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Overdiagnosis of ADHD

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With up to 10% of people being “diagnosed” with ADHD, we ask: What is ADHD? Is it being overdiagnosed? Is there a financial incentive behind the rocketing figures? When is an ADHD diagnosis genuine, and when is it “financially based”? What are the impacts on the well-being of having a genuine case of ADHD? What are the implications of receiving or engineering a false diagnosis?

What is ADHD? Attention Deficit Hyperactivity Disorder is thought to be a condition that gives the impression of people being unable to concentrate for long, suffering from restlessness, and having low levels of impulse control. Some people with the indicators of ADHD may also have sleep disturbance and higher anxiety levels.

The word “disorder”, to some analysts in the field, is highly problematic; what we now call ADH “Disorder” may be a normal part of childhood brain development.

That is supported by the fact that most people diagnosed with ADHD improve with age. Could it be that what is classified as a “neurodevelopmental disorder” is no more than a different route to neurodevelopment? Let’s test that theory from your own observations.

It is claimed that people with ADHD cannot concentrate on one thing for long. Is that true? Are some of your younger relatives with ADHD keen on a sport, hobby or game? Whatever their preferred interest, have you regularly observed that they could engage in it enthusiastically, with amazing levels of concentration, for hours, without a break? Almost certainly.

Have you also witnessed younger relatives who supposedly have ADHD-type symptoms at school, when they decide they want something, persisting for hours, days, weeks, or even months, trying to persuade their parents to have it? Almost certainly.

That indicates focus, attention, impulse control and all the mental behaviours they are purported not to have. Yet, the same children are diagnosed with an inability to concentrate. Would you agree that it seems like a contra-indication, a contradiction, that something does not add up?

Let’s explore

When you are asked to concentrate on a subject with zero interest, can you concentrate for more or less time than normal? Probably, less, much less.

When you have been subjected to an “educator” who seems skilled in sucking the interest, passion, and enthusiasm out of any subject, could you concentrate for more or less time than normal? Probably, less, much less. That is, if you could even stay awake!

By contrast, if you had a teacher who could supercharge your already keen interest in a subject, what would happen to your ability to focus and concentrate? Probably it was greater, much greater.

Are we witnessing some children being “diagnosed” with ADHD more because some inept teachers cannot capture their interest? Is that especially true for kids who can contrate for hours on their favourite sports, hobbies or games?

Throughout history, great teachers have been able to teach those who were deemed ‘unteachable’ by others. Could many ADHD diagnoses be more a reflection of bad teaching than any other factor?

If ADHD is a real phenomenon and isn’t mainly some bad teachers diverting blame or pharmaceutical companies confecting a disorder to sell ‘medication,’ then it is reasonable to ask: What causes ADHD?

Simply put: we don’t know. The cluster of apparent symptoms can have a familial element. It is unknown whether that means it is genetically passed on or behaviourally transmitted.

It is claimed that people with learning difficulties are more likely to experience ADHD. Such claims, in many cases, are circular arguments. Here are three sentences which I have heard being used by those oblivious to their circular “reasoning”:

  •  The person has a learning disability evidenced by the “fact” that they cannot concentrate long enough to learn normally.
  • The person cannot concentrate long enough to learn normally, which is evidence of a learning disability.
  • Therefore, they have a learning disability and ADHD.

In the meantime, the parents or guardians, away from the teaching environment, witness the youngster engaged in a hobby, interest or game for a long time.

We do not know enough about the workings of the brain to say whether the ADHD symptoms are part of a learning disability or a learning disability is part of ADHD. We certainly can’t claim either, or both are present when there is such behavioural evidence of the exact opposite outside of the school environment.

If some childhood ADHD diagnoses are motivated by bad teaching or finance, what is the situation for adults?

Perhaps this direct quote from the UK NHS website can shed some light. “For adults with ADHD, medicine is often the first treatment offered.”

The theory behind ADHD treatments is that they are altering the levels of dopamine and norepinephrine on the assumption that they can influence a person’s attention and concentration. That theory fails to consider that those chemicals are created and released in response to other factors. There are drug-free ways to alter dopamine and norepinephrine levels, such as focusing on something of interest.

ADHD “treatments” have known side effects and unknown side effects. Here are some that we know of: Sleep disturbance (which is known to be a driver of depression), decreased appetite and weight loss (which are known to impact mental functioning negatively), increased blood pressure (which raises the risk of cardiac and vascular disorders), dizziness, headaches and stomach aches (which impairs the ability to concentrate), moodiness and irritability (which impairs social interaction and social skills development).

One of the guiding principles of medicine is, first, to do no harm and take no unnecessary risks. Since all drugs have risks and side effects, in good medical practice, drugs should be used only when all other risk-free options have been tried.

