHD and other factors that might be behind the increase in ADHD prevalence.

Overdiagnosis vs. misdiagnosis

Overdiagnosis is the diagnosis of a condition that would not have caused symptoms or issues. It can be harmful if it leads to unneeded treatments or psychological stress.

Misdiagnosis is when a wrong diagnosis is made — for example, if a person receives a cancer diagnosis when they have a benign cyst.

Read more: “Conditions That Mimic ADHD”

Given the sharp increase in ADHD diagnoses in recent years, studies have looked at the potential overdiagnosis of ADHD in children. The term “overdiagnosis” describes the frequent diagnosis of a condition, even if it doesn’t meet diagnostic criteria.

Some research suggests that certain factors, such as the sex of the child or how old they are compared to others in their grade, may influence ADHD diagnosis.

When diagnosing neurodevelopmental disorders in children, doctors use a multi-person interview approach. The child’s parents, caregivers, and teachers describe the child’s behavior. The healthcare professional then assesses whether the information gathered from these interviews points to a diagnosis.

Researchers found that those close to the child may have unconscious beliefs or biases about how ADHD “looks.” This can lead to imbalanced diagnosis rates in males compared with females.

It can also mean children on the younger side of their grade, who may be less mature than their peers, might be more likely to receive an ADHD diagnosis.

Overdiagnosis of ADHD can lead to a host of issues, including:

  • overprescription of unnecessary medication
  • anxiety or depression related to diagnosis
  • unnecessary labeling or assistance
  • needless financial costs

Researchers have also questioned whether diagnosing and treating milder cases of ADHD may cause more harm than good.

Some research suggests that diagnosing ADHD when symptoms are not severe may cause social, psychological, and academic problems. Medications may also be less effective in these cases.

Medical professionals use the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) to diagnose conditions like ADHD. Each new edition revises diagnostic criteria — sometimes changing, removing, or adding disorders.

The DSM-5 is the most recent edition of the manual. It featured changes to the diagnostic criteria of ADHD from DSM-4 that include:

  • a change in classification, from “disorders usually diagnosed in infancy, childhood, and adolescence” to “neurodevelopmental disorders”
  • more examples of how ADHD can present in adolescents and adults
  • a change to the age of onset, from before age 7 to before age 12, and changed wording from “evidence of impairment” to “evidence of symptoms”
  • an update to “clinically significant” functional impairments, which means they now need to just interfere with social, academic, or occupational functioning
  • removal of autism spectrum disorder as an exclusionary diagnosis

The increased age of onset accounts for the reality that ADHD symptoms may appear in response to expectations and demands from the elementary school environment.

Most studies have found that while, at the very least, the misdiagnosis of ADHD and other neurodevelopmental disorders is common, it’s unclear whether overdiagnosis, specifically, is happening.

There may be several reasons leading to the increase in ADHD diagnoses, including:

  • more awareness of neurodevelopmental disorders and less stigma, leading to healthcare use
  • improved diagnostic procedures, which means better identification of ADHD, especially of milder cases
  • changes in diagnostic criteria between DSM-4 and DSM-5, leading to lower thresholds for a diagnosis
  • doctors may not stick to diagnostic criteria and may be affected by their own bias and judgment

When studying diagnoses, it can be difficult to say whether a diagnosis is “true” or not. Standardized diagnostic procedures are necessary to reduce any bias in clinical judgment and lower the chance of misdiagnosis.

There’s no clear consensus on whether ADHD is overdiagnosed or not. However, misdiagnoses of ADHD do occur among children, teens, and adults.

This could be due, in part, to a lack of standardized diagnostic tests. It could also be due to clinicians’ personal biases or unclear and open-ended criteria.

Being an active part of the diagnostic process can help you reduce your or your child’s risk of receiving an improper ADHD diagnosis. If you have questions, ask your doctor about their reasoning for the diagnosis. Don’t hesitate to get a second opinion if you feel the need.