ADHD Label And Misdiagnosis In Children

Attention deficit hyperactivity disorder (ADHD) in children

Today, attention deficit hyperactivity disorder (ADHD) has become a common diagnosis in children and adolescents. Roughly 7% of American children between the ages of 7 and 13 are diagnosed with ADHD. This phenomenon has been on the rise since the early 1990s, when the first drug was discovered to help parents and teachers control the behaviors of children with what was considered extreme hyperactivity and difficulty concentrating. Individuals with attention deficit disorder (ADD) do not automatically meet the diagnostic criteria for ADHD.

According to studies, many children and teens are misdiagnosed with the H-factor (hyperactivity) when they don't actually meet that criterion. According to the diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), children and teens must exhibit a deficit in the area of attention and display symptoms of impulsivity, hyperkinetic activity, and blurt-out thoughts to receive a diagnosis of ADHD, as opposed to ADD.

The qualifiers listed in the statistical manual that most clinicians seem to miss or gloss over are the words persistent and increasing when it comes to the diagnostic criteria. Some researchers are concerned that evaluators are placing too much stock in parent observation or what teachers have to say. Without following the DSM-5 criteria, these children and teens are labeled with ADHD, which can have negative consequences for them and their families. This emphasizes the importance of understanding, developing the same understanding among professionals, and ensuring that the education system, educators, and services provided to diagnosed children are appropriate and sensitive to the potential risk of stigma associated with labeling children with ADHD.

The difference between hyperactivity and ADHD

Children are typically quite active, and some may seem hyperactive, which is why they get the ADHD label. However, a child's hyperactivity coming from a teacher’s or a parent’s point of view may be subjective. Children are expected to sit for extended periods of the day in schools. For a child who likes to play, this may seem unreasonable. Depending upon how structured the home is, this may be the only time the child is expected to sit still.

Children are typically more active than most adults. They often play, run around, and show a variety of interests and curiosities in the world around them. Young boys and girls who are bored or inactive for long periods may feel they are bursting at the seams with energy. Before parents, caregivers, or teachers label a child as ADHD and seek a supporting diagnosis, they may want to ask themselves a series of questions:

1. What am I doing to engage this child mentally?
2. In what ways and how do I provide physical activity opportunities for this child?
3. Do I allow enough socialization for this child?
4. Do I engage this child in discussions, group or individual?

Understanding the context and expectations placed on young people is crucial. Professionals should encourage teachers to consider alternative explanations for a child's behavior before resorting to labels that may carry a risk of stigma in society. Remember that labels matter, not only for the child but also for how their peers perceive and interact with them.

Some teachers may seem to forget that differentiating classroom instruction and activities does not apply only to children with a learning disability or exceptionalities. Different children have different personalities and learning styles, and education may not work as a one-size-fits-all. 

The same is true at home. If a parent has five children, no two of them will be the same. 

Suppose one child, the oldest of two, is quiet, with a calm demeanor, never giving a moment of trouble. Their younger sibling comes along and is talkative and sometimes naughty. Strategies which work for the older child may not work for the younger child.

If a child seems to be displaying some of the traits of ADHD or ADD, it's important to get medical help and it may be beneficial to also seek mental health help. 

When is it right to seek an ADHD diagnosis?

ADHD may be a very legitimate concern for some children and adolescents. It is a disorder, and that means that there is a persistent pattern of behavior or symptoms that may interfere with the child’s or adolescent’s ability to function in their daily lives. If a child displays this pattern, it may be time to seek clinical support.

The dangerous effects of misdiagnosis

Alternatively, there are the children who are never identified. Their thoughts and behaviors become uncomfortable for them, so they may learn to self-medicate either with alcohol or other substances by the time they reach adolescence. These adolescents may have just opened the door to substance use, and that has the potential to become a dangerous path or continuous cycle.

Many of the characteristics of the gifted child are often confused with that of ADHD. It is important to consult with a medical practitioner before labeling a child with ADHD-like symptoms. A gifted child requires a very different situation from a child with ADHD or ADD.

When a gifted child is placed with others who are also gifted or have above-average intelligence, difficult behaviors that may mask themselves as symptoms of ADHD will often diminish.