If that principle was being followed, what would we expect to see? Those suspected of having ADHD were first assessed to evaluate their ability to concentrate on topics of interest and their learning and focus strategies. Is that happening? Not according to the NHS website.

It seems to me that there are financial motives behind the diagnosis. Is it cheaper to dismiss someone with a prescription that they must pay for? Yes. Have the drug companies sold the idea of a drug “to treat” ADHD to physicians? Yes. Will they benefit from that drug being prescribed? Yes. Will the physician save some time and money with a quick prescription? Yes.

Over the years, with some clients, in my coaching work, when they have been unable to muster the concentration for a task which they knew needed to be completed, for their own benefit, they have asked, “Do I have ADHD?” Why do they ask? They have seen the media coverage. They are looking for answers. They think they fit the symptoms of ADHD.

In nearly every case, when we started exploring their motives for wanting to achieve their stated objective, the reasons were not strong enough to drive them to take action. It is difficult to get started, focus, and concentrate when the motivation, passion, and enthusiasm are lacklustre.

That takes us to alternative explanations of what appears to be ADHD. Some people receiving an ADHD diagnosis have different goals from those making the diagnosis. “Like a kid in a candy shop” has become a (useful) cliché for a reason; it paints a picture of being so excited by so many wonderful things that focusing on anyone is unlikely. That feeling of excited awe is very appealing. What looks like ADHD may be the person seeking that feeling ahead of other priorities. If so, for them, ADHD is no more than a difference in reward perception and emotional priorities.

Some people find so many things interesting that they can’t focus on any one without feeling a sense of losing out on others. That can mimic what looks like ADHD. Again, it is no more than a difference in reward perception and emotional priorities.

Barbara Sher described such people as “scanners” in her series of influential books. Many people have multiple interests and don’t wish to focus on any one of them for too long. There is another, perhaps overlapping group I would call “neophiles”, compellingly attracted to anything new and interesting. They are happy to take an experiential or intellectual taste of many things but feel that focusing on anyone is self-punishment. Yet, again, that seems to be no more than a difference between reward perception and emotional priorities.

In 20 years, the incidence of ADHD diagnosis has nearly doubled to reach just over 10%.

With the “symptoms” of ADHD overlapping with symptoms of so many other “disorders,” it is hardly surprising that there is both misdiagnosis and overdiagnosis. Anxiety, depression, sleep deprivation, borderline personality “disorder,” and autism are just some of the other behavioural variations that can be and regularly are mistaken for ADHD, in addition to those listed above.

Other factors may be behind the increase in the diagnosis rate. It could be that increased awareness has led to more people coming forward to be “assessed”.

Less benign motives may also be at play: getting a diagnosis in order to obtain special or more favourable treatment. The “tests” and questions used to diagnose ADHD (no reliable or objective method exists) are available online. This means anyone who wanted could provide the “test” answers necessary to get the diagnosis that fits their purposes.

By its very nature, the extent of such diagnostic deception is impossible to measure. Many practitioners can confirm having been asked to give diagnoses that suit a client’s intentions. The best estimates are survey-based and indicate that 25% of ADHD cases are faked to get access to the drugs usually prescribed.

There is every reason to believe that ‘pushy parents” seeking to give their children an advantage are also involved in such fakery. A special needs diagnosis, such as ADHD, will secure more support, resources and grade allowances for their children.

In a recent survey, nearly 60% of teachers said there was misdiagnosis of ADHD. Almost 40% thought parents sought such a diagnosis for that purpose, not for genuine reasons. Perhaps it is not just bad teachers looking for an excuse that is driving up the ADHD diagnosis figures.

Schools, too, have the motive to seek an ADHD diagnosis: If they have more ADHD pupils, then the evaluation of their own performance is impacted; more sins of education failure can be passed off as having more students who have special needs.

Several of the above groups benefit from an ADHD diagnosis; the underperformance can be excused away: “A medical condition is the cause.” A false diagnosis can be very beneficial.

Does that mean that there is an ADHD conspiracy? No, merely a confluence of motives for an ADHD diagnosis. How does a confluence of motives work? Where multiple parties (pupils, parents, teachers, schools, medical practitioners, pharmaceutical companies) have their own motives for achieving the same less than honourable end, and all work independently toward the same end, a confluence of motives can look like a conspiracy.

To conclude, if you suspect that you or a relative may have ADHD, probably the main reason for some people reading this article, it would be wise to explore all other possible causes of what may look like ADHD before embarking on any drug-taking.

Professor Nigel MacLennan runs the performance coaching practice PsyPerform.


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