Study ADHD is often misdiagnosed

Study: Rash ADHD diagnoses by psychiatrists and psychotherapists

01/04/2012

Children who can not sit still, suffer from lack of concentration and generally considered „impulsive“ Diagnostists quickly diagnose ADHD. The result: Medicines such as "Ritalin" or "Concerta" are administered, which often cause a significant change in the nature of the still young patients. A recent study by the Ruhr University Bochum and the University of Basel came to the conclusion that established criteria are often used by the treating physicians too inaccurate and hasty diagnoses are made. The study is the first empirical survey in Germany that examined the diagnosis of physicians and therapists.

Children or adolescents who are restless, show aggressive bursts of impulses, and experience difficulty concentrating often receive the diagnosis Attention-Deficit Hyperactivity Disorder (ADHD). That child and adolescent psychiatrists apparently often err, shows a joint research by scientists at the German Ruhr University Bochum and the Swiss University of Basel. „For the first time, false diagnoses could be confirmed with representative data“, so the researchers.

Rapid increase of 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 allocation of typical ADHD medications such as Ritalin has increased ninefold in about the same reporting period. In the age group of 6 to 18 year olds, the daily doses of prescribed medicines have increased by an average of ten percent, according to TK.
The results showed that child and adolescent psychotherapists as well as psychiatrists diagnose diagnostics using simple methods „Rule of thumb instead of adhering to valid diagnostic criteria, so-called heuristics.“ According to the study data, boys are far more likely to make wrong diagnoses than girls.

Diagnostic test with psychiatrists and therapists
The research team wrote about 1,000 child and adolescent psychiatrists and therapists throughout Germany. Exactly 473 therapists and physicians participated in the data collection. All participants were each given one of four different case reports. Based on the case histories, psychotherapists should make diagnoses and propose appropriate therapy. In three of the four fictitious patient stories, there was no ADHD on the basis of the symptoms and circumstances described; only one case was clearly diagnosable as an attention deficit and hyperactivity disorder with the help of current guidelines and criteria. Since the scientists also still the sex of the „patients“ varied, a total of eight different cases were assessed. This resulted in two different case histories a clear difference: „Leon does not have ADHD, Leah“.

In the sexually varied case report with ADHD, the scientists used the current guidelines, so that it was clearly diagnosable as ADHD. However, a large number of the participating therapists misdiagnosed ADHD, although the criteria were not clearly met.

Boys more often affected by ADHD misdiagnosis than girls
Upon evaluation of the returned data, the researchers made an astounding discovery. In many cases, it was based on prototype symptoms. „The prototype is male and shows symptoms of motor restlessness, lack of concentration or impulsivity.“ The diagnosis of attention deficit is almost automatically diagnosed in boys, the research team concludes. For girls this was less the case. The mention of the symptoms evidently triggered different diagnoses of the therapists depending on the sex. „However, if a boy experiences the same symptoms, he or she will be diagnosed with ADHD, but the same symptoms in a girl will not lead to ADHD“. In addition, it was found that male psychiatrists more often diagnosed the attention disorder syndrome among the fictitious clients than female therapists.

Inflationary diagnoses
ADHD diagnoses are being inflated nowadays, the researchers report. Between 1989 and 2001, the number of cases in practice had risen by almost 400 percent. This in turn means that the administration of typical ADHD medicines has increased nine-fold between 1993 and 2003. While doses were rather lower 20 years ago, single dosing has steadily increased over the years.

Noteworthy in the opinion of the experts that socially there is a great interest in the mental disorder, but hardly any investigations were made. „There is a remarkably small base of empirical studies on the subject in the public interest“, criticize Prof. Schneider and dr. Bruchmüller. There was one in the 1970s and 1980s „certain upswing“ In the study of the frequency and causes of ADHD misdiagnosis, research has been ignoring this since then, is the criticism of the investigators. The current work shows: „In order to prevent a wrong diagnosis in ADHD and premature treatment, it is crucial not to rely on his intuition, but to orient himself clearly to the established criteria. This is best achieved with the help of standardized survey instruments, for example diagnostic interviews.“

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

The research results of the study by Prof. dr. Silvia Schneider and Prof. dr. Jürgen Margraf (RUB) and dr. Katrin Bruchmüller (University of Basel) were in the US „Journal of Consulting and Clinical Psychology“ as well as in the German journal „psychotherapist“ released. (Sb)

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Image: Alfred Healer