Do you know someone who questions whether ADHD exists? Or do you have doubts yourself?
All the major medical groups -- including the American Academy of Pediatrics, American Medical Association, American Psychiatric Association, and National Institutes of Health -- recognize attention-deficit hyperactivity disorder as a valid condition that should be treated.
But there are some people, including some doctors and therapists, who disagree.
Some say the problem starts with how the condition is diagnosed.
Too Many Cases?
Critics question the high number of cases of ADHD.
“In most European countries, you don’t see children diagnosed with ADHD anywhere near the rate that American kids are,” says Marilyn Wedge, PhD, author of A Disease Called Childhood.
It’s true that more people have been diagnosed in recent years. This may partly be because more people know about it and because the guidelines that health care professionals use to diagnose the condition changed in 2013.
Is It Really ADHD?
Another issue is that “kids are often misdiagnosed,” says Richard Saul, MD. He wrote ADHD Does Not Exist, and is a member of the American Academy of Pediatrics and the American Academy of Neurology.
“There’s no question that the symptoms of ADHD are real,” Saul says. But he points out that “there are a large number of illnesses and health problems that can [cause] those symptoms.”
A Challenging Diagnosis
A doctor or therapist considers your health history, the symptoms you tell them about, the ones they might notice while observing you, and what other people who know you well (usually your family and your child’s school teachers) say. They may use the “Conners’ Teacher Rating Scale” or the “Vanderbilt questionnaire” to rate how often certain behaviors happen and how much of a problem they are, such as:
- Doesn’t seem to listen when spoken to directly
- Has trouble organizing tasks and activities
- Has trouble waiting in line
“A [doctor or therapist] could make a mistake, especially if he or she doesn’t have extensive experience with ADHD,” says Imad Alsakaf, MD, an assistant professor of psychiatry at Creighton University in Omaha, NE.
More often, though, people with the disorder also have another health problem, like depression or substance abuse. “These issues can mask ADHD, and actually make it harder to get the right diagnosis,” says psychologist Phil Glickman, PsyD.
Saul’s advice is to see a doctor for a full physical exam and health history. He says it’s also wise to see a psychologist. “They have the time to do a very thorough evaluation,” he says
In 2013, the FDA approved NEBA, a medical device that uses brainwaves to help clinicians determine if a child's symptoms might be due to ADHD or some other condition. Research suggests that it should be used in combination with traditional diagnostic methods (see above).
Doctors don’t know everything about how ADHD works in the brain. But “imaging tests like MRIs show there are clear differences in people who have it and people who don’t,” Alsakaf says.
He points to the prefrontal cortex, a brain area that plays a role in behavior, problem solving, and emotions. In people with ADHD, its activity is different from someone who doesn’t have the condition.
Still, those differences are not enough to diagnose the disorder.
The Role of Treatment
Some experts point to the fact that treatment works as evidence that the disorder is real.
“When I work with adults with ADHD or parents of children with ADHD who are skeptical, I tell them that research from thousands of patients shows that behavioral treatment like talk therapy and/or medication improve ADHD symptoms” Glickman says.
Treatment often includes taking medication and getting therapy. Because some of these drugs can be stimulating, some teens and adults who don’t have the disorder use them to boost their focus.
“Doctors do see patients who are seeking habit-forming medications and who claim to have ADHD symptoms in order to get a prescription,” Alsakaf says. “But that’s generally not the case.”
If You Have Doubts
You can get a second opinion from an expert, such as a psychiatrist or psychologist, who is well-trained to help with diagnosis and treatment.
“He or she can talk to you about how ADHD works in a way that relates to you, and help find a treatment strategy that works,” Alsakaf says. “And that can greatly improve your quality of life.”
If it does turn out to be ADHD, Wedge suggests treatment options that aren’t medications, including regular exercise, limits on screen time (especially with “fast-paced” media like video games), and encouraging self-control to help kids stay calm and do well in school and outside of it.