Frequently, parents or caregivers who are feeling frustrated or helpless with a child’s behavior may be willing to accept the opinion of a teacher, school psychologist, or special education evaluator in search of answers. That opinion may not always be accurate, and parents or caregivers may want to seek outside help.

The duality of being mislabeled

There are also kids with dual exceptionalities; they are gifted and have ADHD, yet do not fit neatly under either label. As a recent study has suggested, it may be discomforting to realize that someone is so multifaceted that they cannot easily fit inside a box or be assigned a label. Often, it is simply easier to label a child as ADHD and place the child for treatments. Such students may carry this label with them from elementary school all the way through high school, as once diagnosed, the situation is rarely revisited. 

Alternative ADHD treatments for diagnosed children

Before labeling a child as ADHD, it is important for parents, caregivers, teachers, and practitioners to recognize that a child is more than a diagnosis. It takes time, sometimes even months, of testing, trying different strategies, evaluating different search results, and working closely with the child by all involved parties before a diagnosis should be rendered. Most importantly, time should be taken before prescribing medication to quell ADHD symptoms.

While pharmacological treatments may be recommended for ADHD, nonpharmacological approaches are also being studied and practiced. Although medications can be an effective treatment for ADHD and may work quickly, the long-term side effects are not well known. Medication also doesn’t necessarily address issues children may have managing academic performance or personal relationships. If you feel your child or adolescent may be living with ADHD or has recently been diagnosed, there are many effective treatments you can try before resorting to prescribing medications.

Behavioral intervention

The American Academy of Pediatricians’ 2011 treatment guidelines recommend behavioral strategies as the first line of treatment for ADHD in young children. The key to success is early and consistent intervention. These intervention treatments fall into three main categories: parent programs, teacher programs, and therapeutic recreational programs.

The parent program focuses on parents or caregivers rewarding children for good behavior instead of always commenting on the behaviors they deem bad or poor. This ensures children are getting attention for being good instead of always focusing on the negative.

Teacher programs focus on giving teachers behavioral strategies to use in the classroom. These often include giving children simple step-by-step instructions and announcing consequences ahead of time for not paying attention or following instructions. Contingency management is also used in teacher programs where children receive daily report cards outlining goals within the classroom. Children will receive rewards when they’ve met their goals or contribute to the group.

Therapeutic recreational programs involve regular interactions between children with ADHD. In these programs, children learn traditional activities or sports, behavioral interventions, social skills, contingency management strategies, and team skills.

Online therapy is also a consideration for children and teens who have (or may have) ADHD. An online therapist can help and support a child to work through their feelings and establish strategies for coping with life at school and at home.

Is your child showing symptoms of ADHD?

You or your child may benefit from therapy

Lifestyle changes

Lifestyle changes may be a powerful treatment for children or adolescents with ADHD and caregivers or others involved. Research shows that daily physical activity may help those with ADHD ignore distractions, focus on tasks, and improve academic performance. Studies also show that adequate sleep is crucial for children living with ADHD symptoms, and behaviors improved among children who got more sleep. Unlike adults who become fatigued and slow down with lack of sleep, children with ADHD often become hyperactive.

Online therapy for supporting children with adhd

Parents should be empowered by school counselors, teachers, and pediatricians to advocate for their children. Providing literature, seminars, webcast information, strategies, and the latest educational resources, as well as medical research, can benefit parents.

Until a proper diagnosis has been given and a decision made as to whether medication is the appropriate course of treatment, parents or caregivers may consider other forms of treatment such as behavioral therapies and interventions.

If you feel your child may have ADHD, a therapist may be able to help. BetterHelp is an online therapy platform that can provide you and your family with support and advice to get your child on the right track. An online therapist can offer parents help in processing their feelings about their child and a potential ADHD diagnosis. An online therapist can also be enlisted to help your child or teen develop the best way to cope with ADHD or ADD. 

Online therapy has shown effectiveness in supporting parents who are caring for children with an ADHD diagnosis. In one virtual clinic for parents of children with ADHD, results demonstrated high parent satisfaction with the intervention and high usability.