Study: ADHD is often misdiagnosed

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Study: premature ADHD diagnoses by psychiatrists and psychotherapists

Children who cannot stop, suffer from a lack of ability to concentrate and are generally considered to be “impulsive” are quickly diagnosed with ADHD by diagnosticians. The result: Medicines such as "Ritalin" or "Concerta" are administered, which often bring about a significant change in the nature of the young patients. A current study by the Ruhr-Universität Bochum and the University of Basel came to the conclusion that the criteria set by the treating physicians are often applied too imprecisely and diagnoses are made prematurely. The study is the first empirical survey in Germany to examine the diagnosis of doctors and therapists.

Children or adolescents who are restless, show aggressive bursts of impulse and have difficulty concentrating are often diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). The fact that child and adolescent psychiatrists often seem to be wrong is shown by a joint research project by scientists from the German Ruhr University in Bochum and the Swiss University of Basel. "For the first time, false diagnoses could be backed up with representative data," said the researchers.

Rapid increase in ADHD diagnoses in Germany
Between 1989 and 2001, the number of ADHD cases in clinical practice increased by 381 percent. According to information from the Techniker Krankenkasse (TK), the distribution of typical ADHD medications like Ritalin increased ninefold in the same reporting period. According to TK, the daily doses of prescribed medicines in the age group of 6 to 18 years increased by an average of ten percent.
The result showed that child and adolescent psychotherapists and psychiatrists make diagnostics on the basis of simple “rules of thumb instead of adhering to valid diagnostic criteria, so-called heuristics.” According to the study data, incorrect diagnoses are made more frequently in boys than in girls.

Diagnostic test with psychiatrists and therapists
The research team wrote around 1,000 child and adolescent psychiatrists and therapists across Germany. Exactly 473 therapists and doctors participated in the data collection. All participants received one of four different case reports. Based on the case histories, psychotherapists should make diagnoses and suggest appropriate therapy. In three of the four fictitious patient histories there was no ADHD based on the symptoms and circumstances described, only one case was clearly diagnosed as a deficit in attention deficit and hyperactivity with the help of the applicable guidelines and criteria. Since the scientists also varied the gender of the "patients", a total of eight different cases were assessed. This resulted in a clear difference for two identical case histories: "Leon has ADHD, Lea does not".

In the gender-varied case report with ADHD, the scientists used the applicable guidelines so that it was clearly diagnosed as ADHD. Nevertheless, a large number of the participating therapists misdiagnosed ADHD, although the criteria for this were not clearly met.

Boys are more likely to be misdiagnosed by ADHD than girls
When evaluating the returned data, the researchers made an amazing discovery. In many cases it was based on prototypical symptoms. "The prototype is male and shows symptoms of motor restlessness, lack of concentration or impulsivity." In boys, the diagnosis of attention disorder is almost automatically made, according to the research team. This was less the case with girls. The naming of symptoms apparently triggered different diagnoses for therapists depending on gender. "If the same symptoms occur in a boy, he is diagnosed with ADHD, but the identical symptoms in a girl do not lead to an ADHD diagnosis." It was also shown that male psychiatrists diagnosed attention disorder syndrome more often among fictitious clients than female therapists.

Inflationary diagnoses
ADHD diagnoses are inflated nowadays, the researchers report. In practice, the number of cases increased by almost 400 percent between 1989 and 2001. This in turn has the consequence that the administration of typical ADHD drugs increased ninefold between 1993 and 2003. If even smaller doses were prescribed 20 years ago, the individual dosage has increased steadily over the years.

According to the experts, it is remarkable that there is great social interest in the psychological disorder, but hardly any studies have been undertaken. "There is a remarkably small base of empirical studies on this topic against the great public interest," criticize Prof. Schneider and Dr. Bruchmüller. In the 1970s and 1980s, there was a "certain upswing" in the investigation of the frequency and causes of misdiagnosis of ADHD, and research has hardly paid attention to it since then, the investigators criticize. The current work shows: “In order to prevent a wrong diagnosis of ADHD and a premature treatment, it is crucial not to rely on your intuition, but to orient yourself clearly on the defined criteria. The best way to do this is with the help of standardized survey instruments, for example diagnostic interviews. "

A data analysis of patient data by Techniker Krankenkasse presented in 2011 confirms the study results. In 2009, 27 out of 1,000 adolescents were prescribed a methylphenidate (Ritalin) medicine by a doctor or psychiatrist. Compared to 2006, this corresponds to an increase rate of 32 percent.

The research results of the study by Prof. Dr. Silvia Schneider and Prof. Jürgen Margraf (RUB) and Dr. Katrin Bruchmüller (University of Basel) have been published in the US Journal of Consulting and Clinical Psychology and in the German journal Psychotherapeut. (sb)

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Image: Alfred Heiler /

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