ADHD is a neurodevelopmental disorder that is characterized by symptoms of inattention and/or hyperactivity that are present across multiple settings (school, home, work, etc.). By definition, a neurodevelopmental disorder must become apparent during development, and for ADHD symptoms must emerge before age 12. Most children at this age are in their elementary or primary school years. In the large majority of cases, children with ADHD have both inattention and hyperactivity which is typically diagnosed as ADHD, combined type, though children may also present with only inattention or only hyperactivity. Determining whether a child's (or adult's) symptoms meet the criteria for ADHD requires a careful and nuanced process conducted by a qualified professional that has extensive training in psychological and developmental assessment. Typically, this is a clinical psychologist, a clinical neuropsychologist, or a psychiatrist who has specialized training in assessment, psychometrics, and testing (this latter scenario is quite rare). While many inattentive or hyperactive symptoms reported by the general population may superficially resemble the diagnostic criteria for ADHD, determining whether these symptoms represent ADHD, normal variability in attention, or overlap of cognitive symptoms with other psychosocial processes requires an assessment conducted by a professional who is truly qualified to assess, test, and diagnose the patient.
Why does overdiagnosis occur?
In the Diagnostic and Statistical Manual of Mental Disorders - 5th Edition (DSM-5), symptoms of inattention and/or hyperactivity are fairly subjective. Accordingly, there is varying interpretation of the criteria by healthcare professionals. Additionally, healthcare professionals have difficulty discriminating symptoms of ADHD from other psychological or developmental conditions that can produce similar symptoms. Examples of other psychological or developmental conditions that can mimic ADHD include:
- PTSD/Trauma history
- Fatigue/Poor sleep
- Intellectual disability or borderline intellectual functioning
- Medications with cognitive side effects
Because ADHD symptoms frequently superficially resemble normal variability in attention and behavior, and that there is considerable overlap between ADHD symptoms and other factors like fatigue, stress, or psychiatric symptoms, many clinicians are tempted to label these symptoms as ADHD when in reality the cause is far more benign.
Why do people seek diagnoses of ADHD?
Even among people without any form of developmental evidence of ADHD or any other developmental condition that causes significant barriers or functional impairment in achievement or functioning, many will aggressively seek ADHD diagnoses, and recruit parents, friends, therapists, and physicians on their path. Why to these individuals seek an ADHD diagnosis so tenaciously? Some reasons may include:
- Redefining life experiences following trauma
- Explanation for behavioral health treatment non-response
- Relief of personal responsibility for change
- Avoidance of punishment or culpability
- Access to benefits, accommodations, or compensation
- Access to controlled substances
- Permission to be different
- Social contagion and recent impact of social media
Societal and Cultural Factors
In the United States of America, there is a strong cultural expectation in many communities for high achievement in school, social or work settings. Such high expectations can pull for a desire for a "quick fix" among parents, therapists, workers or students to address perceived shortcomings in achievement, performance, or progress in therapy. Additionally, an aversion to being labeled as "normal" or "average" may pose as a strong motivator in some communities to pursue a diagnosis that identifies them as unusual, special, different, exceptional, or even "neurodivergent," as a way to explain perceived underperformance in school, social, or work settings. While the term "neurodivergent" has traditionally been used to refer to individuals along the autism spectrum, people seeking d